Departments of Clinical Epidemiology, Rheumatology and Radiology, Boston University Medical Center, Brigham and Women’s Hospital, Boston, Massachusetts 02118, USA.
J Rheumatol. 2012 Feb;39(2):359-64. doi: 10.3899/jrheum.110718. Epub 2011 Dec 15.
Enthesopathy has been reported as a feature of osteoarthritis (OA) in the distal interphalangeal (DIP) joints. We previously reported that central bone marrow lesions (BML) on magnetic resonance imaging (MRI) scans are associated with OA. In this study, we evaluated whether hand and knee enthesopathy were related.
We studied knee and hand radiographs of subjects from the Framingham Osteoarthritis Study. Subjects seen in 2002-2005 had bilateral posteroanterior hand radiographs, weight-bearing knee radiographs, and knee MRI scans. Hand radiographs were read for enthesophytes at the juxtaarticular nonsynovial areas of metacarpophalangeal (MCP), proximal interphalangeal (PIP), and DIP joints, and midshafts of the phalanges. We selected 100 cases of knees with central BML and 100 matched controls. Conditional logistic regression was used to assess associations.
Subjects with enthesophytes of at least 1 score ≥ 2 at DIP, PIP, and/or MCP were not more likely to have central knee BML (OR 0.49, 95% CI 0.17-1.40) than those without enthesophytes. Similarly, having at least 1 score ≥ 2 on the shafts was not significantly associated with having a central knee BML (OR 0.59, 95% CI 0.23-1.51). Adjustment for the presence of diabetes mellitus did not affect these results, but there was an increased prevalence of diabetes in those with hand enthesophytes (OR 3.09, 95% 1.29-7.40, enthesophyte score ≥ 2).
We found no increase in the prevalence of hand enthesophytes among persons with central knee BML on their knee MRI scans. This provides evidence against a systemic enthesopathic disorder in association with knee OA.
跟腱病已被报道为远端指间关节（DIP）骨关节炎（OA）的特征之一。我们之前曾报道过，磁共振成像（MRI）扫描上的中央骨髓病变（BML）与 OA 有关。在这项研究中，我们评估了手部和膝部跟腱病是否有关。
我们研究了弗雷明汉骨关节炎研究中的膝关节和手部 X 光片。2002-2005 年就诊的患者拍摄双侧后前位手部 X 光片、负重膝关节 X 光片和膝关节 MRI 扫描。手部 X 光片用于评估掌指关节（MCP）、近指间关节（PIP）和 DIP 关节以及指骨中间干骺端的关节旁非滑膜区的跟腱病骨赘。我们选择了 100 例有中央 BML 的膝关节病例和 100 例匹配的对照。使用条件逻辑回归来评估相关性。
与没有跟腱病骨赘的患者相比，至少有 1 个 DIP、PIP 和/或 MCP 关节的跟腱病骨赘评分≥2 的患者更不可能有中央膝关节 BML（OR 0.49，95%CI 0.17-1.40）。同样，至少有 1 个轴评分≥2 与中央膝关节 BML 也没有显著相关性（OR 0.59，95%CI 0.23-1.51）。调整糖尿病的存在并不影响这些结果，但手部跟腱病骨赘患者的糖尿病患病率更高（OR 3.09，95%CI 1.29-7.40，跟腱病骨赘评分≥2）。
我们没有发现膝关节 MRI 扫描上有中央 BML 的患者手部跟腱病骨赘的患病率增加。这提供了证据，表明与膝关节 OA 相关的全身性跟腱病并不存在。
