Background/Purpose: As hand osteoarthritis (OA) studies with repeated MRI are lacking, longitudinal associations between synovitis and bone marrow lesions (BMLs) and pain are unknown. Our aim was to explore whether changes of synovitis and BMLs are related to changes in joint tenderness in a longitudinal hand OA study.

Methods: We included 70 patients (63 women, mean (SD) age 67.9 (5.5) years) from the Oslo hand OA cohort with 1.0T MRI and clinical joint examination at baseline and 5-year follow-up. All patients had longitudinal Short Tau Inversion Recovery (STIR) images of the interphalangeal joints of dominant hand, n=69 had longitudinal T1w fat-suppressed (fs) pre-Gadolinium (Gd) images, and n=48 had longitudinal T1w fs post-Gd images. The paired MRIs were scored according to the OMERACT hand OA MRI score for synovitis and BMLs on 0-3 scales. We allowed 0.5 increments for smaller changes. The same rheumatologist examined the finger joints for presence of joint tenderness at baseline and follow-up. Among joints without tenderness at baseline, we explored whether increase of synovitis and BMLs (no change/decreasing synovitis and BMLs as reference) were associated with incident tenderness in the same joint using Generalized Estimating Equations. Among joints with tenderness at baseline, we explored whether decrease or loss of synovitis and BMLs (no change/increasing synovitis and BMLs as reference) were associated with loss of joint tenderness. Separate models were performed for synovitis and BMLs, respectively. The analyses were adjusted for age, sex, BMI and follow-up time.

Results: At baseline, synovitis was present in 204/379 (53.8%) joints (n=5 missing), of which the majority was grade 1 (n=139) and grade 2 (n=54). BMLs were present in 108/552 (19.6%) joints, of which the majority (n=80) was grade 1. Joint tenderness was found in 280/664 (40.2%) joints.

The mean (SD) follow-up time was 4.7 (0.4) years. Increase/incident synovitis and BMLs were seen in 96/373 (25.7%) and 88/551 (16.0%), respectively. Decrease of synovitis and BMLs occurred in 63/373 (16.9%) and 47/551 (8.5%) joints, and 39 (10.5%) and 30 (5.4%) joints had complete loss of synovitis and BMLs, respectively. Increasing/incident synovitis and BMLs were significantly associated with incident tenderness in the same joint (Table). The associations were independent of each other (data not shown). No associations were found between decreasing synovitis and BMLs and loss of joint tenderness during follow-up (Table). However, there was a non-significant trend that loss of synovitis was associated with loss of joint tenderness (OR 1.78, 95% CI 0.83, 3.77).

Conclusion: The Oslo hand OA cohort is the first hand OA study with longitudinal MR images of the hands. Increasing synovitis and BMLs were significantly associated with incident joint tenderness. Loss of synovitis was associated with loss of tenderness, but the association was statistically non-significant.

 

The association with incident joint tenderness (in joints without tenderness at baseline)
	N (%) joints with incident tenderness	Crude analysis OR (95% CI)	Adjusted analysis OR (95% CI)
Synovitis
–     No change/decrease –     Increase	46/175 (26.3%) 23/45 (51.1%)	1.0 (ref.) 2.53 (1.39, 4.61)	1.0   (ref.) 2.62 (1.35, 5.06)
Bone marrow lesions
–     No change/decrease –     Increase	88/265 (33.2%) 29/47 (61.7%)	1.0 (ref.) 2.73 (1.33, 5.59)	1.0   (ref.) 2.84 (1.22, 6.60)
The association with loss of joint tenderness (in joints with tenderness at baseline)
	N (%) joints with loss of tenderness	Crude analysis OR (95% CI)	Adjusted analysis OR (95% CI)
Synovitis
–     No change/increase –     Decrease	41/123 (33.3%) 10/30 (33.3%)	1.0 (ref.) 0.99 (0.47, 2.10)	1.0   (ref) 1.19 (0.54, 2.59)
Bone marrow lesions
–     No change/increase –     Decrease	57/203 (28.1%) 10/36 (27.8%)	1.0 (ref.) 0.80 (0.45, 1.42)	1.0   (ref.) 0.82 (0.42, 1.57)
OR=odds ratio, CI=confidence interval

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increasing-synovitis-and-bone-marrow-lesions-are-associated-with-incident-joint-tenderness-in-hand-osteoarthritis/