Karande Shilpa P, Kini Seema
Associate Professor, Department of Medicine, T.N. Medical College and Nair Hospital, Mumbai,Maharashtra.
Associate Professor, Department of Medicine, T.N. Medical College and Nair Hospital, Mumbai,Maharashtra;Corresponding Author.
J Assoc Physicians India. 2018 Jul;66(7):37-39.
Osteoarthritis (OA) is a slowly progressive degenerative joint disease, characterized by pain and functional disability. Various outcome measures for radiographic and clinical OA are described in studies. A limitation of radiographic evaluation is that, except for the direct evaluation of bone, the tissues involved in the OA process are either evaluated indirectly (cartilage) or not at all (synovium). In evaluation of clinical OA, the scores for pain, stiffness and function are commonly used outcome measures. The objective of this study was to co-relate the clinical status with activity and radiological score in osteoarthritis of various joints.
A Cross-sectional study was conducted including 100 consecutive patients of osteoarthritis of various joints. A thorough clinical examination of affected joint was performed and relevant laboratory investigations and radiology of the affected joint was done in all patients. Grading of severity of osteoarthritis was assessed by following clinical indices: Knee/ Hip by Lequesne, Articular Index of Doyle for osteoarthritis and modified WOMAC index - KGMC index. Radiological indices used were: Kellgren and Lawrence global grading scheme for the severity of osteoarthritis of the knee, hip, lumbar disc degeneration and apophyseal joints of the cervical spine, Kallman grading scale for individual features of the hand and Individual radiographic features assessed in radiographs of the hip and lumbar spine.
Knee joint was commonly involved (89%), followed by lumbar spine (49%). Knee joint tenderness was significantly co-relating with KGMC and radiological index. Lequesne and KGMC Indian index were co-relating positively with each other for knee joint. All clinical indices showed significant co-relation with radiological indices for knee joint. Clinical and radiological indices were also co-relating positively in cervical and lumbar spine. Visual analogue scale (VAS) co-related significantly with Lequesne and Indian KGMC index with respect to knee joint, but showed no co-relation with Doyle index. Also for hands, cervical and lumbar spine VAS and clinical indices did not co-relate.
KGMC index is best applicable to assess the osteoarthritis knee joint. Radiological progression in OA co-relates well with all clinical indices including KGMC index. This study highlights the usefulness of visual analogue scale and various radiological and clinical indices to assess osteoarthritis especially for knee joint.
骨关节炎（OA）是一种缓慢进展的退行性关节疾病，其特征为疼痛和功能障碍。研究中描述了多种用于评估影像学和临床骨关节炎的结果指标。影像学评估的一个局限性在于，除了对骨骼的直接评估外，参与骨关节炎进程的组织要么通过间接方式评估（软骨），要么根本未被评估（滑膜）。在临床骨关节炎评估中，疼痛、僵硬和功能评分是常用的结果指标。本研究的目的是将各种关节骨关节炎的临床状况与活动度及放射学评分进行相关性分析。
进行了一项横断面研究，纳入了100例连续的各种关节骨关节炎患者。对所有患者的患关节进行了全面的临床检查，并进行了相关实验室检查及患关节的放射学检查。通过以下临床指标评估骨关节炎的严重程度分级：膝关节/髋关节采用勒凯斯内评分法、多伊尔骨关节炎关节指数以及改良的WOMAC指数 - KGMC指数。使用的放射学指标包括：膝关节、髋关节、腰椎间盘退变及颈椎小关节骨关节炎严重程度的凯尔格伦和劳伦斯全球分级方案、手部个体特征的卡尔曼分级量表以及在髋关节和腰椎X线片上评估的个体放射学特征。
膝关节最常受累（89%），其次是腰椎（49%）。膝关节压痛与KGMC及放射学指数显著相关。膝关节的勒凯斯内指数和KGMC印度指数呈正相关。所有临床指标与膝关节的放射学指标均显示出显著相关性。颈椎和腰椎的临床指标与放射学指标也呈正相关。视觉模拟评分（VAS）与膝关节的勒凯斯内指数和印度KGMC指数显著相关，但与多伊尔指数无相关性。同样，手部、颈椎和腰椎的VAS与临床指标也无相关性。
KGMC指数最适用于评估膝关节骨关节炎。骨关节炎的放射学进展与包括KGMC指数在内的所有临床指标均有良好的相关性。本研究强调了视觉模拟评分以及各种放射学和临床指标在评估骨关节炎尤其是膝关节骨关节炎方面的有用性。
