Section of Rheumatology, Boston University School of Medicine, 650 Albany St. Suite 200, Boston, MA, 02118, USA.
Skeletal Radiol. 2023 Nov;52(11):2007-2010. doi: 10.1007/s00256-023-04285-9. Epub 2023 Feb 2.
Knee osteoarthritis (OA) is a highly prevalent and disabling disease. Most persons age 45 and over with chronic knee pain have OA and with characteristic history and physical findings, diagnostic imaging is usually not necessary. Further, treatment of chronic knee pain with or without evidence of OA is similar, so imaging does not usually alter therapy. The exception is atypical presentations, such as sudden onset of pain perhaps after trauma or evidence of arthritis in atypical locations elsewhere in the body. Imaging is also unnecessary to follow patients. Given the absence of treatments that slow progression, there is little rationale for acquiring repeated imaging. However, ultrasound or other knee imaging may be helpful in locating the joint when carrying out intraarticular corticosteroid injections. There is controversy as to whether imaging should be acquired before these injections, but recent studies suggest no increased risk of disease progression for most persons receiving these injections. While guidelines currently discourage imaging in the diagnosis or management of most persons with OA, this may change for individuals with identifiable correctible lesions, when effective treatments that alter progression emerge or when imaging is used to identify subtypes of disease that may respond to specific treatments.
膝关节骨关节炎（OA）是一种高发且致残的疾病。大多数年龄在 45 岁及以上、有慢性膝关节疼痛的患者都患有 OA，且具有典型的病史和体格检查结果，通常不需要进行诊断性影像学检查。此外，无论是否存在 OA 的证据，慢性膝关节疼痛的治疗方法都相似，因此影像学检查通常不会改变治疗方法。例外情况是不典型表现，例如疼痛突然发作，可能是在创伤后，或身体其他部位出现不典型的关节炎表现。对患者进行随访也不需要进行影像学检查。鉴于目前尚无减缓疾病进展的治疗方法，因此没有理由反复进行影像学检查。然而，在进行关节内皮质类固醇注射时，超声或其他膝关节影像学检查可能有助于确定关节位置。关于是否应该在这些注射之前进行影像学检查存在争议，但最近的研究表明，对于大多数接受这些注射的患者，疾病进展的风险并没有增加。虽然目前的指南不鼓励在大多数 OA 患者的诊断或管理中进行影像学检查，但对于能够识别出可纠正病变的个体、出现可改变进展的有效治疗方法或影像学用于识别可能对特定治疗方法有反应的疾病亚型时，这种情况可能会发生改变。
