Peat G, Thomas E, Duncan R, Wood L, Hay E, Croft P
Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire ST5 5 BG, UK.
Ann Rheum Dis. 2006 Oct;65(10):1363-7. doi: 10.1136/ard.2006.051482. Epub 2006 Apr 20.
Doubts have been expressed about the performance of the American College of Rheumatology (ACR) clinical classification criteria for osteoarthritis when applied in the general population.
To investigate whether the distribution of population subgroups and underlying disease severity might explain the performance of these criteria in the population setting.
Population-based cross-sectional study. 819 adults aged > or = 50 years reporting knee pain in the last 12 months were clinically assessed by research therapists using standardised protocols and blinded to radiographic status. All participants underwent plain radiography of the knees, scored by a single reader blinded to clinical status. The relationship between fulfilling the ACR clinical classification criteria for knee osteoarthritis and the presence of symptomatic radiographic knee osteoarthritis was summarised for the sample as a whole and within subgroups.
Radiographic osteoarthritis was present in 539 participants (68%) and symptomatic radiographic knee osteoarthritis in 259 (33%). 238 participants (30%) fulfilled the ACR clinical criteria for knee osteoarthritis. Agreement between the ACR clinical criteria and symptomatic radiographic knee osteoarthritis was low (sensitivity 41%; specificity 75%; positive predictive value 44%; negative predictive value 72%). Sensitivity and specificity did not vary markedly between population subgroups, although they were influenced by the underlying severity of radiographic osteoarthritis.
The ACR clinical criteria seem to reflect later signs in advanced disease. Other approaches may be needed to identify early, mild osteoarthritis in the general population and primary care.
对于美国风湿病学会（ACR）骨关节炎临床分类标准应用于普通人群时的表现存在疑问。
调查人群亚组的分布和潜在疾病严重程度是否可以解释这些标准在人群中的表现。
基于人群的横断面研究。对819名年龄≥50岁且在过去12个月内报告有膝关节疼痛的成年人，由研究治疗师使用标准化方案进行临床评估，且评估人员对影像学状态不知情。所有参与者均接受了膝关节X线平片检查，由一名对临床状态不知情的阅片者进行评分。对于整个样本以及亚组内，总结了满足ACR膝关节骨关节炎临床分类标准与有症状的影像学膝关节骨关节炎存在之间的关系。
539名参与者（68%）存在影像学骨关节炎，259名（33%）存在有症状的影像学膝关节骨关节炎。238名参与者（30%）满足ACR膝关节骨关节炎临床标准。ACR临床标准与有症状的影像学膝关节骨关节炎之间的一致性较低（敏感性41%；特异性75%；阳性预测值44%；阴性预测值72%）。尽管敏感性和特异性受影像学骨关节炎潜在严重程度的影响，但在人群亚组之间没有明显差异。
ACR临床标准似乎反映了晚期疾病的较晚体征。可能需要其他方法来在普通人群和初级保健中识别早期、轻度骨关节炎。
