From the Louisiana State University Health Sciences Center.
Ochsner Health Orthopedics Department, New Orleans, LA.
J Clin Rheumatol. 2022 Mar 1;28(2):e359-e362. doi: 10.1097/RHU.0000000000001726.
BACKGROUND/OBJECTIVE: The objective of this study was to identify patient and disease characteristics associated with the symptomatic severity of knee osteoarthritis (OA) at the time of initial knee OA diagnosis by an orthopedist.
This medical records review included patients initially diagnosed with knee OA during 2016 to 2017 by a single orthopedic surgeon in a university-based tertiary care setting. All variables were assessed at first OA diagnosis. Main outcomes were subscales of the Knee Injury and Osteoarthritis Outcome Score-Pain, other Symptoms, knee-related quality of life, and function in daily living. Multivariable regression analyses examined the following predictors of main outcomes: sex, race, age, insurance type, body mass index, Charlson comorbidity index, and radiographic OA severity (Kellgren-Lawrence grade).
Of the 559 patients included in the study, most were African American (52.1%), female (71.7%), and had severe radiographic OA (Kellgren-Lawrence grade, 4; 68.7%). Female sex, African American racial/ethnic group, Medicaid insurance, younger age, and severe radiographic OA were independently statistically significantly associated with worse symptoms, pain, and function (p < 0.05 for all). Body mass index and Charlson comorbidity index were not statistically significant predictors of any outcome.
This study identified disparities in the perception of knee OA problems at initial orthopedist diagnosis based on sex, age, race, insurance, and radiographic OA severity. Because most of these variables are also associated with more rapid progression of OA, identifying their biopsychosocial underpinnings may help determine which interventions are most likely to redress these disparities and delay progression to end-stage knee OA.
背景/目的：本研究的目的是通过骨科医生确定初次膝关节骨关节炎（OA）诊断时与膝关节 OA 症状严重程度相关的患者和疾病特征。
本病历回顾性研究纳入了 2016 年至 2017 年期间由一名骨科医生在大学附属医院进行初次膝关节 OA 诊断的患者。所有变量均在初次 OA 诊断时进行评估。主要结局指标为膝关节损伤和骨关节炎结局评分的疼痛、其他症状、膝关节相关生活质量和日常生活功能子量表。多变量回归分析检查了以下主要结局指标的预测因素：性别、种族、年龄、保险类型、体重指数、Charlson 合并症指数和放射学 OA 严重程度（Kellgren-Lawrence 分级）。
在纳入研究的 559 例患者中，大多数为非裔美国人（52.1%）、女性（71.7%），且放射学 OA 严重（Kellgren-Lawrence 分级，4；68.7%）。女性、非裔美国人种族/民族、医疗补助保险、年龄较小和严重的放射学 OA 与更严重的症状、疼痛和功能独立相关（p<0.05）。体重指数和 Charlson 合并症指数不是任何结局的统计学显著预测因素。
本研究根据性别、年龄、种族、保险和放射学 OA 严重程度，确定了在初次骨科医生诊断时对膝关节 OA 问题的感知存在差异。由于这些变量大多数也与 OA 更快进展相关，因此确定其生物学、心理和社会因素可能有助于确定哪些干预措施最有可能解决这些差异并延迟进展为终末期膝关节 OA。
