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Bone marrow lesions and synovitis on MRI associate with radiographic progression after 2 years in hand osteoarthritis
  1. W Damman1,
  2. R Liu1,
  3. JL Bloem2,
  4. FR Rosendaal3,
  5. M Reijnierse2,
  6. M Kloppenburg1
  1. 1Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
  2. 2Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
  3. 3Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
  1. Correspondence to W Damman, Department of Rheumatology, Leiden University Medical Center, C1-R, P.O. Box 9600, Leiden 2300 RC, The Netherlands; w.damman{at}


Objective To study the association of magnetic resonance (MR) features with radiographic progression of hand osteoarthritis over 2 years.

Methods Of 87 primary patients with hand osteoarthritis (82% women, mean age 59 years), baseline distal and proximal interphalangeal joint contrast-enhanced MR images were scored 0–3 for bone marrow lesions (BMLs) and synovitis following the Oslo score. Baseline and 2-year follow-up radiographs were scored following Kellgren-Lawrence (KL) (0–4) and OsteoArthritis Research Society International (OARSI) scoring methods (0–3 osteophytes, joint space narrowing (JSN)). Increase ≥1 defined progression. Associations between MR features and radiographic progression were explored on joint and on patient level, adjusting for age, sex, body mass index, synovitis and BML. Joints in end-stage were excluded.

Results Of 696 analysed joints, 324 had baseline KL=0, 28 KL=4 and after 2 years 78 joints progressed. BML grade 2/3 was associated with KL progression (2/3 vs 0: adjusted risk ratio (RR) (95% CI) 3.3 (2.1 to 5.3)) and with osteophyte or JSN progression, as was synovitis. Summated scores were associated with radiographic progression on patient level (RR crude BML 1.08 (1.01 to 1.2), synovitis 1.09 (1.04 to 1.1), adjusted synovitis 1.08 (1.03 to 1.1)).

Conclusions BMLs, next to synovitis, show, already after 2 years, graded associations with radiographic progression, suggesting that both joint tissues could be important targets for therapy.

  • Magnetic Resonance Imaging
  • Synovitis
  • Inflammation
  • Hand Osteoarthritis
  • Outcomes research

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  • Handling editor Tore K Kvien

  • Contributors WD, FR and MK designed the study. WD and RL included patients in the HOSTAS cohort. MK supervised the HOSTAS cohort. WD scored the radiographs. RL performed the MR imaging and scored the MR images. JLB and MR supervised the MR imaging protocol and scoring. WD, FR and MK were involved in data analysis. WD drafted the manuscript. All authors reviewed the manuscript and approved the final version.

  • Funding Dutch Arthritis Foundation (Reumafonds): 10-1-405.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Leiden University Medical Center medical ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.