Development of classification criteria for hand osteoarthritis: comparative analyses of persons with and without hand osteoarthritis
Development of classification criteria for hand osteoarthritis: comparative analyses of persons with and without hand osteoarthritis
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DOI：
10.1136/rmdopen-2020-001265
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发表时间：
2020-07-01
期刊：
影响因子：
6.2
通讯作者：
Kloppenburg, Margreet
中科院分区：
文献类型：
--
作者：
Haugen, Ida K.;Felson, David T.;Kloppenburg, Margreet
目的进一步了解典型的手骨关节炎（OA）的特点，需要制定新的手OA分类标准。将来自初级和二级/三级护理的具有基于医生的手部OA诊断的患者（n = 128）的便利样本与由于炎症或非炎症状况而手部主诉的对照组（n = 128）进行比较。70）。我们使用逻辑回归分析来检验自我报告的、临床的、影像学的和实验室的发现是否与手OA相关。通过计算受试者工作曲线下面积（AUC）来评估组间的区分度。（OR = 1.62，95%CI 1.40 - 1.88）和关节间隙狭窄（JSN）（OR = 1.57，95%CI 1.36 - 1.82），具有良好的区分度（两者的AUC = 0.82）。对于骨赘和JSN，我们发现近端指间关节的组间区分度可接受（AUC分别为0.77和0.78），但第一腕掌关节的区分度较差（AUC分别为0.67和0.63）。疼痛的DIP关节与手OA相关，但不能区分组间差异（AUC = 0.67）。OA的年龄和家族史与手OA呈正相关，而在掌指关节疼痛，僵硬和软组织肿胀，疼痛和边缘糜烂的手腕，较长的晨僵，炎症生物标志物和自身antibodies.Conclusions手OA患者与对照组的症状，临床表现，影像学改变和实验室检查的差异被发现。影像学OA特征，尤其是DIP关节，最适合区分两组。
Objectives Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA.Methods In a cross-sectional multi-centre international study, a convenience sample of patients from primary and secondary/tertiary care with a physician-based hand OA diagnosis (n = 128) were compared with controls with hand complaints due to inflammatory or non-inflammatory conditions (n = 70). We examined whether self-reported, clinical, radiographic and laboratory findings were associated with hand OA using logistic regression analyses. Discrimination between groups was assessed by calculating the area under receiver operating curves (AUC).Results Strong associations with hand OA were observed for radiographic osteophytes (OR = 1.62, 95% CI 1.40 to 1.88) and joint space narrowing (JSN) (OR = 1.57, 95% CI 1.36 to 1.82) in the distal interphalangeal (DIP) joints with excellent discrimination (AUC = 0.82 for both). For osteophytes and JSN, we found acceptable discrimination between groups in the proximal interphalangeal joints (AUC = 0.77 and 0.78, respectively), but poorer discrimination in the first carpometacarpal joints (AUC = 0.67 and 0.63, respectively). Painful DIP joints were associated with hand OA, but were less able to discriminate between groups (AUC = 0.67). Age and family history of OA were positively associated with hand OA, whereas negative associations were found for pain, stiffness and soft tissue swelling in metacarpophalangeal joints, pain and marginal erosions in wrists, longer morning stiffness, inflammatory biomarkers and autoantibodies.Conclusions Differences in symptoms, clinical findings, radiographic changes and laboratory tests were found in patients with hand OA versus controls. Radiographic OA features, especially in DIP joints, were best suited to discriminate between groups.