Valdes Ana M, McWilliams Daniel, Arden Nigel K, Doherty Sally A, Wheeler Margaret, Muir Kenneth R, Zhang Weiya, Cooper Cyrus, Maciewicz Rose A, Doherty Michael
Department of Twin Research and Genetic Epidemiology, King's College London and St. Thomas' Hospital, London, UK.
Arthritis Rheum. 2010 Sep;62(9):2688-95. doi: 10.1002/art.27574.
To quantify the differences in risk factors influencing total hip replacement (THR) and total knee replacement (TKR) based on the presence versus absence of multiple interphalangeal nodes in 2 or more rays of the fingers of each hand in patients with large joint osteoarthritis (OA).
A group of 3,800 patients with large joint OA who underwent total joint replacement (1,201 of whom had the nodal phenotype) and 1,906 control subjects from 2 case-control studies and a population-based cohort in the UK were studied. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for the risk of total joint replacement in association with age, sex, body mass index (BMI), height, and prevalence of the T allele in the GDF5 rs143383 polymorphism. ORs for total joint replacement were compared between cases of nodal OA and cases of non-nodal OA and between patients who underwent TKR and those who underwent THR.
Age, sex, and BMI had significantly higher ORs for an association with total joint replacement in nodal OA cases than in non-nodal OA cases. The GDF5 polymorphism was significantly associated with THR in cases of nodal OA, but not in cases of non-nodal OA, and increased height was a risk factor for THR in non-nodal OA cases only. Female sex was a protective risk factor for TKR in non-nodal OA cases (OR 0.60, 95% CI 0.52-0.70) but was predisposing for TKR in the nodal form of OA (OR 1.83, 95% CI 1.49-2.26). The nodal phenotype was associated with a significantly higher risk of undergoing both THR and TKR (OR 1.46, 95% CI 1.09-1.94) and also a significantly higher risk of bilateral TKR (OR 1.70, 95% CI 1.37-2.11), but, paradoxically, was associated with a lower risk of bilateral THR (OR 0.72, 95% CI 0.56-0.91).
Nodal and non-nodal forms of large joint OA have significantly different risk factors and outcomes, indicating a different etiology for the 2 forms of OA. With regard to the likelihood of undergoing THR, this appears to be, at least in part, genetically determined.
量化在患有大关节骨关节炎（OA）的患者中，基于双手2条或更多手指指骨间存在或不存在多个指间结节，影响全髋关节置换（THR）和全膝关节置换（TKR）的危险因素差异。
对一组3800例接受全关节置换的大关节OA患者（其中1201例具有结节表型）以及来自英国2项病例对照研究和一项基于人群队列研究的1906例对照受试者进行研究。计算与年龄、性别、体重指数（BMI）、身高以及生长分化因子5（GDF5）基因rs143383多态性中T等位基因的患病率相关的全关节置换风险的比值比（OR）和95%置信区间（95%CI）。比较结节性OA病例与非结节性OA病例之间以及接受TKR的患者与接受THR的患者之间全关节置换的OR。
与非结节性OA病例相比，年龄、性别和BMI在结节性OA病例中与全关节置换的关联具有显著更高的OR。GDF5多态性在结节性OA病例中与THR显著相关，但在非结节性OA病例中不相关，仅在非结节性OA病例中身高增加是THR的危险因素。女性在非结节性OA病例中是TKR的保护性危险因素（OR 0.60，95%CI 0.52 - 0.70），但在结节性OA中是TKR的易感因素（OR 1.83，95%CI 1.49 - 2.26）。结节表型与接受THR和TKR的显著更高风险相关（OR 1.46，95%CI 1.09 - 1.94），也与双侧TKR的显著更高风险相关（OR 1.70，95%CI 1.37 - 2.11），但矛盾的是，与双侧THR的较低风险相关（OR 0.72，95%CI 0.56 - 0.91）。
大关节OA的结节性和非结节性形式具有显著不同的危险因素和结局，表明这两种OA形式的病因不同。关于接受THR的可能性，这似乎至少部分是由基因决定的。
