Bastick A N, Wesseling J, Damen J, Verkleij S P J, Emans P J, Bindels P J E, Bierma-Zeinstra S M A
*Dit onderzoek werd eerder gepubliceerd in British Journal of General Practice (2016;66:32-9) met als titel 'Defining knee pain trajectories in early symptomatic knee osteoarthritis in primary care: 5-year results from a nationwide prospective cohort study (CHECK)'. Afgedrukt met toestemming.
Ned Tijdschr Geneeskd. 2016;160:D449.
Retrospective cohort study.
We obtained data for this study from the 'Cohort Hip and Cohort Knee' (CHECK) study. Participants who presented with knee osteoarthritis at baseline were included. We assessed baseline patient parameters such as demographics, anamnesis and physical examination measurements. Pain outcome measure was assessed annually using a numeric rating scale. Different pain trajectories were defined by latent class growth analysis. Multinomial logistic regression was used to calculate relative risk ratios.
In total, 705 participants were included. Six distinct pain trajectories were identified with favourable and unfavourable courses. We found significant differences in baseline characteristics between the different pain trajectories, including BMI; symptom severity; and pain coping strategies. Higher BMI, lower education, presence of co-morbidities, higher activity limitation scores and joint space tenderness were more often associated with trajectories characterized by more pain at first presentation and pain progression. No association was found for baseline radiographic features.
We defined six distinct pain trajectories in individuals with early symptomatic knee osteoarthritis. Our results can help physicians identify those patients that require more frequent monitoring compared patients for whom a watch-and-wait policy seems justifiable. In general practice, radiography does not provide added value to the follow-up of early symptomatic knee osteoarthritis patients.
回顾性队列研究。
我们从“髋关节与膝关节队列”（CHECK）研究中获取本研究的数据。纳入在基线时患有膝关节骨关节炎的参与者。我们评估了基线患者参数，如人口统计学、既往史和体格检查测量值。每年使用数字评分量表评估疼痛结局指标。通过潜在类别增长分析定义不同的疼痛轨迹。使用多项逻辑回归计算相对风险比。
总共纳入了705名参与者。确定了六种不同的疼痛轨迹，包括有利和不利的病程。我们发现不同疼痛轨迹之间的基线特征存在显著差异，包括体重指数；症状严重程度；以及疼痛应对策略。较高的体重指数、较低的教育程度、合并症的存在、较高的活动受限评分和关节间隙压痛更常与首次出现时疼痛较多且疼痛进展的轨迹相关。未发现与基线放射学特征有关联。
我们在早期有症状的膝关节骨关节炎患者中定义了六种不同的疼痛轨迹。我们的结果可帮助医生识别那些与采用观察等待策略似乎合理的患者相比需要更频繁监测的患者。在一般实践中，放射学检查对早期有症状的膝关节骨关节炎患者的随访没有额外价值。
