Bevers Karen, Zweers Manon C, Vriezekolk Joke E, Bijlsma Johannes W J, den Broeder Alfons A
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Clin Exp Rheumatol. 2014 Nov-Dec;32(6):930-4. Epub 2014 Oct 2.
To investigate the predictive value of ultrasound (US) characteristics for the effect of intra-articular glucocorticoids in knee osteoarthritis (OA).
In this prospective cohort study, 62 patients with symptomatic knee OA (clinical knee OA criteria, pain>4 on a Numerical Rating Scale (NRS; 0-10)) received an intra-articular glucocorticoid injection (40 mg triamcinolone acetonide). Patients with NRS pain ≤4 at 4 weeks were defined as responders. On inclusion, demographics, clinical data (body mass index, local swelling) knee x-rays and knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire were collected. Six US features were assessed including: effusion, synovial hypertrophy, Baker's cyst, infrapatellar bursitis, meniscal protrusion and cartilage thickness. Stepwise multiple logistic regression analyses with forward selection were conducted to identify possible predictors.
At 4 weeks, 42% of the study participants reached a NRS ≤4; an effect comparable to existing literature. Regression analyses showed that patients who used analgesics at baseline were less likely to have a good response. The small proportion of patients with infrapatellar bursitis was more likely to respond to the injection.
No patient, disease or US characteristic of inflammation, turned out to be a reliable and clinically meaningful predictor for the effect of intra-articular glucocorticoids after four weeks in knee OA.
探讨超声（US）特征对膝关节骨关节炎（OA）关节内注射糖皮质激素疗效的预测价值。
在这项前瞻性队列研究中，62例有症状的膝关节OA患者（符合临床膝关节OA标准，数字评定量表（NRS；0 - 10）疼痛>4）接受了关节内糖皮质激素注射（40 mg曲安奈德）。4周时NRS疼痛≤4的患者被定义为反应者。纳入研究时，收集了人口统计学资料、临床数据（体重指数、局部肿胀情况）、膝关节X线片以及膝关节损伤和骨关节炎疗效评分（KOOS）问卷。评估了六项超声特征，包括：关节积液、滑膜增生、腘窝囊肿、髌下囊炎、半月板突出和软骨厚度。采用向前选择法进行逐步多元逻辑回归分析，以确定可能的预测因素。
4周时，42%的研究参与者NRS≤4，这一疗效与现有文献相当。回归分析表明，基线时使用镇痛药的患者获得良好反应的可能性较小。髌下囊炎患者比例较小，但更有可能对注射治疗有反应。
在膝关节OA患者中，四周后，没有任何患者、疾病或超声炎症特征可成为关节内注射糖皮质激素疗效的可靠且具有临床意义的预测指标。
