The Bristol 'OA500' Study: Progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint
The Bristol 'OA500' Study: Progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint
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DOI：
10.1016/s1063-4584(97)80002-7
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发表时间：
1997-03-01
影响因子：
7
通讯作者：
Shepstone, L
中科院分区：
文献类型：
--
作者：
Dieppe, PA;Cushnaghan, J;Shepstone, L
500名患有确诊的、有症状的肢体关节OA的患者已被招募参加一项正在进行的关于该疾病自然史的前瞻性研究。415例患者（平均年龄65.6岁，女性与男性比例2.05：1）在入组后3年接受了完整的临床和影像学审查（平均入组至随访间隔37.6个月，范围31-41）。大多数人报告他们的病情总体恶化，尽管疼痛严重程度没有改变。残疾（Steinbrocker）和使用助行器的患者总体增加，但57例患者（13.7%）改善，其中38例接受了关节手术。不同临床结局指标的变化之间存在很强的相关性，但除了疼痛严重程度与后续手术之间的相关性外，没有基线变量预测3年内的变化。415例患者中有193例在入组时患有膝关节疾病。其中145例患者在两个时间点都有膝关节X线片和完整的临床数据。在276个可评估的胫股关节中，85个（30.1%）观察到一定的变化，但仅10个髌股关节。关节间隙、骨赘的改变与软骨下骨硬化之间有很强的相关性。然而，影像学和临床变化之间没有相关性。可以得出结论，影像学变化可能不是一个很好的替代临床结果在既定的OA。这对OA中可能的结构修饰剂的长期研究的设计具有影响。
Five hundred patients with established, symptomatic limb joint OA have been recruited into an on-going prospective study of the natural history of the condition. Four hundred and fifteen patients (mean age 65.6 years, female to male ratio 2.05:1) were available for a full clinical and radiographic review 3 years after entry (mean entry to follow-up interval 37.6 months, range 31-41). The majority reported an overall worsening of their condition, although pain severity did not change. There was an overall increase in disability (Steinbrocker) and the use of walking aids in the group but 57 patients (13.7%) improved, 38 of whom had undergone joint surgery. There was a strong correlation between changes in different clinical outcome measures, but none of the baseline variables predicted change over 3 years with the exception of an association between pain severity and subsequent surgery. One hundred and ninety-three of the 415 patients had knee joint disease at entry. One hundred and forty-five of these patients had knee radiographs and full clinical data available from both time points. Some change was seen in 85 of 276 evaluable tibiofemoral joints (30.1%), but only 10 patellofemoral joints. There was a strong correlation between changes in joint space, osteophyte and subchondral bone scelerosis. However, there was no correlation between radiographic and clinical changes. It is concluded that radiographic change may not be a good surrogate for clinical outcome in established OA. This has implications for the design of long-term studies of possible structure modifying agents in OA.