Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium.
Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium.
Arthritis Res Ther. 2021 Jan 6;23(1):12. doi: 10.1186/s13075-020-02390-x.
This study measured the magnitude and determinants of clinical and radiological progression in patients with hand osteoarthritis (HOA) over a 2-year prospective follow-up to gain a greater understanding of the disease time course.
Two hundred three consecutive outpatients diagnosed with HOA were followed for 2 years (183 women, median age 69 years). Pain and function were evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and clinical examination recorded the number of painful/swollen joints and nodes. X-rays were scored using Kellgren-Lawrence (KL) and Verbruggen-Veys scales. Clinical progression was defined as deterioration in AUSCAN ≥ the minimal clinically important difference. Radiographic progression was defined as (a) one new erosive/remodeled joint, (b) progression of ≥ one anatomical stage in one joint, or (c) change in KL total score above the smallest detectable difference. Logistic regression was performed to determine whether patient characteristics influenced clinical and radiological progression.
After 2 years, all radiographic scores deteriorated significantly in the study population (p < 0.05), and the number of proximal and distal interphalangeal nodes was significantly higher (p < 0.01). The AUSCAN, number of painful joints at rest or at pressure, number of swollen joints, and pain measure on a visual analog scale remained unchanged. At the individual level, the number of patients with clinically meaningful progression ranged from 25 to 42% (clinical progression) and from 22 to 76% (radiological progression). The only significant predictor of worsening of total AUSCAN was AUSCAN pain subscale < 74.5 (odds ratio [OR] 1.02 [1.01, 1.03]; p < 0.01). The presence of ≥ four swollen joints (OR 2.78 [1.21, 6.39]; p = 0.02) and erosive osteoarthritis (OR 13.23 [5.07, 34.56]; p < 0.01) at baseline predicted a new erosive joint. A meaningful change in KL was more frequent with painful joints at baseline (OR 3.43 [1.68, 7.01]; p < 0.01).
Evidence of radiological progression over 2 years was observed in patients with HOA in the LIHOC population even without clinical worsening of disease. For individual patients, baseline pain level is predictive for clinical progression and the presence of erosive or swollen joints are significant predictors of radiological progression.
本研究通过对 203 例手部骨关节炎（HOA）患者进行为期 2 年的前瞻性随访，测量其临床和影像学进展的程度和决定因素，以更好地了解疾病的病程。
连续招募了 203 名被诊断为手部骨关节炎的门诊患者，随访 2 年（183 名女性，中位年龄 69 岁）。采用澳大利亚/加拿大骨关节炎手部指数（AUSCAN）评估疼痛和功能，临床检查记录疼痛/肿胀关节和结节的数量。X 射线采用 Kellgren-Lawrence（KL）和 Verbruggen-Veys 评分进行评分。临床进展定义为 AUSCAN 恶化≥最小临床重要差异。放射学进展定义为：（a）出现一个新的侵蚀/重塑关节；（b）一个关节的解剖学阶段进展≥一个阶段；（c）KL 总评分的变化超过最小可检测差异。采用逻辑回归确定患者特征是否影响临床和放射学进展。
2 年后，研究人群的所有放射学评分均显著恶化（p<0.05），且近端和远端指间关节的结节数量显著增加（p<0.01）。AUSCAN、休息时或受压时疼痛关节的数量、肿胀关节的数量以及视觉模拟量表上的疼痛测量值保持不变。在个体水平上，临床有意义进展的患者比例为 25%至 42%（临床进展）和 22%至 76%（放射学进展）。AUSCAN 疼痛子量表<74.5 是总 AUSCAN 恶化的唯一显著预测因素（比值比[OR]1.02[1.01, 1.03]；p<0.01）。基线时存在≥4 个肿胀关节（OR 2.78[1.21, 6.39]；p=0.02）和侵蚀性骨关节炎（OR 13.23[5.07, 34.56]；p<0.01）是出现新侵蚀性关节的预测因素。基线时疼痛关节存在与 KL 有意义变化更频繁相关（OR 3.43[1.68, 7.01]；p<0.01）。
即使手部骨关节炎患者的疾病没有临床恶化，LIHOC 人群在 2 年内仍可观察到放射学进展的证据。对于个体患者，基线疼痛水平是临床进展的预测因素，侵蚀性或肿胀关节的存在是放射学进展的显著预测因素。
