Clinical Research Center, National Hospital Organization Sagamihara Hospital, Sakuradai 18-1, Minami-ku, Kanagawa 252-0315, Japan.
BMC Musculoskelet Disord. 2010 Nov 24;11:269. doi: 10.1186/1471-2474-11-269.
Although osteoarthritis (OA) of the knee joints is the most common and debilitating joint disease in developed countries, the factors that determine the severity of symptoms are not yet understood well. Subjects with symptomatic medial knee OA were followed up prospectively to explore the relationship between radiographic changes and symptoms or physical examination findings.
One-hundred six OA knees in 68 subjects (mean age 71.1 years; 85% women) were followed up at 6-month intervals over 36 months. At each visit, knee radiographs were obtained, symptoms were assessed by a validated questionnaire, and the result of physical examination was recorded systematically using a specific chart. Correlations between the change of radiographs and clinical data were investigated in a longitudinal manner.
During the study period, the narrowing of joint space width (JSW) was observed in 34 joints (32%). Although those knees were clinically or radiographically indistinguishable at baseline from those without JSW narrowing, differences became apparent at later visits during the follow-up. The subjects with knees that underwent JSW narrowing had severer symptoms, and the symptoms tended to be worse for those with higher rates of narrowing. A significant correlation was not found between the severity of symptoms and the growth of osteophytes. For the knees that did not undergo radiographic progression, the range of motion improved during the follow-up period, possibly due to the reduction of knee pain. Such improvement was not observed with the knees that underwent JSW narrowing or osteophyte growth.
The result of this study indicates that the symptoms of knee OA patients tend to be worse when JSW narrowing is underway. This finding may explain, at least partly, a known dissociation between the radiographic stage of OA and the severity of symptoms.
尽管膝关节骨关节炎（OA）是发达国家最常见且使人衰弱的关节疾病，但导致症状严重程度的因素仍未得到很好的理解。本研究前瞻性随访有症状的内侧膝关节 OA 患者，以探讨放射影像学变化与症状或体格检查结果之间的关系。
68 名受试者（平均年龄 71.1 岁，85%为女性）的 106 个膝关节在 36 个月内接受了 6 个月一次的随访。每次就诊时均拍摄膝关节 X 线片，采用经过验证的问卷评估膝关节症状，并使用特定图表系统地记录体格检查结果。以纵向方式研究放射影像学变化与临床数据之间的相关性。
在研究期间，34 个关节（32%）出现关节间隙变窄（JSW）。尽管这些膝关节在基线时与未出现 JSW 变窄的膝关节在临床或放射影像学上无法区分，但在随访过程中，差异变得明显。发生 JSW 变窄的膝关节症状更严重，JSW 变窄速度越快，症状越严重。未出现放射影像学进展的膝关节在随访期间活动度增加，这可能是由于膝关节疼痛减轻所致。但未出现 JSW 变窄或骨赘生长的膝关节并未观察到这种改善。
本研究结果表明，当 JSW 变窄时，膝关节 OA 患者的症状往往更严重。这一发现至少部分解释了 OA 的放射影像学分期与症状严重程度之间的已知分离现象。
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