Keen Helen I, Wakefield Richard J, Grainger Andrew J, Hensor Elizabeth M A, Emery Paul, Conaghan Philip G
University of Western Australia, Perth, Australia.
Arthritis Rheum. 2008 Dec 15;59(12):1756-63. doi: 10.1002/art.24312.
Few studies have examined hand osteoarthritis (OA) pathology using sensitive imaging techniques. The aim of this study was to determine the extent of ultrasound (US)-detected pathology and investigate its relationship with symptoms in hand OA.
Subjects with symptomatic hand OA and controls were recruited. All underwent clinical and US examination of the small joints of both hands and completed a range of measures of hand pain, stiffness, and function.
Thirty-six subjects with symptomatic OA and 19 control subjects with similar demographics were recruited. US-detected pathology (osteophytes, joint space narrowing, gray-scale synovitis, and power Doppler signal) occurred frequently in symptomatic hand OA (41%, 40%, 46%, and 7% of joints, respectively), and significantly less often in controls (P < 0.001 for all comparisons). Symptomatic joints were more likely to demonstrate US-detected changes of gray-scale synovitis, power Doppler signal, or osteophytes (P < 0.001, P = 0.002, and P < 0.001, respectively). Neither the number of affected joints per individual nor the summative semiquantitative scores for synovitis per individual correlated with symptoms (pain visual analog scale [VAS], global VAS, or Australian/Canadian Osteoarthritis Hand Index).
This study demonstrated extensive synovitis changes as well as the traditional structural radiographic findings of hand OA. Symptomatic joints were significantly more likely to demonstrate US-detected structural changes or inflammation in symptomatic hand OA; however, the extent of changes in individual joints or in individuals did not correlate with the degree of symptoms, which may relate to both the assessment tools and the complex nature of pain.
很少有研究使用敏感的成像技术来检查手部骨关节炎（OA）的病理情况。本研究的目的是确定超声（US）检测到的病理情况的程度，并研究其与手部OA症状的关系。
招募有症状的手部OA患者和对照组。所有人都接受了双手小关节的临床和超声检查，并完成了一系列关于手部疼痛、僵硬和功能的测量。
招募了36名有症状的OA患者和19名具有相似人口统计学特征的对照者。超声检测到的病理情况（骨赘、关节间隙变窄、灰阶滑膜炎和能量多普勒信号）在有症状的手部OA中频繁出现（分别占关节的41%、40%、46%和7%），而在对照组中出现的频率明显较低（所有比较P<0.001）。有症状的关节更有可能表现出超声检测到的灰阶滑膜炎、能量多普勒信号或骨赘的变化（分别为P<0.001、P=0.002和P<0.001）。个体受影响关节的数量或个体滑膜炎的累计半定量评分均与症状（疼痛视觉模拟量表[VAS]、总体VAS或澳大利亚/加拿大骨关节炎手部指数）无关。
本研究证明了手部OA存在广泛的滑膜炎变化以及传统的结构影像学表现。有症状的关节在有症状的手部OA中更有可能表现出超声检测到的结构变化或炎症；然而，个体关节或个体的变化程度与症状程度无关，这可能与评估工具和疼痛的复杂性质有关。
