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. 2012 Feb;39(2):359-64.
doi: 10.3899/jrheum.110718. Epub 2011 Dec 15.

Relation of hand enthesophytes with knee enthesopathy: is osteoarthritis related to a systemic enthesopathy?

Nadia Gibson  1 , Ali Guermazi, Margaret Clancy, Jingbo Niu, Peter Grayson, Piran Aliabadi, Frank Roemer, David T Felson
Affiliations

Relation of hand enthesophytes with knee enthesopathy: is osteoarthritis related to a systemic enthesopathy?

Nadia Gibson et al. J Rheumatol. 2012 Feb.

Abstract

Objective: Enthesopathy has been reported as a feature of osteoarthritis (OA) in the distal interphalangeal (DIP) joints. We previously reported that central bone marrow lesions (BML) on magnetic resonance imaging (MRI) scans are associated with OA. In this study, we evaluated whether hand and knee enthesopathy were related.

Methods: We studied knee and hand radiographs of subjects from the Framingham Osteoarthritis Study. Subjects seen in 2002-2005 had bilateral posteroanterior hand radiographs, weight-bearing knee radiographs, and knee MRI scans. Hand radiographs were read for enthesophytes at the juxtaarticular nonsynovial areas of metacarpophalangeal (MCP), proximal interphalangeal (PIP), and DIP joints, and midshafts of the phalanges. We selected 100 cases of knees with central BML and 100 matched controls. Conditional logistic regression was used to assess associations.

Results: Subjects with enthesophytes of at least 1 score ≥ 2 at DIP, PIP, and/or MCP were not more likely to have central knee BML (OR 0.49, 95% CI 0.17-1.40) than those without enthesophytes. Similarly, having at least 1 score ≥ 2 on the shafts was not significantly associated with having a central knee BML (OR 0.59, 95% CI 0.23-1.51). Adjustment for the presence of diabetes mellitus did not affect these results, but there was an increased prevalence of diabetes in those with hand enthesophytes (OR 3.09, 95% 1.29-7.40, enthesophyte score ≥ 2).

Conclusion: We found no increase in the prevalence of hand enthesophytes among persons with central knee BML on their knee MRI scans. This provides evidence against a systemic enthesopathic disorder in association with knee OA.

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Figures

Figure 1
Figure 1
Femoral notch bone marrow lesion (BML). Coronal proton density-weighted fat-suppressed magnetic resonance imaging (MRI) shows grade 3 WORMS (whole-organ MRI score) subchondral bone marrow lesion at the tibial subspinous region (arrows) with a cystic component (arrowhead). Image shows the BML at the tibial insertion of the anterior cruciate ligament. There is medial and lateral meniscal subluxation and partial maceration of the body of the medial meniscus. There is a diffuse thinning of the cartilage of the central medial femur.
Figure 2
Figure 2
Grade 1 proximal shaft enthesophyte.
Figure 3
Figure 3
Grade 2 proximal midshaft enthesophyte.
Figure 4
Figure 4
Grade 3 proximal interphalangeal enthesophyte.
See this image and copyright information in PMC

Comment in

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