Gessl Irina, Vinatzer Anna, Supp Gabriela, Zauner Michael, Durechova Martina, Lechner Lisa, Ritschl Valentin, Smolen Josef, Stamm Tanja, Aletaha Daniel, Mandl Peter
Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria.
Rheumatology (Oxford). 2025 Apr 1;64(4):1775-1782. doi: 10.1093/rheumatology/keae395.
To characterize the frequency and influence of tenosynovitis and tendon damage on pain and hand function using clinical examination and US in hand OA.
We included 86 patients with hand OA and 23 age- and sex-matched control subjects. Extensor and flexor tendons of both hands were assessed by clinical examination and US for tenosynovitis and tendon damage. Conventional radiographs were acquired. Hand function was evaluated by the function subtest of the M-SACRAH (modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands) questionnaire and the Moberg pick-up test. K-means cluster analyses was calculated to assess clusters based on radiographic features and sonographic tendon scores.
US identified the involvement of one or more tendon in 60/86 (69.8%) hand OA patients compared with 2/23 (8.7%) subjects (P < 0.01) in the control group. In the hand OA group, US detected tendon damage more often in flexor tendons compared with extensor tendons (2.1% vs 0.9%, P = 0.03), while tenosynovitis was observed more often in extensor tendons compared with flexor tendons (8% vs 0.6%, P < 0001). The sensitivity and specificity of clinical examination to detect tendon involvement was 81.4% and 34.6%, respectively, on the patient level and 14.5% and 83.8% on the tendon level. The cluster analyses revealed one cluster with more radiographic features of hand OA and more tendon damage while more tenosynovitis was found in cluster 2. M-SACRAH function did not correlate with tendon involvement on US.
This study revealed a high frequency of tendon involvement in hand OA. Tendon involvement on US did not impact hand function or self-reported pain.
通过临床检查和超声检查，描述腱鞘炎和肌腱损伤在手部骨关节炎中发生的频率及其对疼痛和手部功能的影响。
我们纳入了86例手部骨关节炎患者以及23例年龄和性别匹配的对照受试者。通过临床检查和超声评估双手的伸肌腱和屈肌腱是否存在腱鞘炎和肌腱损伤。拍摄传统X线片。采用M-SACRAH（改良的手部慢性类风湿性病变评估和量化评分）问卷的功能子测试和Moberg拾物试验评估手部功能。进行K均值聚类分析，以根据X线特征和超声肌腱评分评估聚类情况。
超声检查发现，60/86（69.8%）的手部骨关节炎患者存在一条或多条肌腱受累，而对照组中这一比例为2/23（8.7%）（P < 0.01）。在手部骨关节炎组中，超声检查发现屈肌腱的损伤比伸肌腱更常见（2.1% 对 0.9%，P = 0.03），而腱鞘炎在伸肌腱中比屈肌腱中更常见（8% 对 0.6%，P < 0.001）。在患者层面，临床检查检测肌腱受累的敏感性和特异性分别为81.4%和34.6%，在肌腱层面分别为14.5%和83.8%。聚类分析显示，一个聚类具有更多手部骨关节炎的X线特征和更多的肌腱损伤，而在聚类2中发现更多的腱鞘炎。M-SACRAH功能与超声检查发现的肌腱受累情况无关。
本研究显示手部骨关节炎患者肌腱受累的频率较高。超声检查发现的肌腱受累对手部功能或自我报告的疼痛没有影响。
