title: Bone marrow lesions, subchondral bone cysts and subchondral bone attrition are associated with histological synovitis in patients with end-stage knee osteoarthritis: a cross-sectional study.
abstract: OBJECTIVE
  The aim of this study was to examine the osteoarthritis (OA)-related structural changes associated with histological synovitis in end-stage knee OA patients.
  
  
  METHODS
  Forty end-stage knee OA patients (female: 88%, mean age: 71.8 y) were enrolled. All participants underwent 3.0-T MRI. The structural changes, such as cartilage morphology, subchondral bone marrow lesion (BML), subchondral bone cyst (SBC), subchondral bone attrition (SBA), osteophytes, meniscal lesion and synovitis, were scored using the whole-organ MRI scoring (WORMS) method. Synovial samples were obtained from five regions of interest (ROIs) of the knee joint during total joint replacement surgery. The associations between the histological synovitis score (HSS) and WORMS or the synovial expression levels of cyclooxygenase (COX)-2, interleukin (IL)-1β, IL-6 and transforming growth factor (TGF)-β were examined using Spearman's correlation coefficient.
  
  
  RESULTS
  Among the seven OA-related structural changes, the BML, SBC, SBA and synovitis were significantly associated with the HSS (r = 0.33, 0.35, 0.48 and 0.36, respectively), while other morphological changes were not. Although synovial COX-2, IL-1β or IL-6 expression levels were not associated with the HSS, the synovial TGF-β expression levels were associated with the HSS.
  
  
  CONCLUSIONS
  The presence of BML, SBC and SBA was associated with histological synovitis in end-stage knee OA patients.
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan; Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: anwarjan108@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Yusup
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: harukago@juntendo.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan; Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: liulizu@juntendo.ac.jp.
authors.forename: L
authors.initials: L
authors.lastname: Liu
authors.affiliation: Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: realnl@juntendo.ac.jp.
authors.forename: L
authors.initials: L
authors.lastname: Ning
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: rsadatsu@juntendo.ac.jp.
authors.forename: R
authors.initials: R
authors.lastname: Sadatsuki
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: shada@juntendo.ac.jp.
authors.forename: S
authors.initials: S
authors.lastname: Hada
authors.affiliation: Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: kkamagat@juntendo.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Kamagata
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: mayukok@juntendo.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Kinoshita
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: ippei@juntendo.ac.jp.
authors.forename: I
authors.initials: I
authors.lastname: Futami
authors.affiliation: Department of Orthopedics, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan. Electronic address: shimura@juntendo.ac.jp.
authors.forename: Y
authors.initials: Y
authors.lastname: Shimura
authors.affiliation: Department of Orthopedics, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan. Electronic address: potatointheball_1007@yahoo.co.jp.
authors.forename: M
authors.initials: M
authors.lastname: Tsuchiya
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: saita0617@hotmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Saita
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: ytakaza@juntendo.ac.jp.
authors.forename: Y
authors.initials: Y
authors.lastname: Takazawa
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: hrikeda@juntendo.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: saoki@juntendo.ac.jp.
authors.forename: S
authors.initials: S
authors.lastname: Aoki
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan; Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: k-kaneko@juntendo.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan; Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: ishijima@juntendo.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Ishijima
mesh_terms: D000368:Aged; D001845:Bone Cysts / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D001853:Bone Marrow / Q000473:pathology*; D001855:Bone Marrow Diseases / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D002358:Cartilage, Articular / Q000473:pathology*; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000096:biosynthesis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020370:Osteoarthritis, Knee / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D013582:Synovial Fluid / Q000378:metabolism; D013585:Synovitis / Q000209:etiology / Q000378:metabolism / Q000473:pathology*
chemical_list: D016207:Cytokines
keywords: Bone marrow lesion; Subchondral bone attrition; Subchondral bone cyst; Symptom; Synovitis; TGF-β