title: Increasing synovitis and bone marrow lesions are associated with incident joint tenderness in hand osteoarthritis.
abstract: OBJECTIVE
  To explore whether changes of MRI-defined synovitis and bone marrow lesions (BMLs) are related to changes in joint tenderness in a 5-year longitudinal study of the Oslo hand osteoarthritis (OA) cohort.
  
  
  METHODS
  We included 70 patients (63 women, mean (SD) age 67.9 (5.5) years). BMLs and contrast-enhanced synovitis in the distal and proximal interphalangeal joints were evaluated on 0-3 scales in n=69 and n=48 patients, respectively. Among joints without tenderness at baseline, we explored whether increasing/incident synovitis and BMLs were associated with incident joint tenderness using generalised estimating equations. Among joints with tenderness at baseline, we explored whether decreasing or resolution of synovitis and BMLs were associated with loss of joint tenderness. We adjusted for age, sex, body mass index, follow-up time and changes in radiographic OA.
  
  
  RESULTS
  Among joints without tenderness at baseline, increasing/incident synovitis and BMLs were seen in 45 of 220 (20.5%) and 47 of 312 (15.1%) joints, respectively. Statistically significant associations to incident joint tenderness were found for increasing/incident synovitis (OR=2.66, 95% CI 1.38 to 5.11) and BMLs (OR=2.85, 95% CI 1.23 to 6.58) independent of structural progression. We found a trend that resolution of synovitis (OR=1.72, 95% CI 0.80 to 3.68) and moderate/large decreases of BMLs (OR=1.90, 95% CI 0.57 to 6.33) were associated with loss of joint tenderness, but these associations were non-significant.
  
  
  CONCLUSIONS
  The Oslo hand OA cohort is the first study with longitudinal hand MRIs. Increasing synovitis and BMLs were significantly associated with incident joint tenderness, whereas no significant associations were found for decreasing or loss of synovitis and BMLs.
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Ida K
authors.initials: IK
authors.lastname: Haugen
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Barbara
authors.initials: B
authors.lastname: Slatkowsky Christensen
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Pernille
authors.initials: P
authors.lastname: Bøyesen
authors.affiliation: Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway Department of Radiology, Kongsvinger Hospital, Kongsvinger, Norway.
authors.forename: Sølve
authors.initials: S
authors.lastname: Sesseng
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Désirée
authors.identifier: http://orcid.org/0000-0002-5781-158X
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000473:pathology* / Q000503:physiopathology; D001853:Bone Marrow / Q000473:pathology*; D015331:Cohort Studies; D004487:Edema / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000473:pathology; D050276:Hand Bones / Q000473:pathology*; D050823:Hand Joints / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology; D009664:Norway; D010003:Osteoarthritis / Q000473:pathology* / Q000503:physiopathology; D013585:Synovitis / Q000473:pathology* / Q000503:physiopathology; D016474:Weight-Bearing
keywords: Hand Osteoarthritis; Magnetic Resonance Imaging; Outcomes research