Lanyon P, O'Reilly S, Jones A, Doherty M
Rheumatology Unit, City Hospital, Nottingham.
Ann Rheum Dis. 1998 Oct;57(10):595-601. doi: 10.1136/ard.57.10.595.
To evaluate radiographic features of osteoarthritis (OA) to determine which is more closely associated with knee pain and hence might be used as a radiographic definition of OA in the community. To evaluate joint space width in normal subjects.
452 subjects from a case-control community study of knee pain (294 women, 158 men, mean age 62 years, range 40-80) underwent AP standing and midflexion skyline radiographs. Joint space width, measured by metered calliper to 0.1 mm, and graded individual features of OA (osteophyte 0-3, narrowing 0-3, sclerosis 0-1, cysts 0-1) were assessed in all three compartments independently by two observers who were blind to clinical status. Subjects were categorised as having knee pain by a positive response to both parts of the question "Have you ever had pain in or around the knee on most days for at least a month? If so, have you experienced any pain during the last year?"
Intraobserver reproducibility for joint space width measurements was to within +/- 0.4 mm (95% CI for limits of agreement); kappa values for grading were > 0.7. One hundred and twenty five subjects were without knee pain or osteophyte. In these radiographically normal knees, mean joint space width varied according to sex but did not decrease with age. A definition based on the presence of osteophyte > or = grade 1 in any compartment was more efficient at predicting pain than definitions based on either measurement or grading of joint space; there was no clear threshold of joint space loss at which the likelihood of pain substantially increased. The presence of osteophyte at the patellofemoral joint (PFJ) was more sensitive but less specific than at the tibiofemoral joint (TFJ); the addition of PFJ assessment improved sensitivity from 38.1% to 62.3% with a reduction in specificity from 82.7% to 58.7% for the presence of knee pain.
Among men and women in the community, osteophyte is the radiographic feature that associates best with knee pain. Radiographic assessment of both TFJ and PFJ should be included in all community studies. Joint space loss is not a feature of asymptomatic aging, and there is not a biological cut off for joint space width below which the likelihood of knee pain markedly increases.
评估骨关节炎（OA）的影像学特征，以确定哪种特征与膝关节疼痛的关联更为密切，从而可作为社区中OA的影像学定义。评估正常受试者的关节间隙宽度。
452名来自膝关节疼痛病例对照社区研究的受试者（294名女性，158名男性，平均年龄62岁，范围40 - 80岁）接受了站立位前后位和屈膝侧位X线片检查。由两名对临床状况不知情的观察者独立评估所有三个关节腔的关节间隙宽度（用卡尺测量至0.1毫米）以及OA的分级个体特征（骨赘0 - 3级、狭窄0 - 3级、硬化0 - 1级、囊肿0 - 1级）。通过对“您是否在大多数日子里膝关节或其周围疼痛至少一个月？如果是，您在过去一年中是否经历过任何疼痛？”这两个问题的肯定回答，将受试者分类为有膝关节疼痛。
关节间隙宽度测量的观察者内重复性在±0.4毫米范围内（一致性界限的95%置信区间）；分级的kappa值>0.7。125名受试者无膝关节疼痛或骨赘。在这些影像学正常的膝关节中，平均关节间隙宽度因性别而异，但不随年龄减小。基于任何一个关节腔中存在≥1级骨赘的定义在预测疼痛方面比基于关节间隙测量或分级的定义更有效；关节间隙丢失没有明显的阈值，在该阈值时疼痛的可能性会大幅增加。髌股关节（PFJ）处骨赘的存在比胫股关节（TFJ）处更敏感但特异性更低；对于存在膝关节疼痛，增加PFJ评估可使敏感性从38.1%提高到62.3%，特异性从82.7%降至58.7%。
在社区中的男性和女性中，骨赘是与膝关节疼痛关联最佳的影像学特征。所有社区研究均应包括TFJ和PFJ的影像学评估。关节间隙丢失不是无症状衰老的特征，并且关节间隙宽度没有一个生物学上的临界值，低于该值膝关节疼痛的可能性会显著增加。
