Drummen S J J, Runhaar J, Bierma-Zeinstra S M, Aitken D, Jones G, Otahal P, Grønne D T, Roos E M, Skou S T
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Osteoarthritis Cartilage. 2025 Mar;33(3):364-372. doi: 10.1016/j.joca.2024.11.007. Epub 2024 Nov 29.
Compare prevalence and changes in outcomes among established and early-stage knee osteoarthritis (KOA) patients undertaking supervised exercise and education.
Patients from Good Life with osteoArthritis in Denmark (GLA:D®) were stratified into three groups: established KOA (ACR/EULAR criteria), early-stage KOA (diagnostic-model-outcome ≥70%, Criteria for the Early Diagnosis of knee Osteoarthritis) or potential early-stage KOA (diagnostic-model-outcome 30-69%). Mixed-effects models and the proportion of patients by group achieving minimal clinically important improvements (MCIIs) were used to investigate changes in VAS pain intensity (0-100mm), Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL; 0-100), 40 m Walk test and 30 s chair-stand test at 3 and 12 months.
Compared to established KOA (61% of 10,365 patients), early-stage KOA (27%) had similar knee pain at baseline (mean (standard deviation); 51 (22) vs 45 (22)), and improvement in pain (mean (95% confidence interval) -15 (-15 to -14) vs -14 (-15 to -13), ≥MCII: 55% vs 54%) and KOOS QoL (≥MCII: 50% vs 50%) at 12 months, and in walking speed (≥MCII: 56% vs 52%) and chair-stands (≥MCII: 55% vs 52%) at 3 months. Compared to either group, potential early-stage KOA (10%) had lower baseline pain (34 (32.7)) and less improvement in pain (-9.8 (-11.3 to -8.2; ≥MCII: 47%)), but comparable improvements in KOOS QoL (≥MCII: 50%), walking speed (≥MCII: 51%) and chair-stands (≥MCII: 51%).
Patients with early-stage KOA achieved comparable improvements at 3 and 12 months to those with established KOA, supporting supervised exercise and education as a viable management strategy for early-stage KOA.
比较接受监督性运动和教育的晚期和早期膝关节骨关节炎（KOA）患者的患病率及预后变化。
来自丹麦骨关节炎美好生活（GLA:D®）项目的患者被分为三组：晚期KOA（采用美国风湿病学会/欧洲抗风湿病联盟标准）、早期KOA（诊断模型结果≥70%，膝关节骨关节炎早期诊断标准）或潜在早期KOA（诊断模型结果为30 - 69%）。采用混合效应模型和达到最小临床重要改善（MCII）的各组患者比例，来研究3个月和12个月时视觉模拟评分（VAS）疼痛强度（0 - 100mm）、膝关节损伤和骨关节炎转归评分（KOOS）生活质量（QoL；0 - 100）、40米步行试验和30秒坐立试验的变化。
与晚期KOA（10365例患者中的61%）相比，早期KOA（27%）在基线时膝关节疼痛程度相似（均值（标准差）；51（22）对45（22）），且在12个月时疼痛改善情况（均值（95%置信区间）-15（-15至-14）对-14（-15至-13），≥MCII：55%对54%）和KOOS生活质量（≥MCII：50%对50%），以及在3个月时步行速度（≥MCII：56%对52%）和坐立试验（≥MCII：55%对52%）方面相当。与上述两组相比，潜在早期KOA（10%）基线疼痛较低（34（32.7）），疼痛改善较少（-9.8（-11.3至-8.2；≥MCII：47%）），但在KOOS生活质量（≥MCII：50%）、步行速度（≥MCII：51%）和坐立试验（≥MCII：51%）方面改善相当。
早期KOA患者在3个月和12个月时取得了与晚期KOA患者相当的改善，支持将监督性运动和教育作为早期KOA的一种可行管理策略。
