Fu Q, Cao J, Renner J B, Jordan J M, Caterson B, Duance V, Luo M, Kraus V B
Institute of Endemic Diseases, School of Public Health, Xi'an Jiaotong University Medical Center, Xi'an, Shaanxi, PR China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University Medical Center, Ministry of Education, Xi'an, Shaanxi, PR China; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Institute of Endemic Diseases, School of Public Health, Xi'an Jiaotong University Medical Center, Xi'an, Shaanxi, PR China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University Medical Center, Ministry of Education, Xi'an, Shaanxi, PR China.
Osteoarthritis Cartilage. 2015 Jun;23(6):868-73. doi: 10.1016/j.joca.2015.01.009. Epub 2015 Jan 24.
Kashin-Beck Disease (KBD) is a rare and severe osteoarthropathy endemic to China. We evaluated the frequency and patterns of hand radiographic osteoarthritis (rOA) in adults with and without KBD.
Han Chinese (N = 438) from Yongshou County of central China underwent right hand radiography for determining case status. Presence of KBD was based on characteristic radiographic deformities of articular ends of bones including articular surface depression, carpal crowding, any subchondral bone deformities in the proximal end of phalanges or first metacarpal bone, or the distal ends of metacarpal bones 2-5, and any bony enlargement with deformity of the distal ends of phalanges. Hand rOA severity was determined by osteophyte (OST), joint space narrowing (JSN), and Kellgren and Lawrence (KL) grades.
This study included 127 KBD and 311 non-KBD adults of similar mean age (39 years) and body mass index (BMI) (21 kg/m(2)). Inter- and intra-rater reliability for radiographic determination of case status and rOA features was high (kappa 0.72-0.96). Compared to non-KBD, KBD adults had significantly more severe hand rOA of the thumb, distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. Only KBD adults had end-stage carpometacapal (CMC) disease. In KBD, DIPs and PIPs were more affected than MCPs and the frequency of OSTs was significantly higher in PIPs than DIPs.
Compared with age-matched adults from the same area and farming occupation, KBD hand rOA was more widespread and severe, particularly of PIPs and CMCs. The ability to differentiate adult KBD from non-KBD hand rOA will facilitate genetic analyses of the vast majority of affected individuals.
大骨节病（KBD）是中国特有的一种罕见且严重的骨关节病。我们评估了患有和未患大骨节病的成年人手部放射学骨关节炎（rOA）的发生率及模式。
来自中国中部永寿县的汉族人群（N = 438）接受右手X线摄影以确定病例状态。大骨节病的诊断基于骨关节端的特征性放射学畸形，包括关节面凹陷、腕骨拥挤、指骨近端或第一掌骨、或第2 - 5掌骨远端的任何软骨下骨畸形，以及指骨远端的任何骨质增生伴畸形。手部rOA严重程度通过骨赘（OST）、关节间隙变窄（JSN）以及凯尔格伦和劳伦斯（KL）分级来确定。
本研究纳入了127例大骨节病患者和311例非大骨节病患者，他们的平均年龄（39岁）和体重指数（BMI）（21kg/m²）相似。病例状态和rOA特征的放射学判定的评分者间及评分者内信度较高（kappa 0.72 - 0.96）。与非大骨节病患者相比，大骨节病患者的拇指、远侧指间关节（DIP）、近侧指间关节（PIP）和掌指关节（MCP）的手部rOA明显更严重。只有大骨节病患者患有终末期腕掌关节（CMC）疾病。在大骨节病中，DIP和PIP比MCP更易受累，且PIP的OST频率明显高于DIP。
与来自同一地区且从事农业职业的年龄匹配的成年人相比，大骨节病患者的手部rOA更普遍且更严重，尤其是PIP和CMC。区分成年大骨节病患者与非大骨节病患者手部rOA的能力将有助于对绝大多数受影响个体进行基因分析。
