Department of Rheumatology, Thessaly University School of Medicine, Larissa, 41 110, Greece.
Clin Rheumatol. 2010 May;29(5):511-6. doi: 10.1007/s10067-009-1348-z. Epub 2010 Jan 19.
The objective of this study is to assess the reliability of clinical examination in patients with erosive osteoarthritis (EOA). Eighteen patients with EOA underwent clinical examination for joint tenderness, bony swelling, and inflammation by two independent, blinded assessors. All patients were also examined by ultrasound (US) by an independent radiologist. The inter-observer agreement was moderate for bony swelling and joint tenderness and fair for joint inflammation (kappa = 0.513, 0.448, and 0.402, respectively). US detected significantly more inflamed joints than clinical examination. The sensitivity and specificity of clinical examination for joint inflammation were 0.12 and 0.95, respectively. Clinical joint counts for bony swelling, tenderness, and inflammation all correlated with functional status, assessed by the functional index for hand osteoarthritis (FIHOA), whereas US joint counts for joint inflammation did not correlate with the FIHOA. No correlation was found between any clinical or US joint count and visual analog scale for pain. US detects more joints with inflammation than clinical examination in patients with EOA. US can supplement the clinical examination of patients with EOA, as US-detected subclinical joint inflammation might accelerate joint damage and thus functional impairment.
本研究旨在评估侵蚀性骨关节炎（EOA）患者临床检查的可靠性。18 名 EOA 患者由两名独立的盲法评估员进行关节触痛、骨肿胀和炎症的临床检查。所有患者均由独立放射科医生进行超声（US）检查。骨肿胀和关节触痛的观察者间一致性为中度，关节炎症的观察者间一致性为一般（kappa 值分别为 0.513、0.448 和 0.402）。US 检测到的炎症关节明显多于临床检查。临床检查对关节炎症的敏感性和特异性分别为 0.12 和 0.95。临床关节计数的骨肿胀、触痛和炎症均与手骨关节炎功能指数（FIHOA）评估的功能状态相关，而 US 关节计数的炎症与 FIHOA 不相关。任何临床或 US 关节计数与疼痛视觉模拟评分之间均无相关性。US 检测到的 EOA 患者炎症关节多于临床检查。US 可以补充 EOA 患者的临床检查，因为 US 检测到的亚临床关节炎症可能会加速关节损伤，从而导致功能障碍。
