Utility of digital photographs of the hand for assessing the presence of hand osteoarthritis.
Utility of digital photographs of the hand for assessing the presence of hand osteoarthritis.
复制标题
使用手部数码照片评估手部骨关节炎的存在。
DOI：
10.1016/j.joca.2004.01.003
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发表时间：
2004
影响因子：
7
通讯作者：
Schumacher,HR
中科院分区：
文献类型：
--
作者：
Stern,AG;Moxley,G;SudhaRao,TP;Disler,D;McDowell,C;Park,M;Schumacher,HR
目的手部结节性骨关节炎（hand OA）是OA的一个亚类，具有很强的遗传性。对这种情况的多项遗传分析已经进行，并正在进行中。任何遗传学研究的最高产量取决于病例定义的明确临床表型。X线片可以提供有关病变性质的最详细信息。体格检查是一个不完善的手段来评估每一个病人，特别是当数百或数千名患者需要进行研究。我们的研究评估的准确性，相对于X光片，数字照片的手OA的存在下，在一个特定的关节，以及结节手OA. MethodsConcretive患者的诊断进行了评估的一部分，I-NODAL研究（调查结节骨关节炎检测与基因编码白细胞介素-1 [IL-1]）。评价包括由训练有素的风湿病学家进行的体格检查、手部的后前位X线片和每只手的数码照片。由一名经过培训的观察员使用Kelly-Lawrence量表读取X线片。照片由一人拍摄，并由经验丰富的流变学家进行分析。Kappa统计确定每一种方式和准确性进行了评估，使用X线片读数作为金标准。结果阅片者内部的可靠性，X线片解释是良好的整体诊断手OA（κ0.76 [0.45，1.07]），但在单个关节中存在或不存在K-L 2-4级时差异很大（ACR指数关节的中值κ0.70，范围0.49-0.87）。体格检查的远端指间关节（DIP）淋巴结敏感（中位数96.27，93.94-100），但对相应关节的放射学手OA无特异性（中位数33.0，17.24-42.86）。第一腕掌（CMC）和近端指间（PIP）关节OA的体格检查证据仅提供中等灵敏度和特异性。然而，单个关节检查的阴性预测值良好（IP关节的中位阴性预测值为82.58，范围为68.29-100.00），尤其是DIP关节。手部照片上可见的结节特异性是可变的（所有IP关节和第1个CMC的中位数为83.77，范围为53.37-96.97），在第1个CMC和PIP关节中发现的相应关节中，放射学OA的特异性最高。临床手OA是敏感的，但不具体的手OA的放射学诊断，而摄影OA是中度特异性，但insensitive.ConclusionThe可视化的一个节点上的数字照片的手提供了公平到中度特异性放射学手OA在相应的关节，一般敏感性差。照片作为诊断放射学手OA的筛选工具的价值有限。
ObjectivesNodal osteoarthritis of the hand (hand OA) is a subset of OA with a strong heritable component. Multiple genetic analyses of this condition have been performed and are underway. Highest yield from any genetic study depends upon a clear clinical phenotype for case definition. Radiographs may provide the most detail about the nature of the lesion. Physical examination is an imperfect means of evaluating each patient, particularly when hundreds or thousands of patients are required for study. Our study evaluated the accuracy, relative to a radiograph, of a digital photograph of the hands for the presence of OA in a particular joint, as well as for the diagnosis of nodal hand OA.MethodsConsecutive patients were evaluated as part of the I-NODAL study (Investigation of Nodal Osteoarthritis to Detect an Association with Loci encoding Interleukin-1 [IL-1]). Evaluation included a physical examination by a trained rheumatologist, a postero-anterior radiograph of the hands, and a digital photograph of each hand. Radiographs were read by one trained observer using the Kellgren-Lawrence scale. Photographs were taken by one individual and were analyzed by an experienced rheumatologist. Kappa statistics were determined for each modality and accuracy was assessed using radiographic readings as a gold standard.ResultsIntra-reader reliability for radiograph interpretation was good for the overall diagnosis of hand OA (κ0.76 [0.45,1.07]), but varied widely for the presence or absence of K-L grades 2–4 in individual joints (median κ0.70, range 0.49–0.87 for ACR index joints). Distal interphalangeal joint (DIP) nodes on physical examination were sensitive (median 96.27, 93.94–100), but not specific for radiographic hand OA in the corresponding joint (median 33.0, 17.24–42.86). Physical examination evidence of OA in the 1st carpo-metacarpal (CMC) and proximal interphalangeal (PIP) joints provided only moderate sensitivity and specificity. However, the negative predictive value of the examination of individual joints was good (median negative predictive value was 82.58 for IP joints with a range 68.29–100.00), particularly in the DIP joints. Specificity of a node visualized on hand photograph was variable (median for all IP joints and 1st CMC 83.77, range 53.37–96.97), with greatest specificity for radiographic OA in the corresponding joint found in the 1st CMC and the PIP joints. Clinical hand OA was sensitive, but not specific for the radiographic diagnosis of hand OA; while, photographic OA was moderately specific, but insensitive.ConclusionThe visualization of a node on a digital photograph of the hand provides fair to moderate specificity for radiographic hand OA in the corresponding joint, with generally poor sensitivity. A photograph has limited value as a screening tool for the diagnosis of radiographic hand OA.