Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
Ann Rheum Dis. 2010 Mar;69(3):585-7. doi: 10.1136/ard.2009.104562. Epub 2010 Feb 2.
To assess the impact of different subsets of symptomatic hand osteoarthritis (OA) on pain and disability.
From 308 patients with hand OA a group with carpometacarpal joint (CMCJ) symptoms only (group I, n=20) was identified as well as groups with symptoms at the interphalangeal joints (IPJs) only (group II, n=138), and symptoms at both sites (group III, n=150). Hand pain and function, assessed with the AUSCAN, were compared between groups using linear mixed models. Radiological OA was assessed using the Kellgren-Lawrence grading scale.
Mean (SD) AUSCAN scores for groups I, II and III were 23.1 (11.7), 18.3 (11.9) and 26.4 (12.5), respectively. After adjustment for age, gender, body mass index, family effects and number of symptomatic hand joints, significant differences in AUSCAN scores of 7.4 (95% CI 1.8 to 13.0) between groups I and II, and 5.7 (95% CI 2.7 to 8.6) between groups II and III were found. AUSCAN scores were 5.8 (95% CI 3.1 to 8.6) higher for patients with versus patients without CMCJ symptoms. Kellgren-Lawrence scores did not differ between groups.
In symptomatic hand OA, CMCJ OA contributes more to pain and disability than IPJ OA. Hence, treatment of CMCJ OA should be emphasised, even if it coincides with IPJ OA.
评估不同症状性手部骨关节炎（OA）亚组对手部疼痛和功能障碍的影响。
从 308 例手部 OA 患者中，确定了仅存在腕掌关节（CMCJ）症状的患者（组 I，n=20），以及仅存在指间关节（IPJ）症状的患者（组 II，n=138）和同时存在两个部位症状的患者（组 III，n=150）。使用 AUSCAN 评估手部疼痛和功能，通过线性混合模型比较各组之间的差异。使用 Kellgren-Lawrence 分级评估放射学 OA。
组 I、组 II 和组 III 的 AUSCAN 评分均值（标准差）分别为 23.1（11.7）、18.3（11.9）和 26.4（12.5）。在调整年龄、性别、体重指数、家族效应和症状性手部关节数后，组 I 和组 II 之间 AUSCAN 评分的差异为 7.4（95%可信区间 1.8 至 13.0），组 II 和组 III 之间的差异为 5.7（95%可信区间 2.7 至 8.6）。与无 CMCJ 症状的患者相比，有 CMCJ 症状的患者 AUSCAN 评分高 5.8（95%可信区间 3.1 至 8.6）。各组之间 Kellgren-Lawrence 评分无差异。
在有症状的手部 OA 中，CMCJ OA 比 IPJ OA 对疼痛和功能障碍的影响更大。因此，即使与 IPJ OA 同时存在，也应强调 CMCJ OA 的治疗。
