Bierma-Zeinstra Sita M A, Oster J Dorinde, Bernsen Roos M D, Verhaar Jan A N, Ginai Abida Z, Bohnen Arthur M
Department of General Practice, Erasmus University, Rotterdam, The Netherlands.
J Rheumatol. 2002 Aug;29(8):1713-8.
To study whether clinical symptoms and signs can predict radiological osteoarthritis (OA) of the hip in primary care patients with hip pain.
Consecutive patients (n = 220) aged 50 years or older consulting the general practitioner for hip pain and referred for radiological investigation underwent a standardized history, radiological, laboratory, and physical examination. Radiological OA was confirmed with joint space < or = 2.5 mm. Additionally, a more stringent definition was used (< or = 1.5 mm). The relationship between radiological OA and possible clinical symptoms/signs of OA was tested. Combinations of clinical symptoms/signs that had shown an independent relationship with radiological OA in multivariate analyses were tested for their predictive value.
Radiological OA (joint space < or = 2.5 mm) of the (more) symptomatic hip was present in 35.5% of the study population and more severe OA (joint space < or = 1.5 mm) in 11.4%. Presence of 4 specific symptoms/signs from history and examination showed a positive predictive value (PPV) of 73% (specificity 91%, sensitivity 45%) for radiological OA. When 5 specific symptoms/signs were present, the PPV for the more severe radiological OA was 82% (specificity 98%, sensitivity 72%), and when 6 or 7 specific symptoms/signs were present the PPV was 100% (specificity 100%, sensitivity 40% and 8%, respectively). Negative predictive values were high for almost all combinations.
In primary care patients with hip pain, clinical symptoms and signs can to a moderate extent predict radiological OA and to a large extent more severe radiological OA.
研究临床症状和体征能否预测基层医疗中因髋关节疼痛就诊患者的髋关节放射学骨关节炎（OA）。
连续纳入220例年龄50岁及以上因髋关节疼痛咨询全科医生并被转诊接受放射学检查的患者，进行标准化病史采集、放射学、实验室及体格检查。关节间隙≤2.5mm则确诊为放射学OA。此外，采用了更严格的定义（≤1.5mm）。检测放射学OA与OA可能的临床症状/体征之间的关系。对多变量分析中显示与放射学OA存在独立关系的临床症状/体征组合进行预测价值检测。
研究人群中，（症状）较明显的髋关节出现放射学OA（关节间隙≤2.5mm）的比例为35.5%，出现更严重OA（关节间隙≤1.5mm）的比例为11.4%。病史和检查中出现4种特定症状/体征时，对放射学OA的阳性预测值（PPV）为73%（特异性91%，敏感性45%）。出现5种特定症状/体征时，对更严重放射学OA的PPV为82%（特异性98%，敏感性72%），出现6种或7种特定症状/体征时，PPV为100%（特异性100%，敏感性分别为40%和8%）。几乎所有组合的阴性预测值都很高。
在基层医疗中因髋关节疼痛就诊的患者中，临床症状和体征能在一定程度上预测放射学OA，在很大程度上能预测更严重的放射学OA。
