Prognostic factors for progression of clinical osteoarthritis of the knee: a systematic review of observational studies
Prognostic factors for progression of clinical osteoarthritis of the knee: a systematic review of observational studies
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DOI：
10.1186/s13075-015-0670-x
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发表时间：
2015-06-08
影响因子：
4.9
通讯作者：
Bierma-Zeinstra, Sita M. A.
中科院分区：
文献类型：
--
作者：
Bastick, Alex N.;Runhaar, Jos;Bierma-Zeinstra, Sita M. A.
简介：我们进行了一个系统的回顾性研究的预后因素的进展症状性膝关节骨关节炎（OA），定义为增加疼痛，身体功能下降或全关节replacement.Method：我们搜索了现有的观察性研究，直到2015年1月在Medline和Embase根据指定的搜索策略。对符合我们最初纳入标准的研究进行方法学质量评估。数据提取和结果进行汇总，或在必要时总结根据最佳证据synthes.Results：1,392篇文章确定，30符合纳入标准和38个决定因素进行了调查。由于研究之间存在较大的异质性，因此无法进行合并。最佳证据综合显示，有强有力的证据表明，年龄、种族、体重指数、共病计数、磁共振成像（MRI）检测到的髌下滑膜炎、关节积液和基线OA严重程度（影像学和临床）与临床膝关节OA进展相关。有中度证据表明，教育水平、活力、疼痛应对子量表休息、MRI检测到的内侧股胫软骨损失和一般骨髓病变与临床膝关节OA进展相关。然而，大多数的决定因素的证据是有限的（包括膝关节活动范围或标记）或冲突（包括年龄，性别和关节线压痛）。结论：强有力的证据发现临床膝关节OA进展的多个预后因素。临床膝关节OA（进展）的定义仍然存在很大差异，这使得无法通过荟萃分析总结证据。需要使用症状进展作为结局指标对膝关节OA的预后因素进行更多研究。值得注意的是，只有少数研究使用疼痛进展作为结局指标。影像学因素的病理生理学及其与症状的关系有待进一步探讨。
Introduction: We performed a systematic review of prognostic factors for the progression of symptomatic knee osteoarthritis (OA), defined as increase in pain, decline in physical function or total joint replacement.Method: We searched for available observational studies up to January 2015 in Medline and Embase according to a specified search strategy. Studies that fulfilled our initial inclusion criteria were assessed for methodological quality. Data were extracted and the results were pooled, or if necessary summarized according to a best evidence synthesis.Results: Of 1,392 articles identified, 30 met the inclusion criteria and 38 determinants were investigated. Pooling was not possible due to large heterogeneity between studies. The best evidence synthesis showed strong evidence that age, ethnicity, body mass index, co-morbidity count, magnetic resonance imaging (MRI)-detected infrapatellar synovitis, joint effusion and baseline OA severity (both radiographic and clinical) are associated with clinical knee OA progression. There was moderate evidence showing that education level, vitality, pain-coping subscale resting, MRI-detected medial femorotibial cartilage loss and general bone marrow lesions are associated with clinical knee OA progression. However, evidence for the majority of determinants was limited (including knee range of motion or markers) or conflicting (including age, gender and joint line tenderness).Conclusion: Strong evidence was found for multiple prognostic factors for progression of clinical knee OA. A large variety in definitions of clinical knee OA (progression) remains, which makes it impossible to summarize the evidence through meta-analyses. More research on prognostic factors for knee OA is needed using symptom progression as an outcome measure. Remarkably, only few studies have been performed using pain progression as an outcome measure. The pathophysiology of radiographic factors and their relation with symptoms should be further explored.