Cerhan J R, Wallace R B, el-Khoury G Y, Moore T E
Department of Preventive Medicine and Environmental Health, University of Iowa College of Medicine, Iowa City 52242-1008, USA.
J Rheumatol. 1996 Sep;23(9):1565-78.
To describe the association between hormonally related risk factors and the progression to new sites of radiographically defined full body (generalized) osteoarthritis (OA) in a cohort of older women.
A retrospective cohort design was used to study former radium dial painters over the age of 40 years who had minimal radium exposure. At study entry and at varying followup times, clinical examinations were conducted and full body radiographs were taken. Two followup groups were defined: women with a followup radiograph 1-9 years after baseline (n = 75) and 10-19 years after baseline (n = 53). Fifty-five joints (10 joint groups) were independently graded at baseline and followup for OA by the method of Kellgren and Lawrence, and provided the basis for summary full body OA progression scores. Progression was defined as an increase in the number of sites with OA and in separate analyses as an increase in the number of joint groups with OA.
Increasing length of followup and lower baseline OA score were associated with greater OA progression, while age at baseline examination showed no clear relation to progression. Beyond these variables, increasing height and having ever smoked were inversely associated with OA progression, while body mass index (BMI) showed a weak positive association. In multivariable modeling for followup 1-9 years, only lower baseline OA score predicted greater OA progression to new sites (partial r2 = 0.13, p = 0.0009). In followup 10-19 years, baseline OA score (partial r2 = 0.12, p = 0.0011), height (partial r2 = 0.057, p = 0.033), and smoking status (partial r2 = 0.09, p = 0.035) were independent predictors of OA progression to new sites, while greater BMI was a positive, weak, and nonsignificant predictor (partial r2 = 0.031, p = 0.29). History of prior cholecystectomy, hysterectomy, dilation and curetage, number of pregnancies, and change in BMI were not significantly related to progression of OA to new sites. Similar results were found for predictors of OA progression to new joint groups.
Lower baseline level of OA is associated with greater OA progression to new sites or joint groups independent of age, suggesting a "burnout" phenomenon. In addition, shorter height and having never smoked appear to be independent risk factors that predict the progression of radiographic OA to new sites or joint groups.
描述一组老年女性中与激素相关的危险因素与影像学定义的全身（广泛性）骨关节炎（OA）新发病部位进展之间的关联。
采用回顾性队列设计，研究年龄40岁以上、镭暴露极少的 former radium dial painters。在研究开始时以及不同的随访时间进行临床检查并拍摄全身X光片。定义了两个随访组：基线后1 - 9年有随访X光片的女性（n = 75）和基线后10 - 19年有随访X光片的女性（n = 53）。采用Kellgren和Lawrence方法在基线和随访时对55个关节（10个关节组）进行独立的OA分级，并为全身OA进展总分提供依据。进展定义为OA发病部位数量增加，在单独分析中定义为OA关节组数量增加。
随访时间延长和基线OA评分较低与OA进展较大相关，而基线检查时的年龄与进展无明显关系。除这些变量外，身高增加和曾经吸烟与OA进展呈负相关，而体重指数（BMI）呈弱正相关。在1 - 9年随访的多变量模型中，只有较低的基线OA评分预测OA向新部位进展更大（偏r² = 0.13，p = 0.0009）。在10 - 19年随访中，基线OA评分（偏r² = 0.12，p = 0.0011）、身高（偏r² = 0.057，p = 0.033）和吸烟状况（偏r² = 0.09，p = 0.035）是OA向新部位进展的独立预测因素，而较高的BMI是一个正向、微弱且无显著意义的预测因素（偏r² = 0.031，p = 0.29）。既往胆囊切除术、子宫切除术、刮宫术病史、妊娠次数以及BMI变化与OA向新部位进展无显著关系。在OA进展到新关节组的预测因素方面也发现了类似结果。
较低的基线OA水平与OA向新部位或关节组的更大进展相关，与年龄无关，提示存在“倦怠”现象。此外，较矮的身高和从不吸烟似乎是预测影像学OA向新部位或关节组进展的独立危险因素。
