Leiden University Medical Center, Leiden, The Netherlands.
Arthritis Care Res (Hoboken). 2013 Apr;65(4):552-62. doi: 10.1002/acr.21851.
To assess the risk factors for progression of hand osteoarthritis (OA).
In a systematic review of cohort studies, medical literature databases were searched up to May 2012 for articles reporting data on the association between risk factors and hand OA progression. The quality of these studies was assessed by 2 independent reviewers using a criteria scoring system of 16 items, and studies were dichotomized into those with scores of 69% or over and those with scores under 69%. Best evidence synthesis was used to determine the level of evidence per risk factor.
In total, 14 articles that fulfilled the selection criteria were included, of which 8 were high quality. The most frequently investigated risk factors were age, sex, radiographic features (e.g., erosive OA), and scintigraphy. Progression was mostly defined by radiographic criteria, but also clinical progression as an outcome was described. Most of the investigated risk factors showed limited or inconclusive evidence for an association with hand OA progression. Limited evidence according to the best evidence synthesis with most available studies was present for the association between a positive scintigraphic scan and radiographic progression (up to 2.8 times more progression than negative joints).
Limited evidence is available for a positive association between an abnormal scintigraphic scan and radiographic hand OA progression. These data suggest that a positive scintigraphic scan as an inclusion criterion for studies that aim to show structural modification can increase the power of such studies. Future longitudinal studies with a well-defined baseline population are needed to search for risk factors of hand OA progression.
评估手部骨关节炎（OA）进展的危险因素。
通过对队列研究的系统评价，截至 2012 年 5 月，对医学文献数据库进行了检索，以查找报告危险因素与手部 OA 进展之间关系的数据的文章。两名独立评审员使用 16 项标准评分系统评估这些研究的质量，并将研究分为评分 69%或以上和评分低于 69%的两类。使用最佳证据综合来确定每个危险因素的证据水平。
共纳入 14 篇符合选择标准的文章，其中 8 篇为高质量文章。最常研究的危险因素是年龄、性别、影像学特征（如侵蚀性 OA）和闪烁扫描。进展主要通过放射学标准来定义，但也描述了临床进展作为结局。大多数研究的危险因素与手部 OA 进展的相关性有限或尚无定论。根据最佳证据综合，大多数可用研究都提供了有限的证据表明，闪烁扫描阳性与手部 OA 放射学进展之间存在关联（进展的可能性比阴性关节高出 2.8 倍）。
闪烁扫描阳性与手部 OA 放射学进展之间存在阳性关联的证据有限。这些数据表明，将闪烁扫描阳性作为旨在显示结构改变的研究的纳入标准可以提高此类研究的效力。需要进行具有明确基线人群的未来纵向研究，以寻找手部 OA 进展的危险因素。
