Bone Marrow Lesions Linked to Ligament Lesions in Hand OA

Medscape

05-05-2025

Bone marrow lesions (BMLs) were linked to collateral ligament lesions (CLLs) in the interphalangeal joints of patients with hand osteoarthritis (OA), with BMLs being less common than CLLs. CLLs showed persistence after their initial appearance and became more common over 4 years, whereas BMLs fluctuated in their occurrence over time.
METHODOLOGY:
Researchers analysed data from an ongoing prospective study to investigate the extent of bone activity adjacent to collateral ligaments and CLLs of the interphalangeal joints in patients with primary hand OA.
They included 261 patients (mean age, 60.5 years; 84% women) who underwent MRI of the right hand between January 2011 and August 2015, with follow-up scans performed at 2 and 4 years; data on year 4 were available for 81% of patients.
BMLs and CLLs were scored on MRI scans using HOAMRIS and OSLO scoring methods, respectively, for the radial and ulnar side of the proximal and distal interphalangeal joints.
BMLs were considered adjacent to the collateral ligament if located in the ulnar or radial one third of the joint.
TAKEAWAY:
BMLs were present in 3% of joint sides at both baseline and year 4; however, the prevalence of CLLs increased from 12% of joint sides at baseline to 17% of joint sides at year 4.
The presence of BMLs varied over time, with only 36% of joint sides with a BML at baseline still showing it after 2 years; however, CLLs remained consistently present.
A cross-sectional analysis revealed strong associations between BMLs and CLLs at baseline (adjusted odds ratio [aOR], 7.4; 95% CI, 4.5-12.0), year 2 (aOR, 7.7; 95% CI, 4.5-13.2), and year 4 (aOR, 7.0; 95% CI, 4.2-11.7).
The presence of BMLs in joint sides without CLLs at baseline was associated with an increased risk for CLLs at year 2 (aOR, 3.7; 95% CI, 1.5-9.0) and year 4 (aOR, 4.9; 95% CI, 2.0-10.8); similarly, having CLLs in joint sides without BMLs at baseline was linked to an increased risk for BMLs at year 2 (aOR, 9.2; 95% CI, 3.9-22.1) and year 4 (aOR, 11.0; 95% CI, 5.8-20.9).
IN PRACTICE:
"BMLs at baseline are associated with collateral ligament lesions at follow-up, and collateral ligament lesions at baseline were associated with BMLs at follow-up," the authors wrote.
"These results could provide prognostic value and more targeted treatment for hand OA patients," they added.
SOURCE:
This study was led by Sietse E.S. Terpstra, Leiden University Medical Center, Leiden, the Netherlands. It was published online on April 24, 2025, in Osteoarthritis and Cartilage .
LIMITATIONS:
BMLs scored on MRI scans served only as a proxy for bone activity, with no histologic studies found to clarify their exact implications. The study experienced a significant non-random loss to follow-up, which may have influenced longitudinal associations. Smaller BMLs and collateral ligaments might not have been detected using the MRI scanner.
DISCLOSURES:
The original prospective study was financially supported by the Dutch Arthritis Society. Two authors reported receiving grants, royalties, consultancy fees, and/or honoraria from several sources, including the funding agency. One of them also reported being a member or president of certain boards, councils, and societies.