Buckland-Wright J C, MacFarlane D G, Lynch J A, Jasani M K
Division of Anatomy and Cell Biology, UMDS Guy's Hospital, London, UK.
J Rheumatol. 1995 May;22(5):937-43.
To assess the usefulness of, and define the time course of changes in the features of osteoarthritic (OA) knees measurable using microfocal radiography, and to determine whether it differs in patients taking a nonsteroidal antiinflammatory drug (NSAID).
Forty-five patients with knee OA were randomly allocated to receive either diclofenac sodium or placebo for 18 months; 33 (17 NSAID, 16 placebo) completed the study. Clinical and 5 x high definition macroradiographic assessments of both knees in standing semiflexed views were carried out at 6-monthly intervals. Precise measurements were taken of the tibial and femoral subchondral thickness and osteophyte size, and of joint space width (JSW) across the narrowest part of the medial and lateral tibiofemoral compartments.
In all knees as a group, there was no statistically significant difference in JSW between treatment groups. However, changes in JSW were significantly different (p < 0.04, multivariate analysis of variance) between treatments in 51 knees with early disease, i.e., those with initially > 50% JSW (22 active, 29 placebo), but not in 15 knees with severe disease, i.e., initially < 50% JSW (10 active, 5 placebo). During the study, osteophyte size in all knees and in those with > 50% JSW increased significantly (p < 0.016; p < 0.008) in the placebo group but remained unchanged in the treatment group. No significant changes were detected in subchondral cortical thickness.
Using microfocal radiography the time course of changes in JSW and osteophyte size of knees with early, but not late OA, was found to differ in both pattern and magnitude in patients receiving NSAID: In knees with late stage OA the JSW progressively decreased irrespective of treatment. The observations may prove useful for the design of future therapeutic trials.
评估使用微焦点射线照相术测量骨关节炎（OA）膝关节特征的有用性，并确定其变化的时间进程，同时确定服用非甾体抗炎药（NSAID）的患者是否存在差异。
45例膝关节OA患者被随机分配接受双氯芬酸钠或安慰剂治疗18个月；33例（17例服用NSAID，16例服用安慰剂）完成了研究。每隔6个月对站立半屈曲位的双膝进行临床和5倍高清大剂量射线照相评估。精确测量胫骨和股骨软骨下厚度、骨赘大小以及内侧和外侧胫股关节间隙最窄处的关节间隙宽度（JSW）。
作为一个整体，所有膝关节中，治疗组之间的JSW没有统计学上的显著差异。然而，在51例早期疾病膝关节（即初始JSW>50%的患者，22例服用活性药物，29例服用安慰剂）中，治疗组之间JSW的变化存在显著差异（p<0.04，多变量方差分析），但在15例严重疾病膝关节（即初始JSW<50%的患者，10例服用活性药物，5例服用安慰剂）中没有差异。在研究期间，安慰剂组中所有膝关节以及JSW>50%的膝关节的骨赘大小显著增加（p<0.016；p<0.008），而治疗组中保持不变。软骨下皮质厚度未检测到显著变化。
使用微焦点射线照相术发现，早期而非晚期OA膝关节的JSW和骨赘大小变化的时间进程在接受NSAID治疗的患者中，在模式和程度上均存在差异：在晚期OA膝关节中，无论治疗如何，JSW都会逐渐降低。这些观察结果可能对未来治疗试验的设计有用。
