Dieppe P, Cushnaghan J, Tucker M, Browning S, Shepstone L
Rheumatology Unit, University of Bristol Division of Medicine, Bristol Royal Infirmary, UK.
Osteoarthritis Cartilage. 2000 Mar;8(2):63-8. doi: 10.1053/joca.1999.0272.
To study the natural history of peripheral joint osteoarthritis (OA) and assess its impact over eight years in a prospective study of 500 patients.
500 consecutive patients with peripheral joint OA were recruited from a hospital-based rheumatology clinic. All were invited for review 3 and 8 years after entry. Joint sites involved, pain severity, change in index joints, global change in the condition, use of medication, surgery and walking aids were all recorded at each visit, and after eight years disability was assessed by the health assessment questionnaire (HAQ) and anxiety and depression by the Hospital anxiety and depression scale (HAD).
At eight-year review, 349 patients were seen: 90% of those remaining alive. Outcome was heterogeneous. Sixty patients (17.2%) reported worsening in all three subjective parameters (pain, index joint and global change) compared with 22 (6.3%) who improved in all three parameters. Using this definition of worsening or improvement, strong baseline predictors of clinical outcome did not emerge. For further description, the group was split according to the index joint sites involved at entry to the study, there being 111 with knee OA alone, 87 with hand and knee OA, 72 with hand disease alone, and 29 with hip disease alone. Forty-four percent of those with lone hand disease at entry had acquired significant knee or hip OA 8 years later. The mean HAQ and HAD scores at 8 years were high, especially in those with knee disease, indicating significant disability as a result of the disease. Those with knee or knee and hand disease had the worst outcome in all parameters recorded. The data showed a general decrease in use of NSAIDs over the eight years, but an increase in utilization of analgesics, surgery (especially for hip disease) and walking aids.
Patients with peripheral joint OA of sufficient severity to lead to hospital referral have a heterogeneous, but generally bad outcome over 8 years, the disease resulting in high levels of physical disability, anxiety and depression, with a high level of utilization of healthcare resources, including joint replacement, drugs and walking aids. The results were consistent with previous suggestions that peripheral joint OA in older people is characterized by the slow acquisition of new joint sites. Progression and outcome may depend on a complex set of psychosocial factors, as well as biological ones.
在一项对500名患者的前瞻性研究中，研究外周关节骨关节炎（OA）的自然病史，并评估其在八年中的影响。
从一家医院的风湿病诊所招募了500名连续的外周关节OA患者。所有患者在入组后3年和8年受邀进行复查。每次就诊时均记录受累关节部位、疼痛严重程度、指标关节变化、病情整体变化、药物使用、手术和助行器使用情况，八年后通过健康评估问卷（HAQ）评估残疾情况，通过医院焦虑抑郁量表（HAD）评估焦虑和抑郁情况。
在八年复查时，见到了349名患者，占存活患者的90%。结果存在异质性。60名患者（17.2%）报告所有三个主观参数（疼痛、指标关节和整体变化）均恶化，而22名患者（6.3%）所有三个参数均有所改善。使用这种恶化或改善的定义，未出现临床结果的强基线预测因素。为进一步描述，根据研究入组时受累的指标关节部位将该组进行划分，其中仅膝关节OA患者111例，手和膝关节OA患者87例，仅手部疾病患者72例，仅髋关节疾病患者29例。入组时仅患手部疾病的患者中，44%在8年后出现了明显的膝关节或髋关节OA。8年时的平均HAQ和HAD评分较高，尤其是膝关节疾病患者，表明该疾病导致了明显的残疾。膝关节或膝关节和手部疾病患者在所有记录参数中的结果最差。数据显示，八年来非甾体抗炎药的使用总体减少，但镇痛药、手术（尤其是髋关节疾病）和助行器的使用增加。
外周关节OA严重程度足以导致转诊至医院的患者在8年中结果存在异质性，但总体较差，该疾病导致高水平的身体残疾、焦虑和抑郁，医疗资源利用率高，包括关节置换、药物和助行器。结果与先前的观点一致，即老年人外周关节OA的特点是新关节部位缓慢出现。病情进展和结果可能取决于一系列复杂的社会心理因素以及生物学因素。
