REPLY
Osteoarthritis and Knee Pain
David T. Felson and
Daniel Gale
16 April 2002 | Volume 136 Issue 8 | Page 630
IN RESPONSE:
To respond to the questions posed, first, we did not count any cysts as marrow edema lesions, even though cysts are often contained within these lesions. We scored edema lesions alone.
Second, the consensus way of defining osteoarthritis, according to the American College of Rheumatology (1) and to a large number of epidemiologic studies (2), is to use osteophytosis as the criterion. Joint space narrowing, although carefully assessed in our study, can be hard to characterize definitively and may sometimes represent thinning cartilage caused by age and not disease. We believe our definition of osteoarthritis as osteophytosis is appropriate.
Third, the assertion that none of the patients in our study were examined is incorrect. In fact, all of the patients were examined. Those who did not have knee osteoarthritis were excluded. Many patients with physical and radiographic evidence of clinical osteoarthritis have patellar pain and pain in the anserine area; these findings would not necessarily have excluded patients.
Fourth, pain at rest was uncommon in our sample, as it is in most patients with osteoarthritis. Most of our participants had pain on activity, such as walking up and down stairs or walking long distances on level ground. Our findings suggest that even those symptoms, not just pain at rest, are probably related to lesions characterized by bone marrow edema.
Fifth, Dr. Simkin presents an interesting hypothesis regarding fat depletion and its relation to bone pain. Arnoldi and coworkers (3) hypothesized that the pain of osseous hypertension was caused more by the increased pressure inside the bone than by any depletion of elements within it.
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Author and Article Information
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Boston University Arthritis Center; Boston, MA 02118 (Felson)
Boston Veterans Affairs Medical Center; Boston, MA 02130 (Gale)
1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association Arthritis Rheum. 1986;29:1039-49. [PMID: 3741515].[Medline]
2. Lanyon P, O'Reilly S, Jones A, Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space Ann Rheum Dis. 1998;57:595-601. [PMID: 9893570].[Abstract/Free Full Text]
3. Arnoldi CC, Djurhuus JC, Heerfordt J, Karle A. Intraosseous phlebography, intraosseous pressure measurements and 99mTc-polyphosphate scintigraphy in patients with various painful conditions in the hip and knee Acta Orthop Scand. 1980;51:19-28. [PMID: 7376840].[Medline]
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