Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Arthritis Care Res (Hoboken). 2022 Jul;74(7):1179-1187. doi: 10.1002/acr.24563. Epub 2022 Apr 19.
The Cohort Hip and Cohort Knee (CHECK) is a cohort of middle-aged individuals with hip or knee pain. Radiographs were assigned Kellgren/Lawrence (K/L) scores under different conditions at each follow-up visit for 10 years. We aimed to describe and consolidate each scoring approach, then illustrate implications of their use by comparing baseline K/L scores assigned using 2 of these approaches, and evaluating their respective associations with joint replacement and incident radiographic osteoarthritis (ROA).
We compared baseline K/L scores assigned to hips and knees using 2 scoring approaches: 1) assigned by senior researchers to baseline images alone and 2) assigned by trained readers, with images read paired and in known sequence with up to 10 years of follow-up radiographs (Poisson regression). We evaluated the associations of baseline ROA (any: K/L grade ≥1; established: K/L ≥2) with joint replacement, and of K/L 1 joints with incident established ROA (survival analysis).
Of 1,002 participants (79% women, mean ± SD age 55.9 ± 5.2 years, body mass index 26.2 ± 4.0 kg/m ), the second scoring approach had 2.4 times (95% confidence interval [95% CI] 1.8-3.1 for knees) and 2.9 times (95% CI 2.3-3.7 for hips) higher prevalence of established ROA than the first approach. Established hip ROA had a higher risk of joint replacement using the first approach (hazard ratio [HR] 24.2 [95% CI 15.0-39.8] versus second approach HR 7.7 [95% CI 4.9-12.1]), as did knees (HR 19.3 [95% CI 10.3-36.1] versus second approach HR 4.8 [95% CI 2.4-9.6]). The risk of incident ROA did not differ by approach.
This study demonstrates that evaluating ROA prevalence and predicting outcomes depends on the scoring approach.
Cohort Hip 和 Cohort Knee（CHECK）是一个中年人群队列，有髋部或膝关节疼痛。在每次随访的 10 年内，对每位患者的髋关节和膝关节进行放射学检查，并按照不同条件分配 Kellgren/Lawrence（K/L）评分。我们旨在描述和整合每种评分方法，然后通过比较使用其中两种方法在基线时分配的 K/L 评分，以及评估它们与关节置换和新发放射学骨关节炎（ROA）的相关性，来说明其使用的意义。
我们比较了使用两种评分方法在基线时分配给髋关节和膝关节的 K/L 评分：1）由资深研究人员仅根据基线图像分配，2）由经过培训的读者分配，图像以配对方式读取，并与最多 10 年的随访放射学图像相关联（Poisson 回归）。我们评估了基线 ROA（任何：K/L 分级≥1；确诊：K/L≥2）与关节置换的相关性，以及 K/L 1 关节与新发确诊 ROA 的相关性（生存分析）。
在 1002 名参与者中（79%为女性，平均年龄 55.9±5.2 岁，平均体重指数 26.2±4.0kg/m²），第二种评分方法在膝关节中确诊 ROA 的患病率是第一种评分方法的 2.4 倍（95%置信区间 [95%CI] 1.8-3.1），在髋关节中确诊 ROA 的患病率是第一种评分方法的 2.9 倍（95%CI 2.3-3.7）。使用第一种评分方法，确诊髋关节 ROA 的关节置换风险更高（风险比 [HR] 24.2[95%CI 15.0-39.8]与第二种评分方法 HR 7.7[95%CI 4.9-12.1]），膝关节也是如此（HR 19.3[95%CI 10.3-36.1]与第二种评分方法 HR 4.8[95%CI 2.4-9.6]）。两种评分方法在预测新发 ROA 方面风险无差异。
本研究表明，评估 ROA 患病率和预测结果取决于评分方法。
