Miletic Ivan, Agten Christoph, Sutter Reto, Pfirrmann Christian, Peterson Cynthia
Chiropractic, Dr. Jörg Häusler private practice, Luzern, Switzerland.
Radiology, Balgrist University Hospital, Zurich, Switzerland.
Rofo. 2018 Feb;190(2):134-143. doi: 10.1055/s-0043-112337. Epub 2017 Jun 26.
To be able to predict which patients are more likely to have a positive treatment outcome, the purpose of this study is 1: To compare outcomes after intra-articular corticosteroid knee injections with the Kellgren and Lawrence (KL) 5 and 3 grading systems for knee osteoarthritis, the Osteoarthritis Research Society International (OARSI) grading system and actual joint space measurements; and 2: To compare the reliability of these grading systems.
Knee radiographs of 117 patients who received intra-articular corticosteroid injections were independently evaluated by two radiologists blinded to the outcome. Evaluation included the KL5, KL3, OARSI systems and actual joint space widths. The numerical rating scale for pain was collected at baseline and along with the Patient's Global Impression of Change on day 1, in week 1 and in month 1. The number of 'improved' patients was compared between the OA grades using the Chi-square test. Logistic regression determined which findings were predictive for improvement. Agreement was assessed using Kappa statistics and the intraclass correlation coefficient (ICC).
Patients with OARSI grade 2 reported the highest rates of 'improvement' at all time points, which was significant on day 1 (p = 0.004). No relationship with improvement was found with KL5, KL3 or actual joint space measurements. Patients with OARSI grade 2 were 8 times more likely to report improvement on day 1 (p = 0.024). Reliability was best for joint space measurements (ICC = 0.812 - 0.882), followed by the OARSI.
The OARSI for joint space narrowing grade 2 (34 - 66 % narrowing) was linked with a better outcome on day 1 with trends in week 1 and month 1. The reliability of the OARSI was better than the KL5 or KL3 systems.
· OARSI grading of OA had better reliability than KL3 or KL5.. · OARSI grade 2 was related to a better treatment outcome.. · Neither KL grades nor joint space measurements were related to improvement..
· Miletic I, Agten C, Sutter R et al. Relationship of Radiographic Osteoarthritis Severity with Treatment Outcomes after Imaging-Guided Knee Injections: A Prospective Outcomes Study. Fortschr Röntgenstr 2018; 190: 134 - 143.
为了能够预测哪些患者更有可能获得积极的治疗结果，本研究的目的是：1. 比较膝关节内注射皮质类固醇后，根据凯尔格伦和劳伦斯（KL）5级和3级膝关节骨关节炎分级系统、国际骨关节炎研究学会（OARSI）分级系统以及实际关节间隙测量得出的结果；2. 比较这些分级系统的可靠性。
117例接受膝关节内皮质类固醇注射患者的膝关节X线片由两名对结果不知情的放射科医生独立评估。评估包括KL5、KL3、OARSI系统以及实际关节间隙宽度。在基线时以及第1天、第1周和第1个月收集疼痛数字评分量表以及患者的整体变化印象。使用卡方检验比较不同骨关节炎等级中“改善”患者的数量。逻辑回归确定哪些结果可预测改善情况。使用Kappa统计量和组内相关系数（ICC）评估一致性。
OARSI分级为2级的患者在所有时间点报告“改善”的比例最高，在第1天具有显著性（p = 0.004）。未发现与KL5、KL3或实际关节间隙测量结果与改善情况有关。OARSI分级为2级的患者在第1天报告改善的可能性高8倍（p = 0.024）。关节间隙测量的可靠性最佳（ICC = 0.812 - 0.882），其次是OARSI。
OARSI关节间隙狭窄2级（狭窄34 - 66%）与第1天更好的结果相关，在第1周和第1个月有相关趋势。OARSI的可靠性优于KL5或KL3系统。
· OARSI对骨关节炎的分级可靠性优于KL3或KL5。· OARSI 2级与更好的治疗结果相关。· KL分级和关节间隙测量均与改善情况无关。
· Miletic I, Agten C, Sutter R等。影像学引导下膝关节注射后影像学骨关节炎严重程度与治疗结果的关系：一项前瞻性结果研究。Fortschr Röntgenstr 2018; 190: 134 - 143。
