Driban Jeffrey B, Stout Alina C, Lo Grace H, Eaton Charles B, Price Lori Lyn, Lu Bing, Barbe Mary F, McAlindon Timothy E
Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA 02111, USA.
Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
Ther Adv Musculoskelet Dis. 2016 Oct;8(5):165-171. doi: 10.1177/1759720X16658032. Epub 2016 Jul 6.
We evaluated agreement among several definitions of accelerated knee osteoarthritis (AKOA) and construct validity by comparing their individual associations with injury, age, obesity, and knee pain.
We selected knees from the Osteoarthritis Initiative that had no radiographic knee osteoarthritis [Kellgren-Lawrence (KL) 0 or 1] at baseline and had high-quality quantitative medial joint space width (JSW) measures on two or more consecutive visits ( = 1655 knees, 1143 participants). Quantitative medial JSW was based on a semi-automated method and was location specific ( = 0.25). We compared six definitions of AKOA: stringent JSW (averaged): average JSW loss greater than 1.05 mm/year over 4 years; stringent JSW (consistent): JSW loss greater than 1.05 mm/year for at least 2 years; lenient JSW (averaged): average JSW loss greater than 0.25 mm/year over 4 years; lenient JSW (consistent): JSW loss greater than 0.25 mm/year for at least 2 years; comprehensive KL based: progression from no radiographic osteoarthritis to advance-stage osteoarthritis (KL 3 or 4; development of definite osteophyte and joint space narrowing) within 4 years; and lenient KL based: an increase of at least two KL grades within 4 years.
Over 4 years the incidence rate of AKOA was 0.4%, 0.8%, 15.5%, 22.1%, 12.4%, and 7.2% based on the stringent JSW (averaged and consistent), lenient JSW (averaged and consistent), lenient KL-based definition, and comprehensive KL-based definition. All but one knee that met the stringent JSW definition also met the comprehensive KL-based definition. There was fair substantial agreement between the lenient JSW (averaged), lenient KL-based, and comprehensive KL-based definitions. A comprehensive KL-based definition led to larger effect sizes for injury, age, body mass index, and average pain over 4 years.
A comprehensive KL-based definition of AKOA may be ideal because it represents a broader definition of joint deterioration compared with those focused on just joint space or osteophytes alone.
我们通过比较几种加速性膝骨关节炎（AKOA）定义与损伤、年龄、肥胖及膝关节疼痛的个体关联，评估了这些定义之间的一致性及结构效度。
我们从骨关节炎倡议项目中选取膝关节，这些膝关节在基线时无影像学膝骨关节炎[凯尔格伦-劳伦斯（KL）分级为0或1]，且在连续两次或更多次就诊时具有高质量的定量内侧关节间隙宽度（JSW）测量值（n = 1655个膝关节，1143名参与者）。定量内侧JSW基于半自动方法，且具有特定位置（精度 = 0.25）。我们比较了六种AKOA定义：严格JSW（平均值）：4年内平均JSW丢失大于1.05毫米/年；严格JSW（持续）：至少2年JSW丢失大于1.05毫米/年；宽松JSW（平均值）：4年内平均JSW丢失大于0.25毫米/年；宽松JSW（持续）：至少2年JSW丢失大于0.25毫米/年；基于KL的综合定义：4年内从无影像学骨关节炎进展为晚期骨关节炎（KL 3或4；明确骨赘形成和关节间隙变窄）；基于KL的宽松定义：4年内KL分级至少增加两级。
4年间，基于严格JSW（平均值和持续）、宽松JSW（平均值和持续）、基于KL的宽松定义及基于KL的综合定义，AKOA的发病率分别为0.4%、0.8%、15.5%、2
