Duke University School of Medicine, Durham, North Carolina.
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Arthritis Rheumatol. 2018 Jan;70(1):80-87. doi: 10.1002/art.40348. Epub 2017 Dec 15.
To evaluate radiographic subchondral trabecular bone texture (TBT) as a predictor of clinically relevant osteoarthritis (OA) progression (combination of symptom and structural worsening).
The Foundation for the National Institutes of Health (FNIH) OA Biomarkers Consortium undertook a study of progressive knee OA cases (n = 194 knees with both radiographic and pain progression over 24-48 months) and comparators (n = 406 OA knees not meeting the case definition). TBT parameters were extracted from a medial subchondral tibial region of interest by fractal signature analysis of radiographs using validated semiautomated software. Baseline TBT and time-integrated values over 12 and 24 months were evaluated for association with case status and separately with radiographic and pain progression status, adjusted for age, sex, body mass index, race, baseline Kellgren/Lawrence grade, baseline joint space width, Western Ontario and McMaster Universities Osteoarthritis Index pain score, and pain medication use. C statistics were generated from receiver operating characteristic curves.
Relative to comparators, cases were characterized by thinner vertical and thicker horizontal trabeculae. The summed composite of 3 TBT parameters at baseline and over 12 and 24 months best predicted case status (odds ratios 1.24-1.43). The C statistic for predicting case status using the TBT composite score (0.633-0.649) was improved modestly but statistically significantly over the use of covariates alone (0.608). One TBT parameter, reflecting thickened horizontal trabeculae in cases, at baseline and over 12 and 24 months, predicted risk of any progression (radiographic and/or pain progression).
Although associations are modest, TBT could be an attractive means of enriching OA trials for progressors since it can be generated from screening knee radiographs already standard in knee OA clinical trials.
评估软骨下骨小梁的放射学骨纹理（TBT）作为临床相关骨关节炎（OA）进展（症状和结构恶化的组合）的预测因子。
美国国立卫生研究院基金会（FNIH）OA 生物标志物联盟对进行了一项进展性膝 OA 病例（24-48 个月时既有放射学又有疼痛进展的 194 个膝关节）和对照组（不符合病例定义的 406 个 OA 膝关节）的研究。使用经过验证的半自动软件，通过对 X 线片的分形特征分析，从内侧软骨下胫骨感兴趣区提取 TBT 参数。评估基线 TBT 以及 12 个月和 24 个月的时间积分值与病例状态的关系，并分别与放射学和疼痛进展状态相关，同时调整年龄、性别、体重指数、种族、基线 Kellgren/Lawrence 分级、基线关节间隙宽度、西安大略和麦克马斯特大学骨关节炎指数疼痛评分以及疼痛药物使用情况。来自接收器操作特性曲线的 C 统计量。
与对照组相比，病例的垂直骨小梁较薄，水平骨小梁较厚。基线和 12 个月和 24 个月时 3 个 TBT 参数的总和最佳预测了病例状态（优势比 1.24-1.43）。使用 TBT 综合评分预测病例状态的 C 统计量（0.633-0.649）略高于单独使用协变量（0.608）。基线和 12 个月和 24 个月时，反映病例中水平骨小梁增厚的 1 个 TBT 参数预测了任何进展（放射学和/或疼痛进展）的风险。
尽管关联程度较小，但 TBT 可能是一种有吸引力的 OA 试验富集方法，因为它可以从已经在膝骨关节炎临床试验中标准的筛选膝关节 X 线片中生成。
