Cooper C, Egger P, Coggon D, Hart D J, Masud T, Cicuttini F, Doyle D V, Spector T D
MRC Environmental Epidemiology Unit, University of Southampton, Southampton General Hospital, UK.
J Rheumatol. 1996 Nov;23(11):1938-42.
To ascertain whether clustering between joint sites in osteoarthritis (OA) is more common than would be expected simply from the rising prevalence of the disorder with age, and to explore a definition of generalized OA (GOA) by determining the pattern of joint group involvement, in a population sample of peri and postmenopausal women.
Radiographs of the hands, knees, and hips were obtained in a population sample of 702 women aged 45 to 64 years. Distal interphalangeal, proximal interphalangeal, carpometacarpal, knee, and hip OA were assessed using the Kellgren-Lawrence grading system. Logistic regression was used to test for overall clustering of OA between joint sites, and log linear models were used to study the patterns of association between different sites.
Multiple involvement of the 5 joint groups studied occurred significantly more frequently than could be expected by chance alone (chi 2 = 52.3, df = 5, p < 0.001), and this clustering remained significant after age adjustment (chi 2 = 26.1, df = 5, p < 0.001). Thresholds could be defined for the number of involved joint groups that distinguished a polyarticular subset of OA. These thresholds varied with age and the radiographic cutoff at which OA was assigned. Thus, for grade 2+ disease, GOA could be defined by involvement of 2 or more joint groups at age 45-47 years, but required involvement of all 5 joint groups at age 60-64 years. Symmetry within joint groups was the most pronounced feature in the pattern of joint involvement in the sample as a whole, with associations between different joint groups being substantially weaker than those for symmetrical bilateral involvement of a particular joint.
There is a clear tendency towards polyarticular OA among women aged 45-64 years. However, there is no single threshold number of joint sites that can be used to define GOA. The pattern of joint involvement in OA is primarily symmetrical, and this pattern strongly suggests a systemic etiology in this subset of postmenopausal women.
在围绝经期和绝经后女性人群样本中，确定骨关节炎（OA）关节部位之间的聚集是否比仅因该疾病随年龄增长而上升的患病率所预期的更为常见，并通过确定关节组受累模式来探索全身性OA（GOA）的定义。
对702名年龄在45至64岁的女性人群样本进行了手部、膝盖和髋部的X线片检查。使用Kellgren-Lawrence分级系统评估远端指间关节、近端指间关节、腕掌关节、膝关节和髋关节OA。采用逻辑回归检验OA在关节部位之间的总体聚集情况，并使用对数线性模型研究不同部位之间的关联模式。
所研究的5个关节组的多处受累发生频率显著高于仅靠随机因素所预期的频率（χ2 = 52.3，自由度 = 5，p < 0.001），并且在年龄调整后这种聚集仍然显著（χ2 = 26.1，自由度 = 5，p < 0.001）。可以为区分OA多关节亚组的受累关节组数量定义阈值。这些阈值随年龄以及指定OA的X线片截断值而变化。因此，对于2级及以上疾病，GOA在45 - 47岁时可定义为2个或更多关节组受累，但在60 - 64岁时则需要所有5个关节组受累。在整个样本的关节受累模式中，关节组内的对称性是最显著的特征，不同关节组之间的关联明显弱于特定关节双侧对称受累的关联。
45 - 64岁女性中存在明显的多关节OA倾向。然而，没有单一的关节部位阈值可用于定义GOA。OA的关节受累模式主要是对称的，这种模式强烈提示在这一绝经后女性亚组中存在全身性病因。
