University Department of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
Ann Rheum Dis. 2011 Dec;70(12):2140-3. doi: 10.1136/annrheumdis-2011-200349. Epub 2011 Aug 20.
Pain in the first metatarsophalangeal joint (MTPJ) is common, though the link between pathology and symptoms is poorly understood.
To examine the relationship between pain, function and ultrasound (US)-detected pathology in the first MTPJ.
33 subjects with first MTPJ pain and 20 asymptomatic controls completed questionnaires about pain and function, then underwent clinical examination, US examination and objective assessment of function using a motion tracking system.
Low-level grey scale synovitis and osteophytes were common in patients and controls. Osteophytes were more prevalent in symptomatic first MTPJ [24/33 (73%) vs. 7/20 (35%), p=0.007], and greater osteophyte numbers were weakly associated with higher levels of pain [increase in pain VAS per osteophyte (95% CI)=13.78mm (0.12mm-27.43mm), p=0.048]. A power Doppler (PD) signal was present in a fifth of painful first MTPJs and absent in controls. A PD signal was associated with osteophytes and joint space narrowing but was not independently related to target joint pain. For all first MTPJs, osteophytes and the presence of a PD signal was associated with worse patient-reported function. US features did not predict objective function.
Osteophytes, representing subchondral bone remodelling, were associated with the presence of first MTPJ pain and, together with more severe (PD) synovitis, also contributed to poorer function. Detailed imaging of bone may provide more information on peripheral pain associations.
第一跖趾关节（MTPJ）疼痛很常见，但病理与症状之间的联系尚不清楚。
检查第一 MTPJ 疼痛、功能与超声（US）检测到的病理之间的关系。
33 例第一 MTPJ 疼痛患者和 20 例无症状对照者完成疼痛和功能问卷，然后接受临床检查、US 检查和运动跟踪系统的客观功能评估。
低水平灰阶滑膜炎和骨赘在患者和对照者中均很常见。骨赘在有症状的第一 MTPJ 中更为常见[33 例中有 24 例（73%）比 20 例对照中有 7 例（35%），p=0.007]，且骨赘数量与更高的疼痛水平呈弱相关[每增加一个骨赘疼痛视觉模拟评分（VAS）增加（95%CI）=13.78mm（0.12mm-27.43mm），p=0.048]。有五分之一的疼痛第一 MTPJ 存在彩色多普勒（PD）信号，而对照者中没有。PD 信号与骨赘和关节间隙狭窄有关，但与靶关节疼痛无关。对于所有第一 MTPJ，骨赘和 PD 信号的存在与患者报告的功能较差相关。US 特征不能预测客观功能。
代表软骨下骨重塑的骨赘与第一 MTPJ 疼痛的存在相关，与更严重的（PD）滑膜炎一起，也与功能更差相关。骨的详细成像可能提供更多关于周围疼痛相关性的信息。
