Influence of periarticular bone marrow lesion on joint destruction in rheumatoid arthritis

• Project/Area Number: 16K10898
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Orthopaedic surgery
• Research Institution: Kyoto University
• Principal Investigator: Ito Hiromu 京都大学, 医学研究科, 准教授 (70397537)
• Research Collaborator: FURU Moritoshi ; MORITA Yugo
• Project Period (FY): 2016-04-01 – 2019-03-31
• Project Status: Completed (Fiscal Year 2018)
• Budget Amount: ¥4,810,000 (Direct Cost: ¥3,700,000、Indirect Cost: ¥1,110,000); Fiscal Year 2018: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000); Fiscal Year 2017: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2016: ¥2,730,000 (Direct Cost: ¥2,100,000、Indirect Cost: ¥630,000)
• Keywords: 関節リウマチ / 変形性関節症 / 人工関節置換術 / bone marrow lesion / 変形性膝関節症 / MRI / 骨髄

Outline of Final Research Achievements

MRI was taken before total knee arthroplasty in a consecutive 42 patients with rheumatoid arthritis or osteoarthritis. Bone marrow lesion (BML) was evaluated by a method of Peterfly (Osteoarthritis Cartilage 2004).
Total BML score was significantly and negatively associated with range of motion of knee flexion and extension. The score was also significantly and positively associated with the muscle strength of the knee extension. The score of tibial intercondylar lesion was significantly associated with the pain score.
The parameters in microCT and histology of the BML significantly differed between grades 0&1 and 2&3, indicating that the changes were reactive bone sclerosis.

Academic Significance and Societal Importance of the Research Achievements

関節破壊やその後の変化を予測するMRI所見として、関節近傍のbone marrow lesionはよく知られているが、その本態は不明のままである。今回の研究で、臨床症状や所見との関係が一定程度明らかになった。さらにマイクロCTや組織所見との関係をある程度明らかにできたことで、今後病理的意義、分子生物学的解明につながると考えられる。その病態が一層明らかになれば、治療法を探索・開発し、関節破壊進行を抑制できる可能性があり、今回の結果はそのような今後の大きな展開の一助となると考えられる。