Arden Nigel K, Lane Nancy E, Parimi Neeta, Javaid Kassim M, Lui Li-Yung, Hochberg Marc C, Nevitt Michael
MRC Epidemiology Resource Centre, Southampton, UK and University of Oxford, Oxford, UK.
Arthritis Rheum. 2009 Apr;60(4):1052-9. doi: 10.1002/art.24382.
To evaluate definitions of radiographic hip osteoarthritis (RHOA) for use in longitudinal epidemiologic studies of disease incidence in women.
We studied 5,839 women from the Study of Osteoporotic Fractures who had had serial pelvic radiographs obtained (mean of 8.3 years apart) and who were followed up (mean followup 7.1 years from the time of the second radiograph) for evaluation of clinical outcomes. Definitions of RHOA were assessed for construct validity (association with symptoms and signs at the time of the second radiograph) and predictive validity (association with total hip replacement [THR] and signs and symptoms a mean of 7.1 years later). Odds ratios (ORs) and 95% confidence intervals were calculated to assess the strength of association using logistic regression.
The cumulative incidence of RHOA ranged from 2.2% to 11.7%. All definitions displayed significant construct validity; the most consistent was found for composite definitions that required the concurrent presence of 2 or more individual radiographic features and definitions based on stringent criteria for joint space narrowing. All definitions except minimum joint space < or =2.5 mm displayed consistent predictive validity. Composite definitions had the strongest associations with THR (OR 10.5-18.5) and hip pain (OR 2.6-2.9). The hips identified as having OA by each definition varied, with especially small overlap between findings using definitions based on osteophytes and those using definitions based on joint space narrowing alone.
Most definitions of incident RHOA display good construct and predictive validity. Composite definitions have the best overall performance, and definitions requiring the presence of both osteophytes (in particular, femoral osteophytes) and joint space narrowing would be recommended for most epidemiologic and genetic studies.
评估用于女性疾病发病率纵向流行病学研究的影像学髋关节骨关节炎（RHOA）定义。
我们研究了来自骨质疏松性骨折研究的5839名女性，她们接受了系列骨盆X线片检查（平均间隔8.3年），并进行了随访（从第二次X线片检查时起平均随访7.1年）以评估临床结局。对RHOA的定义进行了结构效度（与第二次X线片检查时的症状和体征的关联）和预测效度（与全髋关节置换术[THR]以及平均7.1年后的体征和症状的关联）评估。使用逻辑回归计算比值比（OR）和95%置信区间以评估关联强度。
RHOA的累积发病率在2.2%至11.7%之间。所有定义均显示出显著的结构效度；对于需要同时存在2个或更多个体影像学特征的综合定义以及基于关节间隙狭窄严格标准的定义，一致性最高。除最小关节间隙<或=2.5mm外，所有定义均显示出一致的预测效度。综合定义与THR（OR 10.5 - 18.5）和髋部疼痛（OR 2.6 - 2.9）的关联最强。根据每个定义确定为患有骨关节炎的髋关节各不相同，基于骨赘的定义和仅基于关节间隙狭窄的定义之间的发现重叠尤其小。
大多数新发RHOA的定义显示出良好的结构效度和预测效度。综合定义总体表现最佳，对于大多数流行病学和遗传学研究，建议采用同时存在骨赘（特别是股骨骨赘）和关节间隙狭窄的定义。
