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Imaging the painful osteoarthritic knee joint: what have we learned?

Nature Reviews Rheumatology volume 5, pages 149–158 (2009)Cite this article

Abstract

Pain in the peripheral joints is an increasingly common problem, resulting in significant patient disability and health-care expenditure. Osteoarthritis (OA), a syndrome of joint pain with associated structural changes, is the most prevalent joint disease, yet the etiology of pain in OA is not entirely clear. Traditional assessment of the structure–pain relationship in knee OA has relied on conventional radiography, which has several limitations, not least the discrepancy between symptoms and radiographic findings. MRI has the capability to visualize all the structures within the knee joint, and there is a growing body of work using MRI to examine the correlation between structural findings and symptoms. In large cohort studies, synovial hypertrophy, synovial effusions, and abnormalities in the subchondral bone have been associated with knee pain. Advances in our understanding of the etiology of pain in OA will assist in the identification of further targets for treatment of this common and painful disease.

Key Points

  • Osteoarthritis (OA) is the most common joint disease and a major cause of joint pain, disability and health-care expenditure

  • Traditional imaging for diagnosing OA has relied upon radiography, but there are discrepancies between clinical symptoms and radiographic findings

  • As OA is now seen as a whole-organ joint disease, MRI is increasingly important in giving insight into the structures affected in OA, especially in symptomatic patients with normal radiographic findings

  • The cause of pain in OA is unclear, but MRI studies of the structure–pain relationship have suggested the importance of subchondral bone and the synovium; these are targets for ongoing research

  • The importance of extra-articular sources of joint pain and the psychosocial factors contributing to pain should not be ignored

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Figure 1: Medial tibial bone marrow lesion and macerated medial meniscus.
Figure 2: Medial articular cartilage loss and bone marrow lesions.
Figure 3: Large osteophytes and synovitis.
Figure 4: Synovitis in suprapatellar pouch and osteophytes.

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Acknowledgements

Thanks to Dr Andrew Grainger, Consultant Musculoskeletal Radiologist, Leeds Teaching Hospitals Trust, for providing the images. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. CYJ Wenham is a Rheumatology Clinical Research Fellow at the Department of Rheumatology, Leeds Teaching Hospitals Trust, and PG Conaghan is Professor of Musculoskeletal Medicine, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, UK.,

    Claire YJ Wenham & Philip G Conaghan

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Correspondence to Philip G Conaghan.

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Wenham, C., Conaghan, P. Imaging the painful osteoarthritic knee joint: what have we learned?. Nat Rev Rheumatol 5, 149–158 (2009). https://doi.org/10.1038/ncprheum1023

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