Ledingham J, Regan M, Jones A, Doherty M
Rheumatology Unit, City Hospital, Nottingham.
Ann Rheum Dis. 1995 Jan;54(1):53-8. doi: 10.1136/ard.54.1.53.
To evaluate the prognostic significance of patient characteristics and radiographic features at the knee for outcome of knee osteoarthritis.
This was a prospective observational study of 350 osteoarthritic knees. Clinical and radiographic data were obtained on 188 hospital referred patients (mean age 70, range 34-91 years).
Median duration of follow up was two years (range 1-5 years). The majority of patients (48%) reported deterioration, but 23% experienced improvement in symptoms during the study period. Reported exercise tolerance remained unchanged in the majority (62%) and deteriorated in 35%. Change in at least one individual radiographic feature of osteoarthritis was seen in 252 (72%) knees: increase in joint space narrowing occurred in 52%, osteophyte in 32%, cysts in 19%, sclerosis in 14%, and attrition in 30%. Increase in Kellgren grade occurred in 137 (39%) knees. Knee effusion, osteoarthritis at multiple joint sites, and nodal change associated with change in Kellgren grade (odds ratios 1.03, 2.39, and 1.80; 95% confidence intervals (CI) 1.01 to 1.05, 1.16 to 4.93, and 1.02 to 3.17, respectively); warmth at the knee associated with change in any radiographic feature (odds ratio 2.22; 95% CI 1.19 to 4.14). Development of, or increase in, attrition and joint space narrowing associated with worsening symptoms and function and occurred with increased frequency in knees with effusions, clinical warmth and calcium pyrophosphate crystals in synovial fluid (p < 0.05).
A high rate of change, radiographic more than clinical, was seen in osteoarthritic knees during this study. Poor clinical and radiographic outcome associated with calcium pyrophosphate crystal deposition and clinical inflammation as reflected by knee effusion and warmth.
评估膝关节患者特征及影像学特征对膝骨关节炎预后的意义。
这是一项对350个骨关节炎膝关节的前瞻性观察研究。收集了188例转诊至医院患者（平均年龄70岁，范围34 - 91岁）的临床和影像学数据。
随访时间中位数为两年（范围1 - 5年）。大多数患者（48%）报告病情恶化，但23%的患者在研究期间症状有所改善。大多数患者（62%）报告运动耐量保持不变，35%的患者运动耐量恶化。252个（72%）膝关节出现至少一项骨关节炎个体影像学特征改变：关节间隙变窄增加的占52%，骨赘形成的占32%，囊肿形成的占19%，硬化的占14%，磨损的占30%。137个（39%）膝关节的凯尔格伦分级增加。膝关节积液、多关节部位骨关节炎以及与凯尔格伦分级变化相关的结节改变（优势比分别为1.03、2.39和1.80；95%置信区间分别为1.01至1.05、1.16至4.93和1.02至3.17）；膝关节发热与任何影像学特征改变相关（优势比2.22；95%置信区间1.19至4.14）。磨损和关节间隙变窄的出现或加重与症状和功能恶化相关，且在有积液、临床发热及滑膜液中存在焦磷酸钙晶体的膝关节中出现频率增加（p < 0.05）。
在本研究中，骨关节炎膝关节出现变化的比例较高，影像学变化多于临床变化。临床和影像学预后不良与焦磷酸钙晶体沉积以及膝关节积液和发热所反映的临床炎症相关。
