Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia.
Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney, Australia.
BMC Musculoskelet Disord. 2019 May 17;20(1):220. doi: 10.1186/s12891-019-2610-4.
Thumb-base osteoarthritis (OA) is a common cause of pain and disability This study aimed to investigate the associations of musculoskeletal ultrasound OA pathologies with the extent of pain, function, radiographic scores, and muscle strength in symptomatic thumb-base osteoarthritis.
This is a cross-sectional study of an ongoing clinical trial with eligibility criteria including thumb-base pain on Visual Analogue Scale (VAS) ≥40 (0 to 100 mm), Functional Index for Hand OA (FIHOA) ≥ 6 (0 to 30) and Kellgren Lawrence (KL) grade ≥ 2. The most symptomatic side was scanned to measure synovitis and osteophyte severity using a 0-3 semi-quantitative score, power Doppler and erosion in binary score. A linear regression model was used for associations of ultrasound findings with VAS pain, FIHOA and hand grip and pinch strength tests after adjusting for age, gender, body mass index, disease duration and KL grade as appropriate. For correlation of ultrasound features with KL grade, OARSI ((Osteoarthritis Research Society International) osteophyte and JSN scores, Eaton grades, Spearman coefficients were calculated, and a significant test defined as a p-value less than 0.05.
The study included 93 participants (mean age of 67.04 years, 78.5% females). Presence of power Doppler has a significant association with VAS pain [adjusted β coefficient = 11.29, P = 0.02] while other ultrasound pathologies revealed no significant associations with all clinical outcomes. In comparison to radiograph, ultrasonographic osteophyte score was significantly associated with KL grade [r = 0.44 (P < 0.001)], OARSI osteophyte grade [r = 0.35 (P = 0.001)], OARSI JSN grade [r = 0.43 (P < 0.001)] and Eaton grade [r = 0.30 (P < 0.01)]. Ultrasonographic erosion was significantly related with radiographic erosion [r = - 0.49 (P = 0.001)].
From a clinical perspective the significant relationship of power Doppler with pain severity in thumb base OA suggests this might be a useful tool in understanding pain aetiology. It is important to recognise that power Doppler activity was only detected in 14% of the study so this might be an important subgroup of persons to monitor more closely.
Registered at Australian New Zealand Clinical Trials Registry (ANZCTR), http://www.anzctr.org.au/ , ACTRN12616000353493.
拇指基部骨关节炎（OA）是疼痛和残疾的常见原因。本研究旨在探讨肌肉骨骼超声 OA 病理学与症状性拇指基部 OA 的疼痛程度、功能、放射评分和肌肉力量之间的关系。
这是一项正在进行的临床试验的横断面研究，纳入标准包括视觉模拟量表（VAS）上的拇指基部疼痛≥40（0 至 100 毫米）、手部骨关节炎功能指数（FIHOA）≥6（0 至 30）和 KL 分级≥2。最痛的一侧用 0-3 半定量评分、功率多普勒和二进制评分的侵蚀来测量滑膜炎和骨赘严重程度。调整年龄、性别、体重指数、疾病持续时间和 KL 分级后，使用线性回归模型评估超声发现与 VAS 疼痛、FIHOA 和手部握力和捏力测试之间的相关性。为了评估超声特征与 KL 分级的相关性，计算了 OARSI（国际骨关节炎研究协会）骨赘和 JSN 评分、Eaton 分级、Spearman 系数，并定义显著检验为 P 值小于 0.05。
本研究纳入了 93 名参与者（平均年龄 67.04 岁，78.5%为女性）。存在功率多普勒与 VAS 疼痛有显著相关性[调整后的β系数=11.29，P=0.02]，而其他超声病理学与所有临床结局均无显著相关性。与 X 线相比，超声骨赘评分与 KL 分级显著相关[r=0.44（P<0.001）]、OARSI 骨赘分级[r=0.35（P=0.001）]、OARSI JSN 分级[r=0.43（P<0.001）]和 Eaton 分级[r=0.30（P<0.01）]。超声侵蚀与放射侵蚀显著相关[r=-0.49（P=0.001）]。
从临床角度来看，拇指基部 OA 中功率多普勒与疼痛严重程度的显著关系表明，这可能是理解疼痛发病机制的有用工具。需要认识到，在研究中仅检测到 14%的功率多普勒活动，因此这可能是一个需要更密切监测的重要亚组人群。
在澳大利亚和新西兰临床试验注册中心（ANZCTR）注册，http://www.anzctr.org.au/ ，ACTRN12616000353493。
