侵蚀性骨关节炎：是手部放射学骨关节炎的一种更严重形式，而非一种独立的疾病？
Erosive osteoarthritis: a more severe form of radiographic hand osteoarthritis rather than a distinct entity?
作者信息
Marshall Michelle, Nicholls Elaine, Kwok Wing-Yee, Peat George, Kloppenburg Margreet, van der Windt Danielle, Myers Helen, Dziedzic Krysia
机构信息
Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Ann Rheum Dis. 2015 Jan;74(1):136-41. doi: 10.1136/annrheumdis-2013-203948. Epub 2013 Oct 4.
OBJECTIVES
To determine whether erosive osteoarthritis shares the same pattern of joint involvement and risk profile as increasing grades of non-erosive hand osteoarthritis.
METHODS
Participants were from two population-based cohorts, aged ≥50 years, reporting hand symptoms in the previous month. Interphalangeal joints were assessed for erosive osteoarthritis (Verbruggen-Veys erosive or remodelled phase) and radiographic osteoarthritis (sliding cut-offs of K&L≥2, K&L≥3 and K&L=4). At the joint level, similarities in the frequency and pattern of erosive and non-erosive osteoarthritis were assessed by Spearman's rank correlation coefficients and generalised estimating equations. At the person level, individuals with erosive osteoarthritis were compared to those with non-erosive osteoarthritis using logistic regression, adjusted for age and gender (aOR), for the following exposures: family history, previous injury, overuse and metabolic factors (BMI, dyslipidaemia, hypertension, diabetes).
RESULTS
In 1076 symptomatic participants the ranked frequency of involvement for erosive joints was comparable to joints with K&L≥3 and K&L=4 (r>0.95). Patterns of joint involvement in erosive osteoarthritis were strongest for symmetry (aOR=6.5; 95% CI 3.0 to 14.1), followed by row (2.0; 0.8 to 5.0) and ray (0.3; 0.0 to 2.5), which was similar to joints with K&L≥3 and K&L=4. Individuals with erosive osteoarthritis (n=80) had an increased risk of metabolic syndrome (2.7; 1.0 to 7.1), notably dyslipidaemia (4.7; 2.1 to 10.6) compared with non-erosive osteoarthritis classed K&L≥3 (n=193).
CONCLUSIONS
The similar frequency of radiographic joint involvement and patterning in erosive osteoarthritis and more severe non-erosive osteoarthritis is consistent with prevalent erosive osteoarthritis being a severe form of hand osteoarthritis rather than a distinct entity. Metabolic exposures, dyslipidaemia in particular, may be implicated in erosive osteoarthritis.
目的
确定侵蚀性骨关节炎与非侵蚀性手部骨关节炎病情加重时的关节受累模式及风险特征是否相同。
方法
研究对象来自两个基于人群的队列，年龄≥50岁，在前一个月有手部症状。对指间关节进行侵蚀性骨关节炎（Verbruggen-Veys侵蚀期或重塑期）及影像学骨关节炎（K&L分级≥2、K&L分级≥3和K&L分级=4的滑动截断值）评估。在关节层面，通过Spearman等级相关系数和广义估计方程评估侵蚀性和非侵蚀性骨关节炎在频率和模式上的相似性。在个体层面，使用逻辑回归对侵蚀性骨关节炎患者与非侵蚀性骨关节炎患者进行比较，并根据年龄和性别进行调整（校正比值比），比较以下暴露因素：家族史、既往损伤、过度使用和代谢因素（体重指数、血脂异常、高血压、糖尿病）。
结果
在1076名有症状的参与者中，侵蚀性关节的受累排名频率与K&L分级≥3和K&L分级=4的关节相当（r>0.95）。侵蚀性骨关节炎的关节受累模式中，对称性最强（校正比值比=6.5；95%置信区间3.0至14.1），其次是排（2.0；0.8至5.0）和射线（0.3；0.0至2.5），这与K&L分级≥3和K&L分级=4的关节相似。与K&L分级≥3的非侵蚀性骨关节炎患者（n=193）相比，侵蚀性骨关节炎患者（n=80）发生代谢综合征的风险增加（2.7；1.0至7.1），尤其是血脂异常（4.7；2.1至10.6）。
结论
侵蚀性骨关节炎与更严重的非侵蚀性骨关节炎在影像学关节受累频率和模式上相似，这与普遍认为侵蚀性骨关节炎是手部骨关节炎的一种严重形式而非一个独立病种相符。代谢暴露因素，尤其是血脂异常，可能与侵蚀性骨关节炎有关。
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