Clinical classification criteria for knee osteoarthritis: performance in the general population and primary care
Clinical classification criteria for knee osteoarthritis: performance in the general population and primary care
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DOI：
10.1136/ard.2006.051482
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发表时间：
2006-10-01
影响因子：
27.4
通讯作者：
Croft, P.
中科院分区：
文献类型：
--
作者：
Peat, G.;Thomas, E.;Croft, P.
背景：美国风湿病学会(ACR)的骨性关节炎临床分类标准在普通人群中的应用受到了质疑。目的：调查人群亚组的分布和潜在的疾病严重程度是否可以解释这些标准在人群设置中的表现。819名年龄=50岁的成年人在过去12个月中报告膝关节疼痛，由研究治疗师使用标准化方案进行临床评估，并对放射学状态视而不见。所有参与者都接受了膝盖的平片，由一位临床状态失明的阅读器评分。结果：符合ACR膝关节骨关节炎临床分类标准者539人(68%)，症状性膝骨性关节炎259人(33%)。238名参与者(30%)符合ACR膝关节骨性关节炎的临床标准。ACR临床标准与有症状的膝关节骨关节炎的符合率较低(敏感性41%；特异性75%；阳性预测值44%；阴性预测值72%)。灵敏度和特异度在人群亚组之间没有明显差异，尽管它们受到放射学骨性关节炎潜在严重程度的影响。结论：ACR临床标准似乎反映了晚期疾病的较晚体征。可能需要其他方法来识别普通人群和初级保健中的早期、轻度骨关节炎。
Background: Doubts have been expressed about the performance of the American College of Rheumatology (ACR) clinical classification criteria for osteoarthritis when applied in the general population.Objective: To investigate whether the distribution of population subgroups and underlying disease severity might explain the performance of these criteria in the population setting.Methods: Population-based cross-sectional study. 819 adults aged >= 50 years reporting knee pain in the last 12 months were clinically assessed by research therapists using standardised protocols and blinded to radiographic status. All participants underwent plain radiography of the knees, scored by a single reader blinded to clinical status. The relationship between fulfilling the ACR clinical classification criteria for knee osteoarthritis and the presence of symptomatic radiographic knee osteoarthritis was summarised for the sample as a whole and within subgroups.Results: Radiographic osteoarthritis was present in 539 participants (68%) and symptomatic radiographic knee osteoarthritis in 259 (33%). 238 participants (30%) fulfilled the ACR clinical criteria for knee osteoarthritis. Agreement between the ACR clinical criteria and symptomatic radiographic knee osteoarthritis was low (sensitivity 41%; specificity 75%; positive predictive value 44%; negative predictive value 72%). Sensitivity and specificity did not vary markedly between population subgroups, although they were influenced by the underlying severity of radiographic osteoarthritis.Conclusion: The ACR clinical criteria seem to reflect later signs in advanced disease. Other approaches may be needed to identify early, mild osteoarthritis in the general population and primary care.