Systemic and local factors are involved in the evolution of erosions in hand osteoarthritis
Systemic and local factors are involved in the evolution of erosions in hand osteoarthritis
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DOI：
10.1136/ard.2010.138230
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发表时间：
2011-02-01
影响因子：
27.4
通讯作者：
Kloppenburg, M.
中科院分区：
文献类型：
--
作者：
Bijsterbosch, J.;van Bemmel, J. M.;Kloppenburg, M.
目的探讨手部骨关节炎（OA）侵蚀性病变的演变过程及其危险因素，为进一步认识OA的发病机制提供依据（平均年龄59岁，83%为女性），来自GARP（“遗传学关节炎和进展”）同胞对研究。侵蚀演化包括从非侵蚀阶段到侵蚀阶段以及从主动侵蚀到重塑的阶段转变。使用卡方（2）检验评估患者内糜烂演变的聚类。通过估计兄弟姐妹和先证者共享侵蚀性演变的OR，在兄弟姐妹对中评估家族聚集性。当地的基线决定因素和高敏C反应蛋白的影响进行了评估，使用广义estimating equations.Results埃克塞特演变发生在181的4120指间关节的风险（4.4%），对应于60例（25.4%的研究样本）。1例患者中多个指间关节发生骨关节炎的发生率高于预期的偶然发生率（χ 2 = 373.0，p < 0.001）。如果先证者有糜烂性进展，则兄弟姐妹有糜烂性进展的调整OR（95%CI）为4.7（1.4 - 15.8）。全身炎症与糜烂活动无关。独立的局部决定因素为关节间隙狭窄（OR（95%CI）8.9（4.8 ~ 16.4））和自我报告疼痛（OR（95%CI）2.3（1.1 ~ 4.7））。地方因素也参与了演变。对糜烂性手OA发病机制的深入了解将有助于开发新的治疗方法。
Objective In order to gain insight in the pathogenesis of erosive hand osteoarthritis (OA), the evolution of erosions in hand OA and risk factors involved were investigated.Methods The 6-year evolution in radiographic Verbruggen-Veys anatomical phase was assessed in interphalangeal joints of 236 patients with hand OA (mean age 59 years, 83% women) from the GARP (for 'Genetics ARthrosis and Progression') sibling pair study. Erosive evolution comprised phase transitions from non-erosive to erosive phases and from active erosions to remodelling. Clustering of erosive evolution within patients was assessed using the chi(2) test. Familial aggregation was evaluated in sibling pairs by estimating ORs for siblings and probands sharing erosive evolution. Local baseline determinants and the effect of high sensitivity C reactive protein were assessed using generalised estimating equations.Results Erosive evolution took place in 181 of 4120 interphalangeal joints at risk (4.4%), corresponding to 60 patients (25.4% of study sample). Erosive evolution was found more often in multiple interphalangeal joints in one patient than would be expected by chance (chi(2) 373.0, p < 0.001). The adjusted OR (95% CI) for a sibling having erosive evolution if the proband had erosive evolution was 4.7 (1.4 to 15.8). Systemic inflammation was not associated with erosive activity. Independent local determinants were joint space narrowing (OR (95% CI) 8.9 (4.8 to 16.4)) and self-reported pain (OR (95% CI) 2.3 (1.1 to 4.7)).Conclusions Erosive evolution was clustered within patients and families. Local factors were also involved in the evolution. This increase in insight in the pathogenesis of erosive hand OA will contribute to the development of new treatments.