Associations between MRI features versus knee pain severity and progression: Data from the Vancouver Longitudinal Study of Early Knee Osteoarthritis

Objective To determine associations between features of osteoarthritis (OA) on MRI and knee pain severity and knee pain progression. Design Baseline, 3.3- and 7.5-year assessments were performed for 122 subjects with baseline knee pain (age 40-79), sample-weighted for population (with knee pain) representativeness. MRIs were scored for: osteophytes (0: absent to 3: large); cartilage (0: normal to 4: full thickness defect; 0/1 collapsed); subchondral sclerosis (0: none to 3:>50% of site), subchondral cyst (0: absent to 3: severe), bone marrow lesions (0: none to 3:>= 50% of site); and meniscus (0: normal to 3: maceration/resection), in 6-8 regions each. Per feature, scores were averaged across regions. Effusion/synovitis (0: absent to 3: severe) was analyzed as >= 2 vs. <2. Linear models predicted WOMAC knee pain severity (0-100), and binary models predicted 10+ (minimum perceptible clinical improvement [ MPCI]) and 20+ (minimum clinically important difference [ MCID]) increases. Models were adjusted for age, sex, BMI (and follow-up time for longitudinal models). Results Pain severity was associated with osteophytes (7.17 per unit average; 95% CI = 3.19, 11.15) and subchondral sclerosis (11.03; 0.68, 21.39). MPCI-based pain increase was associated with osteophytes (odds ratio per unit average 3.20; 1.36, 7.55), subchondral sclerosis (5.69; 1.06, 30.44), meniscal damage (1.68; 1.08, 2.61) and effusion/synovitis >= 2 (2.25; 1.07, 4.71). MCID-based pain increase was associated with osteophytes ( 3.79; 1.41, 10.20) and cartilage defects ( 2.42; 1.24, 4.74). Conclusions Of the features investigated, only osteophytes were consistently associated with pain cross-sectionally and longitudinally in all models. This suggests an important role of bone in early knee osteoarthritis.