Menzies Research Institute, University of Tasmania, Hobart, Australia.
Intern Med J. 2012 Mar;42(3):274-80. doi: 10.1111/j.1445-5994.2011.02438.x.
There is controversy about whether pain and radiographic osteoarthritis (ROA) predict subsequent cartilage loss. The aim of this study was to describe the relationship between ROA, pain and cartilage loss in the knee.
We studied randomly selected subjects at baseline and approximately 2.9 years later (n= 399). The presence of ROA was assessed at baseline with a standing anteroposterior semiflexed radiograph scored using the Osteoarthritis Research Society International atlas for osteophytes (OP) and joint space narrowing (JSN). Pain was assessed by the Western Ontario McMaster Osteoarthritis Index. Subjects' medial and lateral tibial cartilage volumes were determined by magnetic resonance imaging at both time points.
In cross-sectional analysis, both medial and lateral tibial cartilage volumes were lower in those with ROA. Any medial ROA predicted medial tibial cartilage loss (3.2% (standard deviation (SD) 5.6) vs 1.9% (SD 5.3) per annum) while any lateral ROA predicted both medial (4.0% (SD 6.0) vs 2.2% (SD 5.3) per annum) and lateral (3.5% (SD 5.8) vs 1.6% (SD 4.2) per annum) tibial cartilage loss (all P < 0.05). In multivariate analysis, JSN and OP at both medial and lateral sites had independent dose-response associations with tibial cartilage loss at both sites. Pain was an independent predictor of lateral, but not medial, tibial cartilage loss after taking ROA into account.
Subjects with ROA (either JSN or OP) and, to a lesser extent, pain lose cartilage faster than subjects without ROA and the more severe the ROA the greater the rate of loss. These findings have implications for the design of clinical trials.
关于疼痛和放射学骨关节炎（ROA）是否预测随后的软骨损失存在争议。本研究的目的是描述膝关节 ROA、疼痛与软骨损失之间的关系。
我们在基线时和大约 2.9 年后（n=399）随机选择研究对象。使用 Osteoarthritis Research Society International 骨赘（OP）和关节间隙狭窄（JSN）图谱对基线时的 ROA 进行评估。通过 Western Ontario McMaster Osteoarthritis Index 评估疼痛。在两个时间点，通过磁共振成像确定受试者的内侧和外侧胫骨软骨体积。
在横断面分析中，ROA 患者的内侧和外侧胫骨软骨体积均较低。任何内侧 ROA 均预测内侧胫骨软骨损失（3.2%（标准差（SD）5.6）与每年 1.9%（SD 5.3）），而任何外侧 ROA 均预测内侧（4.0%（SD 6.0）与每年 2.2%（SD 5.3））和外侧（3.5%（SD 5.8）与每年 1.6%（SD 4.2））胫骨软骨损失（均 P<0.05）。在多变量分析中，内侧和外侧部位的 JSN 和 OP 与双侧胫骨软骨损失均具有独立的剂量反应关系。考虑到 ROA 后，疼痛是外侧胫骨软骨损失的独立预测因素，但不是内侧胫骨软骨损失的独立预测因素。
有 ROA（无论是 JSN 还是 OP）的患者，并且在较小程度上，疼痛患者的软骨损失速度比没有 ROA 的患者更快，ROA 越严重，损失速度越快。这些发现对临床试验的设计具有重要意义。
