Englund M, Paradowski P T, Lohmander L S
Lund University Hospital, Lund, Sweden.
Arthritis Rheum. 2004 Feb;50(2):469-75. doi: 10.1002/art.20035.
To evaluate the association between radiographic hand osteoarthritis (OA), a disease with marked heredity, and radiographic knee OA in patients treated with meniscectomy.
We retrospectively identified 170 patients (mean age 54 years [range 33-87 years], 23% women) who had undergone isolated meniscectomy an average of 20 years earlier (range 17-22 years). Patients with cruciate ligament injury were excluded. All subjects were examined by standardized knee and hand radiography. Individual joints were considered to have OA when displaying radiographic features corresponding to a Kellgren/Lawrence (K/L) grade > or =2. Hand OA was considered present if at least 1 of the following criteria was fulfilled: the presence of radiographic OA (K/L grade > or =2) in at least 1 interphalangeal joint in each hand symmetrically, or in at least 2 distal or proximal interphalangeal joints in the same hand in a pattern consistent with primary OA (in the same row or ray), or in the first carpometacarpal joint bilaterally. The association between radiographic hand OA and radiographic knee OA was evaluated using logistic regression.
Radiographic hand OA was present in 57 patients (34%) and radiographic knee OA was identified in 105 patients (62%), within 94 index knees (55%) and 47 contralateral knees (28%). In a multivariate model, radiographic hand OA was associated with an increased likelihood of radiographic OA in the index knee (odds ratio [OR] 3.0, 95% confidence interval [95% CI] 1.2-7.5) and in the nonoperated contralateral knee (OR 3.5, 95% CI 1.0-12.2).
The presence of radiographic hand OA is associated with an increased frequency of radiographic knee OA after meniscectomy. This finding confirms and extends that of a single previous study showing an interaction between hereditary and environmental risk factors for OA, a common and genetically complex disease. Accordingly, the development of OA following a meniscal tear and the resulting meniscal surgery should not be regarded to be of secondary origin only.
评估影像学诊断的手部骨关节炎（OA）（一种具有显著遗传性的疾病）与半月板切除术患者影像学诊断的膝关节OA之间的关联。
我们回顾性纳入了170例患者（平均年龄54岁[范围33 - 87岁]，23%为女性），这些患者平均在20年前（范围17 - 22年）接受了单纯半月板切除术。排除有交叉韧带损伤的患者。所有受试者均接受标准化的膝关节和手部X线检查。当单个关节显示出符合Kellgren/Lawrence（K/L）分级≥2级的影像学特征时，即认为该关节患有OA。如果满足以下至少一项标准，则认为存在手部OA：双手各至少1个指间关节对称出现影像学OA（K/L分级≥2级），或同一只手至少2个远端或近端指间关节出现符合原发性OA的模式（在同一排或同一射线），或双侧第一腕掌关节出现OA。使用逻辑回归评估影像学手部OA与影像学膝关节OA之间的关联。
57例患者（34%）存在影像学手部OA，105例患者（62%）存在影像学膝关节OA，其中94个患侧膝关节（55%）和47个对侧膝关节（28%）出现OA。在多变量模型中，影像学手部OA与患侧膝关节出现影像学OA的可能性增加相关（比值比[OR] 3.0，95%置信区间[95%CI] 1.2 - 7.5），与未手术的对侧膝关节出现影像学OA的可能性增加也相关（OR 3.5，95%CI 1.0 - 12.2）。
半月板切除术后，影像学手部OA的存在与影像学膝关节OA的发生率增加相关。这一发现证实并扩展了之前一项研究的结果，该研究表明OA（一种常见的遗传复杂疾病）的遗传和环境风险因素之间存在相互作用。因此，半月板撕裂及由此导致的半月板手术后OA的发生不应仅被视为继发性的。
