Driban Jeffrey B, Price Lori Lyn, Eaton Charles B, Lu Bing, Lo Grace H, Lapane Kate L, McAlindon Timothy E
Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA.
The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA, 02111, USA.
Clin Rheumatol. 2016 Jun;35(6):1565-71. doi: 10.1007/s10067-015-3128-2. Epub 2015 Nov 27.
We evaluated whether accelerated knee osteoarthritis (AKOA) was associated with greater pain and other outcomes and if outcomes varied over time differently among those with incident AKOA or common knee osteoarthritis (KOA), which we defined as a gradual onset of disease. We conducted longitudinal analyses among participants in the Osteoarthritis Initiative who had no radiographic KOA at baseline (Kellgren-Lawrence [KL] <2). Participants were considered AKOA if ≥1 knees progressed to KL grade ≥3 and common KOA if ≥1 knees increased in radiographic scoring within 48 months. We defined the index visit as the study visit when they met the AKOA or common KOA criteria. Our observation period included up to 3 years before and after the index visit. Our primary outcome was WOMAC pain converted to an ordinal scale: none (pain score = 0/1 out of 20), mild (pain score = 2/3), and moderate-severe pain (pain score >3). We explored 11 other secondary outcome measures. We performed an ordinal logistic regression or linear models with generalized estimating equations. The predictors were group (AKOA or common KOA), time (seven visits), and a group-by-time interaction. Overall, individuals with AKOA (n = 54) had greater pain, functional disability, and global rating scale as well as slower chair-stand and walking pace compared with those with common KOA (n = 187). There was no significant interaction between group and time for knee pain; however, there was for chair-stand pace and global rating scale. In conclusion, AKOA may be a painful and disabling phenotype that warrants more attention by clinicians and researchers.
我们评估了快速进展性膝骨关节炎（AKOA）是否与更严重的疼痛及其他结局相关，以及在新发AKOA患者或普通膝骨关节炎（KOA，我们将其定义为疾病逐渐起病）患者中，结局随时间的变化是否存在差异。我们对骨关节炎倡议研究中基线时无影像学KOA（Kellgren-Lawrence [KL]分级<2）的参与者进行了纵向分析。如果≥1个膝关节进展至KL分级≥3，则参与者被视为AKOA；如果≥1个膝关节在48个月内影像学评分增加，则被视为普通KOA。我们将符合AKOA或普通KOA标准的研究访视定义为索引访视。我们的观察期包括索引访视前后长达3年的时间。我们的主要结局是将WOMAC疼痛转换为有序量表：无（疼痛评分=20分中的0/1分）、轻度（疼痛评分=2/3分）和中度至重度疼痛（疼痛评分>3分）。我们还探索了11项其他次要结局指标。我们使用广义估计方程进行有序逻辑回归或线性模型分析。预测因素包括组（AKOA或普通KOA）、时间（7次访视）以及组与时间的交互作用。总体而言，与普通KOA患者（n = 187）相比，AKOA患者（n = 54）有更严重的疼痛、功能障碍和整体评分，以及更慢的从椅子上站起速度和步行速度。组与时间在膝关节疼痛方面无显著交互作用；然而，在从椅子上站起速度和整体评分方面存在交互作用。总之，AKOA可能是一种疼痛且致残的表型，值得临床医生和研究人员更多关注。
