Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Ann Rheum Dis. 2011 Feb;70(2):326-30. doi: 10.1136/ard.2010.138230. Epub 2010 Nov 19.
In order to gain insight in the pathogenesis of erosive hand osteoarthritis (OA), the evolution of erosions in hand OA and risk factors involved were investigated.
The 6-year evolution in radiographic Verbruggen-Veys anatomical phase was assessed in interphalangeal joints of 236 patients with hand OA (mean age 59 years, 83% women) from the GARP (for 'Genetics ARthrosis and Progression') sibling pair study. Erosive evolution comprised phase transitions from non-erosive to erosive phases and from active erosions to remodelling. Clustering of erosive evolution within patients was assessed using the χ² test. Familial aggregation was evaluated in sibling pairs by estimating ORs for siblings and probands sharing erosive evolution. Local baseline determinants and the effect of high sensitivity C reactive protein were assessed using generalised estimating equations.
Erosive evolution took place in 181 of 4120 interphalangeal joints at risk (4.4%), corresponding to 60 patients (25.4% of study sample). Erosive evolution was found more often in multiple interphalangeal joints in one patient than would be expected by chance (χ² 373.0, p < 0.001). The adjusted OR (95% CI) for a sibling having erosive evolution if the proband had erosive evolution was 4.7 (1.4 to 15.8). Systemic inflammation was not associated with erosive activity. Independent local determinants were joint space narrowing (OR (95% CI) 8.9 (4.8 to 16.4)) and self-reported pain (OR (95%CI) 2.3 (1.1 to 4.7)).
rosive evolution was clustered within patients and families. Local factors were also involved in the evolution. This increase in insight in the pathogenesis of erosive hand OA will contribute to the development of new treatments.
为了深入了解侵蚀性手骨关节炎（OA）的发病机制，本研究调查了手部 OA 中的侵蚀演变以及涉及的危险因素。
本研究纳入了来自 GARP（“遗传关节炎和进展”）同胞对研究的 236 例手部 OA 患者（平均年龄 59 岁，83%为女性）的指间关节，评估了其在 6 年内 X 线 Verbruggen-Veys 解剖学分期的演变。侵蚀性演变包括从非侵蚀性到侵蚀性阶段以及从活动性侵蚀到重塑的阶段转变。采用卡方检验评估患者内侵蚀性演变的聚类情况。通过估计共享侵蚀性演变的同胞对和患者的比值比（OR）来评估同胞间的家族聚集性。采用广义估计方程评估局部基线决定因素和高敏 C 反应蛋白的影响。
在 4120 个有风险的指间关节中，有 181 个（4.4%）发生了侵蚀性演变，对应 60 例患者（研究样本的 25.4%）。与随机预期相比，在一名患者中多个指间关节同时发生侵蚀性演变更为常见（卡方 373.0，p<0.001）。如果患者有侵蚀性演变，那么同胞有侵蚀性演变的调整后 OR（95%CI）为 4.7（1.4 至 15.8）。全身炎症与侵蚀性活动无关。独立的局部决定因素是关节间隙变窄（OR（95%CI）8.9（4.8 至 16.4））和自我报告的疼痛（OR（95%CI）2.3（1.1 至 4.7））。
侵蚀性演变在患者内和家族内聚类。局部因素也参与了演变。对手部侵蚀性 OA 发病机制的深入了解将有助于新疗法的开发。
