髋部积液-滑膜炎的量化及其与髋部疼痛、MRI表现和早期髋关节放射学骨关节炎的横断面和纵向关联。

Quantification of hip effusion-synovitis and its cross-sectional and longitudinal associations with hip pain, MRI findings and early radiographic hip OA.

作者信息

Ahedi Harbeer, Aitken Dawn, Blizzard Leigh, Cicuttini Flavia, Jones Graeme

机构信息

Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.

Institute of Musculoskeletal Health, Sydney, NSW, Australia.

出版信息

BMC Musculoskelet Disord. 2020 Aug 10;21(1):533. doi: 10.1186/s12891-020-03532-7.

DOI:10.1186/s12891-020-03532-7

PMID:32778082

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7419183/

Abstract

BACKGROUND

Hip effusion-synovitis may be relevant to osteoarthritis (OA) but is of uncertain etiology. The aim of this study was to describe the cross-sectional and longitudinal associations of hip effusion-synovitis with clinical and structural risk factors of OA in older adults.

METHODS

One hundred ninety-six subjects from the Tasmanian Older Adult Cohort (TASOAC) study with a right hip STIR (Short T1 Inversion Recovery) Magnetic Resonance Imaging (MRI) on two occasions were included. Hip effusion-synovitis CSA (cm) was assessed quantitatively. Hip pain was determined by WOMAC (Western Ontario and McMaster Universities Osteoarthritis) while hip bone marrow lesions (BMLs), cartilage defects (femoral and/or acetabular) and high cartilage signal were assessed on MRI. Joint space narrowing (0-3) and osteophytes (0-3) were measured on x-ray using Altman's atlas.

RESULTS

Of 196 subjects, 32% (n = 63) had no or a small hip effusion-synovitis while 68% (n = 133) subjects had a moderate or large hip effusion-synovitis. Both groups were similar but those with moderate or large hip effusion-synovitis were older, had higher BMI and more hip pain. Cross-sectionally, hip effusion-synovitis at multiple sites was associated with presence of hip pain [Prevalence ratio (PR):1.42 95%CI:1.05,1.93], but not with severity of hip pain. Furthermore, hip effusion-synovitis size associated with femoral defect (βeta:0.32 95%CI:0.08,0.56). Longitudinally, and incident hip cartilage defect (PR: 2.23 95%CI:1.00, 4.97) were associated with an increase in hip effusion-synovitis CSA. Furthermore, independent of presence of effusion-synovitis, hip BMLs predicted incident (PR: 1.62 95%CI: 1.13, 2.34) and worsening of hip cartilage defects (PR: 1.50 95%CI: 1.20, 1.86). While hip cartilage defect predicted incident (PR: 1.11 95%CI: 1.03, 1.20) and worsening hip BMLs (PR: 1.16 95%CI: 1.04, 1.30).

CONCLUSIONS

Hip effusion-synovitis at multiple sites (presumably reflecting extent) may be associated with hip pain. Hip BMLs and hip cartilage defects are co-dependent and predict worsening hip effusion-synovitis, indicating causal pathways between defects, BMLs and effusion-synovitis.

摘要

背景

髋关节积液 - 滑膜炎可能与骨关节炎（OA）相关，但其病因尚不确定。本研究的目的是描述老年人髋关节积液 - 滑膜炎与OA临床及结构危险因素之间的横断面和纵向关联。

方法

纳入了196名来自塔斯马尼亚老年队列（TASOAC）研究的受试者，他们接受了两次右侧髋关节短T1反转恢复（STIR）磁共振成像（MRI）检查。定量评估髋关节积液 - 滑膜炎的CSA（平方厘米）。通过西部安大略和麦克马斯特大学骨关节炎指数（WOMAC）确定髋关节疼痛，同时在MRI上评估髋关节骨髓病变（BMLs）、软骨缺损（股骨和/或髋臼）以及软骨高信号。使用阿尔特曼图谱在X射线上测量关节间隙狭窄（0 - 3级）和骨赘（0 - 3级）。

结果

在196名受试者中，32%（n = 63）没有或仅有少量髋关节积液 - 滑膜炎，而68%（n = 133）的受试者有中度或大量髋关节积液 - 滑膜炎。两组情况相似，但有中度或大量髋关节积液 - 滑膜炎的受试者年龄更大、体重指数更高且髋关节疼痛更严重。横断面分析显示，多个部位的髋关节积液 - 滑膜炎与髋关节疼痛的存在相关[患病率比（PR）：1.42，95%置信区间：1.05，1.93]，但与髋关节疼痛的严重程度无关。此外，髋关节积液 - 滑膜炎的大小与股骨缺损相关（β系数：0.32，95%置信区间：0.08，0.56）。纵向分析表明，新发的髋关节软骨缺损（PR：2.23，95%置信区间：1.00，4.97）与髋关节积液 - 滑膜炎CSA的增加相关。此外，独立于积液 - 滑膜炎的存在，髋关节BMLs可预测新发（PR：1.62，95%置信区间：1.13，2.34）及髋关节软骨缺损的恶化（PR：1.50，95%置信区间：1.20，1.86）。而髋关节软骨缺损可预测新发（PR：1.11，95%置信区间：1.03，1.20）及髋关节BMLs的恶化（PR：1.16，95%置信区间：1.04，1.30）。