Progression of osteoarthritis as a state of inertia
Progression of osteoarthritis as a state of inertia
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DOI：
10.1136/annrheumdis-2012-201575
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发表时间：
2013-06-01
影响因子：
27.4
通讯作者：
Nevitt, Michael C.
中科院分区：
文献类型：
--
作者：
Felson, David;Niu, Jingbo;Nevitt, Michael C.
目的测试最近发生疾病的膝关节是否比稳定的膝关节有更高的X射线进展风险，这表明最近的变化会产生进一步的变化，而最近的稳定会产生随后的稳定性(惯性模式)。方法我们使用骨关节炎倡议(OAI)获得的年度后前位X线片的中心读数，重点关注Kellgren和Lawrence(KL)分级的变化和半定量关节间隙的变化。我们检查了发生疾病(KL 2级)的膝关节是否比已经2级且病情稳定的膝关节有更高的后续进展风险。我们综合了多项检查的数据。使用广义估计方程调整膝关节之间的相关性，进行Logistic回归分析，调整年龄、性别、体重指数、体力活动、股四头肌力量和机械对齐，评估疾病进展测试事件与稳定疾病的风险。结果1562名患有2级疾病的OAI患者的平均年龄为61.8岁，平均BMI为29.4，其中61.7%为女性。在病情稳定的膝关节中，4.1%的膝关节在接下来的12个月内表现出KL分级的进展，而在有偶发疾病的膝关节中，有13.7%的膝关节出现进展(调整后的OR为4.0；95%的可信区间为2.4至6.7)。对于关节间隙丢失的进展，我们发现与事件与稳定疾病的关系相似(调整后的OR为5.3；95%CI为3.6至7.9)。结论膝关节骨关节炎的放射学进展遵循惯性模式。应寻找促使疾病从稳定状态向进展状态转变的因素。
Objectives To test whether knees which recently developed disease were at higher risk for subsequent x-ray progression than knees which had been stable, suggesting that recent change produces further change and recent stability yields subsequent stability (a pattern of inertia).Methods We used central readings of the annual posteroanterior x-rays obtained in the Osteoarthritis Initiative (OAI) focusing on change in Kellgren and Lawrence (KL) grade and change in semiquantitative joint space. We examined whether knees that had developed incident disease (KL grade 2) were at higher risk of subsequent progression than knees that were already grade 2 and had had stable disease. We combined data from multiple examinations. Using generalised estimating equations to adjust for the correlation between knees, we carried out logistic regression evaluating the risk for disease progression testing incident versus stable disease adjusting for age, sex, body mass index, physical activity, quadriceps strength and mechanical alignment.Results 1562 OAI subjects with grade 2 disease had a mean age of 61.8 years, mean BMI of 29.4, and 61.7% were women. Of knees with stable disease, 4.1% showed progression within the next 12 months in KL grade versus 13.7% in those with incident disease (adjusted OR 4.0; 95% CI 2.4 to 6.7). For progression of joint space loss, we found a similar relation with incident versus stable disease (adjusted OR 5.3; 95% CI 3.6 to 7.9).Conclusions Knee osteoarthritis radiographic progression follows a pattern of inertia. Factors that trigger the transition from stable disease to progression should be sought.