Progression of radiographic hip osteoarthritis over eight years in a community sample of elderly white women
Progression of radiographic hip osteoarthritis over eight years in a community sample of elderly white women
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DOI：
10.1002/art.20213
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发表时间：
2004-05-01
影响因子：
--
通讯作者：
Palermo, L
中科院分区：
文献类型：
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作者：
Lane, NE;Nevitt, MC;Palermo, L
目标。描述一个以社区为基础的老年妇女样本中8年来的进展，这些老年妇女有髋关节骨关节炎(RHOA)的放射学结果，并伴有或不伴有髋关节疼痛。在骨质疏松性骨折研究的基线检查中，年龄大于或等于65岁的女性在平均+/-SD8.3+/-0.4年的随访期内获得基线和随访骨盆正位X线片。我们评估了745名女性的936个髋关节的进展情况，这些患者有一个或多个类风湿性关节炎的基线结果：总结性骨性关节炎分级大于或等于2，最小关节间隙(MJS)小于或等于1.5 mm，明确的股骨或髋臼骨赘，明确的上外侧关节间隙狭窄(JSN)，或中度或更严重的JSN。我们分别检查了MJS在1.5 mm和2.5 mm之间的髋关节的进展情况。通过问卷调查和检查评定髋部疼痛和肢体功能障碍。进展的衡量标准包括放射学结果的综合分级增加，骨赘总分增加，MJS大于或等于0.5 mm的减少，全髋关节置换术(THR)，以及下肢残疾评分的增加。使用一般估计方程估计基线放射学进展预测指标的优势比(OR)和95%可信区间(95%CI)。在随访期间，12.9%的有基线RHOA的女性接受了全髋关节置换术，22.8%的女性患者的下肢残疾显著恶化，而64.6%的RHOA患者的髋关节表现为放射学进展或被置换。在所有指标中，37%的髋关节和47%的女性在基线时同时患有类风湿关节炎和髋部疼痛，进展更大。在有疼痛的髋关节中，23.6%进展到全髋关节置换，而无疼痛的髋关节则有2.7%(OR8.1[95%CI 4.2，15.4]，P<；0.001)，53.7%的髋关节MJS下降大于或等于0.5 mm，而无疼痛的髋关节有30.7%(OR 1.9[95%CI 1.4，2.6]，P<；0.001)。有髋部疼痛的女性更有可能加重下肢功能障碍(29.3%比17.6%；OR 1.8[95%CI 1.2，2.8]，P=0.0053)。MJS>；1.5 mm和小于或等于2.5 mm(n=1,868)的髋关节主要表现为超正中段狭窄和相对较低的进展率，这与髋关节疼痛没有区别。股骨骨赘、上外侧JSN和软骨下骨改变是进展的独立预测因素。在社区招募的女性中，有症状的类风湿性关节炎患者的放射学和临床进展较大，但仍比临床环境中髋部骨性关节炎患者的发生率低得多。无症状的RHOA和髋关节单独发现轻度JSN(MJS为1.5 mm至2.5 mm)不太可能在8年内进展。
Objective. To describe progression over 8 years in a community-based sample of elderly women with radiographic findings of hip osteoarthritis (RHOA) with or without hip pain.Methods. Baseline and followup anteroposterior pelvic radiographs were obtained at a mean +/- SD 8.3 +/- 0.4 years of followup in women age greater than or equal to65 years at the baseline examination of the Study of Osteoporotic Fractures. We evaluated progression in 936 hips of 745 women with one or more baseline findings of RHOA: summary OA grade greater than or equal to2, minimum joint space (MJS) less than or equal to1.5 mm, definite femoral or acetabular osteophytes, definite superolateral joint space narrowing (JSN), or moderate or worse superomedial JSN. We separately examined progression in hips with an MJS between 1.5 mm and 2.5 mm. Hip pain and lower extremity disability were assessed by questionnaire and examination. Measures of progression included an increase in summary grade of radiographic findings, increase in total osteophyte score, decrease in MJS of greater than or equal to0.5 mm, total hip replacement (THR), and increase in lower extremity disability score. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for baseline radiographic predictors of progression were estimated using general estimating equations.Results. During followup, 12.9% of women with baseline RHOA underwent THR, and 22.8% had substantial worsening of lower extremity disability, while 64.6% of hips with RHOA showed radiographic progression or were replaced. Progression was greater by all measures in the 37% of hips and 47% of women with both RHOA and hip pain at baseline. Of hips with pain, 23.6% progressed to THR compared with 2.7% of hips without pain (OR 8.1 [95% CI 4.2, 15.4], P < 0.001), and MJS decreased greater than or equal to0.5 mm in 53.7% of hips with pain compared with 30.7% of hips without pain (OR 1.9 [95% CI 1.4, 2.6], P < 0.001). Women with hip pain were more likely to have worsened lower extremity disability (29.3% versus 17.6%; OR 1.8 [95% CI 1.2, 2.8], P = 0.0053). Hips with an MJS >1.5 mm and less than or equal to2.5 mm (n = 1,868) had primarily superomedial narrowing and comparatively low rates of progression that did not differ by hip pain. Femoral osteophytes, superolateral JSN, and subchondral bone changes were independent predictors of progression.Conclusion. Among women recruited from the community, radiographic and clinical progression was greater in those with symptomatic RHOA, but still substantially less frequent than previously reported for hip OA patients in clinical settings. Asymptomatic RHOA and hips with an isolated finding of mild JSN (MJS of 1.5 mm to 2.5 mm) were unlikely to progress over 8 years.