How Bad Will Your Arthritis Get?

by Carole Jackson, Bottom Line Health

It’s not exactly a crystal ball, but doctors have a new way to predict the future health of your knees — research shows that patients who have both osteoarthritis of the knee and bone cysts are headed for severe arthritis. But don’t get discouraged — if you’re not there yet, you still have time to change the outcome.

To understand what this means to arthritis sufferers, I turned to Patience White, MD, chief public health officer at the National Arthritis Foundation, pediatric rheumatologist and a professor of medicine and pediatrics in the department of medicine at George Washington University. She told me that bone cysts (abnormal pockets of synovial fluid, which is the liquid that normally lubricates joints) are present in about half of patients with osteoarthritis of the knee — most particularly if it is advanced. She said the relationship between the two is a chicken and egg dilemma — it’s unclear whether people have bone cysts because of their severe arthritis or it’s the other way around, that the arthritis is made more severe by the bone cysts.

To learn more about this relationship, researchers at Monash University in Melbourne, Australia, recruited and examined 109 people with knee osteoarthritis. About half of these people also had bone cysts. The group was then reexamined two years later, and researchers found that…

  • Patients whose previous MRI showed both bone cysts and arthritis at the start of the study experienced an average 9.3% loss of cartilage.
  • Those who’d had arthritis and bone marrow lesions — less serious abnormalities that may or may not lead to bone cysts — had a 6.3% cartilage loss.
  • Individuals with arthritis only — no cysts or bone lesions — experienced only a 2.6% cartilage loss.

With increasing bone abnormalities (i.e., lesions and cysts), the likelihood that a patient would require knee replacement also rose significantly. This research was reported in the March 2010 issue of Arthritis Research & Therapy.

Fight Arthritis Aggressively!

Dr. White told me that there’s more to be learned from a larger osteoarthritis study going on now at the National Institutes of Health. In the meantime, she said there’s not much you can do to treat bone cysts (they’re removed surgically only in rare cases where they present specific difficulties), but their presence should be viewed as a call to action. To that end, Dr. White urges anyone with knee osteoarthritis to…

  • Stay active — movement is the best medicine, Dr. White said. Physical activities such as swimming, walking, stretching and range-of-motion exercises keep your joints flexible and improve muscle strength, which helps take the strain off joints. If you are not sure about the right exercises for people with arthritis, check with your doctor and go to and look for the AF Life Improvement Series that offers programs and DVDs on how to exercise.
  • Shed pounds if you are overweight. The heavier you are, the more damage is done to weight-bearing joints like the knees — but the good news is, every pound lost reduces the load on each knee when you stand or walk by four pounds. That’s a big result from just a bit of weight loss!


Patience White, MD, vice president of public health, National Arthritis Foundation, pediatric rheumatologist and professor of medicine and pediatrics, department of medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.