Evaluating the Relation between Bone Marrow Lesions and Synovitis with Pain and Structural Damage in Hand Osteoarthritis

Abstract

Osteoarthritis (OA) is the most prevalent arthritis worldwide and is a condition affecting the whole joint. Changes in subchondral bone, cartilage integrity and synovitis are recognised during OA progression. Although advances have been made in our understanding of OA pathophysiology, there are no current treatments that delay or halt the progression of the disease. Treatments are largely based upon physical therapies to improve function, anti-inflammatory agents for pain symptoms and joint replacement surgery for late stage disease in large weight bearing joints. There is an urgent need to better understand the pathophysiology of OA that could translate into improved treatments for this condition. In recent years, more advanced imaging techniques including magnetic resonance imaging (MRI) have led to an improved understanding of changes at the bone-cartilage interface in OA, with recognition that loss of integrity at the cartilage-bone junction and development of bone marrow lesions (BMLs) in the subchondral bone are associated with OA pain in large epidemiological studies. In this book chapter, we review the evidence for the role of BMLs and synovitis, particularly in the pathophysiology of hand OA. Based on a systematic review of the literature, we have identified 15 articles reported on BMLs and synovitis in hand OA, which will be discussed in this chapter.