Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Relation of Hand Enthesophytes on Plain Radiographs with Findings of Knee Enthesopathy: Is Osteoarthritis a Generalized Enthesopathy?

Gibson1,  Nadia, Clancy4,  Mary M., Niu3,  Jingbo, Grayson2,  Peter, Aliabadi6,  Piran, Guermazi2,  Ali, Felson5,  David T.

Boston Medical Center, Boston, MA
Boston Medical Center
Boston University, Boston, MA
Boston University Sch Med, Boston, MA
Boston University School of Medicine, Boston, MA
Brigham's and Women Hospital


Enthesopathy, an abnormality at the attachment of a tendon or ligament to bone, has been reported as a feature of osteoarthritis (OA) in the DIP joints. Some patients have central bone marrow lesions (BMLs) on MRI at the insertion sites of the ACL and PCL suggesting enthesopathy in the knee that might be similar to that seen in the hand. We have reported that these central BMLs on MRI are associated with OA (Arthritis Rheum 2008; 58: 130– 136). In this study, we evaluated whether hand enthesopathy was related to this presumed knee enthesopathy and whether in those with knee OA, hand enthesopathy was associated with these central BMLs.


We studied knee and hand x-rays of subjects from the Framingham Osteoarthritis Study, a population based study. Subjects seen in 2002–2005 had bilateral PA hand x-rays, weight bearing knee x-rays and knee MRI's using a 1.5 T magnet. We used T-2 weighted fat suppressed images to identify central BMLs. Knee x-rays were read for K/L grade. Hand x-rays were read for enthesophytes defined as bony spurs at the juxta-articular nonsynovial areas of MCP, PIP and DIP joints (excluding osteophytes) and midshafts of proximal, middle and distal phalanges. We scored lesions as 0: none, 1:small, 2:moderate, 3:large. The intra-observer kappa was 0.67. To determine whether there was a relation of presence of enthesophytes in either hand with central BML's in the knees (one knee/person), we selected 100 cases of knees withcentral BML's and 100 matched controls without this finding of the same age (2 year categories) and sex. We assessed the association by using conditional logistic regression adjusting for worst K/L grade in the knee. To determine if hand enthesopathy was related to central BMLs in the context of knee OA, further analyses restricted cases and controls to those with knee OA.


Mean age of subjects was 68 years, mean BMI 29.5. Those with enthesophytes of at least one score >= 2 at DIP, PIP and/or MCP were less likely to have central BMLs of the knee (OR = 0.49, 95% CI 0.17–1.40), than those without such enthesophytes, although this was not statistically significant (see Table). Similarly, having at least one score >=2 on the shafts (distal, middle and/or proximal) was not significantly associated with having central knee BMLs (OR=0.59, 95% CI 0.23 –1.51). Considering all hand sites, the number of subjects with at least one score >=2 was 38 in the cases and 42 in the controls (OR = 0.57, 95% CI 0.26–1.27). Analyses using enthesophyte score >= 1 yielded similar results. When we examined only cases and controls with OA, we found similarly null results.


We found no relation between hand enthesophytes and central BML's in the knee. We also found no clear association of hand enthesophytes with central BMLs in patients with established OA. This provides evidence against a generalized enthesopathic disorder in association with knee OA.

To cite this abstract, please use the following information:
Gibson, Nadia, Clancy, Mary M., Niu, Jingbo, Grayson, Peter, Aliabadi, Piran, Guermazi, Ali, et al; Relation of Hand Enthesophytes on Plain Radiographs with Findings of Knee Enthesopathy: Is Osteoarthritis a Generalized Enthesopathy? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :198
DOI: 10.1002/art.27967

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