Defining radiographic incidence and progression of knee osteoarthritis: suggested modifications of the Kellgren and Lawrence scale.
Defining radiographic incidence and progression of knee osteoarthritis: suggested modifications of the Kellgren and Lawrence scale.
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DOI：
10.1136/ard.2011.155119
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发表时间：
2011-11
影响因子：
27.4
通讯作者：
Aliabadi P
中科院分区：
文献类型：
--
作者：
Felson DT;Niu J;Guermazi A;Sack B;Aliabadi P
Ann Rheum Dis 2011; 70：1884-1886. doi：10.1136/ard. 2011.155119 1885 2级;但由于此处阐述的问题，我们对量表进行了修改，以要求发生疾病时狭窄和骨赘均存在。由于软骨损失作为骨关节炎的定义特征，并且由于它与X射线上的关节间隙损失最密切相关，现在可以随着时间的推移进行测量，因此我们建议事件疾病包括关节间隙损失。因此，在MOST和OAI中，我们将新发放射学骨关节炎定义为新发K&L 2级，但我们详细阐述了这一定义，以便膝关节新发疾病必须同时存在狭窄和骨赘，其中至少有一种是新发的。我们意识到这种对发生率的替代定义所造成的困境，即在描述膝关节出现明确的大骨赘但没有变窄方面缺乏明确性。如果所有的疾病都需要关节间隙丢失，那么这些只有骨赘的膝关节将无法分类。对于这些膝关节，我们推荐一种新的K&L评分，可以称为2/骨赘，这表明膝关节已经单独形成了明确的骨赘。为了研究这2例/骨赘膝关节是否与包括关节间隙丢失的2级事件膝关节不同，我们评价了获得X线和MRI的骨折性骨关节炎研究膝关节。我们将K&L 2级膝关节分为1级关节间隙丧失和0级关节间隙丧失（使用国际骨关节炎研究协会（OARSI）图谱对关节间隙进行分级，评分为0-3）（见表1）。在165名受试者的189个膝关节中，28个关节间隙评分为0（其余关节间隙狭窄评分为1）。在这项研究中，使用全器官磁共振成像评分（蠕虫）量表的MRI阅片者不了解X线图像。蠕虫评分为4分或更高（0-6分）意味着弥漫性关节间隙丢失（在5级和6级中，这种丢失延伸到骨）。在K&L 2级但X线检查无狭窄的膝关节中，28个膝关节中只有3个（4%）的任何胫股区域的蠕虫评分≥ 4。然而，在K&L 2级伴1级或以上狭窄的膝关节中，73/161（44%）膝关节胫股负重区评分为4或以上（差异p< 0.001，χ 2）。当我们使用其他蠕虫软骨损失阈值时，结果相似。该分析表明，软骨损失在2级K&L疾病中比在2级疾病中更常见。如果K&L等级用于定义发生率，我们建议采用一种新方法，将新发骨赘与狭窄和骨赘的组合区分开来。我们还注意到，对单个影像学特征进行分级（如使用OARSI图谱对骨赘和狭窄进行评分）可能会使这个问题变得毫无意义。由于没有明确的定义，骨关节炎或疾病的发病率使用分级的个人特征，修改的K&L的方法，我们建议可能是可取的。K&L分级系统也被用来定义进展在一些研究。与发病率一样，使用该分级系统定义进展的方法因研究而异。5 6在以前的工作中，7我们已经表明，使用个体放射学特征，特别是关节间隙丢失，来定义进展导致更多的膝关节被准确地描述为具有进展性疾病，而不是使用粗糙的K&L量表。K&L 3级在定义进展方面造成了特殊的困难。3级需要明确的关节间隙狭窄，但这种狭窄可以...
Ann Rheum Dis 2011; 70: 1884–1886. doi: 10.1136/ard. 2011.155119 1885 grade 2; but because of the concerns elaborated here, we have modified the scale also to require for incident disease that both narrowing and osteophytes be present at the time of incidence. As cartilage loss serves as the defining feature of osteoarthritis and as it is most closely related to joint space loss on the x-ray that is now measurable over time, we suggest that incident disease include the incorporation of joint space loss. Therefore, in MOST and OAI we define incident radiographic osteoarthritis as a new-onset K&L grade 2, but we elaborate this definition so that new-onset disease in the knee has to have both narrowing and an osteophyte, with at least one of these being new. We are aware of the dilemma caused by this alternative definition of incidence, which is the lack of clarity in characterising knees that develop large definite osteophytes but without narrowing. If all incident disease requires joint space loss, then these knees with only osteophytes will be unclassifiable. For these knees, we recommend a new K&L score that could be called 2/osteophyte, which designates that the knee has developed definite osteophytes alone. To investigate whether these 2/osteophyte knees are different from incident grade 2 knees that include joint space loss, we evaluated Framingham Osteoarthritis Study knees in which both x-rays and MRI were acquired. We divided K&L grade 2 knees into those with grade 1 joint space loss and those with grade 0 joint space loss (using the Osteoarthritis Research Society International (OARSI) atlas for grading joint space, which is scored 0–3)(see table 1). Of 189 knees from 165 subjects, 28 had joint space scores of 0 (the rest had narrowing scores of 1). MRI readers using the whole-organ magnetic resonance imaging score (WORMS) scale were not privy to x-ray images in this study. A WORMS score of 4 or greater (scale 0–6) connotes diffuse joint space loss (in grades 5 and 6, this loss extends to bone). Of knees with K&L grade 2 but with no x-ray narrowing, only three out of 28 knees (4%) had WORMS scores 4 or greater in any tibiofemoral region. However, in K&L grade 2 knees with grade 1 or greater narrowing, 73/161 (44%) knees had a score of 4 or higher in a tibiofemoral weightbearing region (difference p< 0.001 by χ 2). When we used other thresholds for WORMS cartilage loss, results were similar. This analysis reveals that cartilage loss is far more common in grade 2 K&L disease with narrowing than it is in grade 2 disease with no narrowing. If the K&L grade is to be used to define incidence, we suggest a new approach in which new-onset osteophytes are differentiated from a combination of narrowing and osteophytes. We also note that using grades for individual radiographic features (as in using the OARSI atlas to score osteophytes and narrowing) may make this problem moot. As there is no clearcut definition of osteoarthritis or disease incidence using grades for individual features, the modification of the K&L approach we propose may be preferable.The K&L grading system has also been used to define progression in some studies. 4 5 As with incidence, approaches to defining progression using this grading system have varied from study to study. 5 6 In previous work, 7 we have shown that using individual radiographic features, especially joint space loss, to define progression results in more knees being accurately characterised as having progressive disease than using the cruder K&L scale. K&L grade 3 creates special difficulties in defining progression. Grade 3 requires definite joint space narrowing, but such narrowing can …
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影响因子：
27.4
作者：
BUCKLANDWRIGHT, JC;MACFARLANE, DG;BRADSHAW, CR
通讯作者：
BRADSHAW, CR
影响因子：
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作者：
FELSON, DT;ZHANG, YQ;LEVY, D
通讯作者：
LEVY, D
影响因子：
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作者：
Hunter, DJ;Zhang, YQ;Felson, DT
通讯作者：
Felson, DT
影响因子：
27.4
作者：
Reijman, M.;Pols, H. A. P.;Bierma-Zeinstra, S. M. A.
通讯作者：
Bierma-Zeinstra, S. M. A.
影响因子：
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作者：
Sharma, Leena;Eckstein, Felix;Dunlop, Dorothy
通讯作者：
Dunlop, Dorothy