首先出现什么？多组织受累导致放射学骨关节炎：基于磁共振成像的轨迹分析在骨关节炎倡议中进行了四年。
What comes first? Multitissue involvement leading to radiographic osteoarthritis: magnetic resonance imaging-based trajectory analysis over four years in the osteoarthritis initiative.
机构信息
Boston University School of Medicine, Boston, Massachusetts, and University of Erlangen-Nuremberg, Erlangen, Germany.
University of Arizona College of Medicine, Tucson, and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
出版信息
Arthritis Rheumatol. 2015 May;67(8):2085-96. doi: 10.1002/art.39176.
OBJECTIVE
To assess whether the presence of structural osteoarthritis (OA) features over as many as 4 years prior to incident radiographic OA increases the risk of radiographic OA in a nested, case-control design.
METHODS
We studied 355 knees from the Osteoarthritis Initiative cohort that developed radiographic OA before the 48-month visit. They were matched one-to-one by sex, age, and contralateral knee radiographic status with a control knee. Magnetic resonance images (MRIs) were read for bone marrow lesions (BMLs), cartilage damage, meniscal damage (including tears and extrusion), Hoffa synovitis, and effusion synovitis. Conditional logistic regression was applied to assess the risk of radiographic OA with regard to the presence of BMLs (score ≥2), cartilage lesions (score ≥1.1), meniscal damage (any) and extrusion of ≥3 mm ± (score ≥2), and Hoffa and effusion synovitis (any). Time points were defined as incident radiographic OA visit (P0), 1 year prior to the detection of radiographic OA (P -1), 2 years prior to the detection of radiographic OA (P -2), etc.
RESULTS
The presence of Hoffa synovitis (hazard ratio [HR] 1.76 [95% confidence interval (95% CI) 1.18-2.64]), effusion synovitis (HR 1.81 [95% CI 1.18-2.78]), and medial meniscal damage (HR 1.83 [95% CI 1.17-2.89]) at P -2 predicted radiographic OA incidence. At P -1, all features but meniscal extrusion predicted radiographic OA, with highest odds for medial BMLs (HR 6.50 [95% CI 2.27-18.62]) and effusion synovitis (HR 2.50 [95% CI 1.76-3.54]). The findings at P -3 and P -4 did not reach statistical significance.
CONCLUSION
Our findings indicate that the presence of specific structural features of MRI-detected joint damage 2 years prior to incident radiographic OA increases the risk of incident radiographic OA. However, 1 year prior to radiographic OA, the presence of almost any abnormal morphologic feature increases the risk of radiographic OA in the subsequent year.
目的
通过巢式病例对照设计，评估在出现放射学骨关节炎（OA）之前长达 4 年是否存在结构性 OA 特征是否会增加放射学 OA 的风险。
方法
我们研究了来自骨关节炎倡议队列的 355 个膝关节，这些膝关节在 48 个月就诊前发生了放射学 OA。根据性别、年龄和对侧膝关节放射学状况，将它们与对照膝关节一一匹配。对磁共振成像（MRI）进行阅读，以评估骨髓病变（BML）、软骨损伤、半月板损伤（包括撕裂和挤出）、Hoffa 滑膜炎和关节积液滑膜炎的情况。采用条件逻辑回归评估存在 BML（评分≥2）、软骨病变（评分≥1.1）、半月板损伤（任何）和挤出≥3mm±（评分≥2）以及 Hoffa 和关节积液滑膜炎（任何）时放射学 OA 的风险。时间点定义为放射学 OA 就诊时（P0）、放射学 OA 检测前 1 年（P-1）、放射学 OA 检测前 2 年（P-2）等。
结果
P-2 时存在 Hoffa 滑膜炎（危险比 [HR] 1.76 [95%置信区间（95%CI）1.18-2.64]）、关节积液滑膜炎（HR 1.81 [95%CI 1.18-2.78]）和内侧半月板损伤（HR 1.83 [95%CI 1.17-2.89]）预测放射学 OA 的发生。在 P-1 时，除半月板挤出外，所有特征均预测放射学 OA，内侧 BML 的优势比最高（HR 6.50 [95%CI 2.27-18.62]）和关节积液滑膜炎（HR 2.50 [95%CI 1.76-3.54]）。在 P-3 和 P-4 时，发现无统计学意义。
结论
我们的研究结果表明，在出现放射学 OA 之前 2 年存在特定的 MRI 检测到的关节损伤的结构性特征会增加放射学 OA 的风险。然而，在放射学 OA 发生前 1 年，几乎任何异常形态特征的存在都会增加随后一年发生放射学 OA 的风险。
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