What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis.
What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis.
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DOI：
10.1007/s11999-015-4349-z
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发表时间：
2015-09
影响因子：
4.2
通讯作者：
Bierma-Zeinstra SM
中科院分区：
文献类型：
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作者：
Bastick AN;Belo JN;Runhaar J;Bierma-Zeinstra SM
先前对膝关节骨关节炎（OA）进展的预后因素进行的系统评价显示，全身OA与透明质酸水平相关。膝关节疼痛、影像学严重程度、性别、股四头肌力量、膝关节损伤和定期体育活动无关。自该综述的文献检索以来已经过去了十年，此后进行了许多研究，研究了放射学膝关节OA进展的预后因素。本研究的目的是提供关于放射学膝关节OA进展预后因素的现有证据的更新系统综述。我们在MEDLINE和EMBASE中检索了观察性研究。关键词是：膝关节、骨关节炎（或关节炎、或关节病、或退行性关节疾病）、进展（或预后、或突发、或预测）和病例对照（或队列、或纵向、或随访）。符合纳入标准的研究，根据已建立的肌肉骨骼疾病预后因素的审查标准进行方法学质量评估。提取数据，如可能，汇总结果或根据最佳证据合成进行总结。共识别出1912篇额外的文章; 43篇符合我们的纳入标准。上一篇综述包含36篇文章，因此新的文章总数为79篇。纳入的文章中有72篇被评为高质量，其余7篇为低质量。两个决定因素的合并比值比（OR）显示与膝关节OA进展相关：基线膝关节疼痛（OR，2.38 [95% CI，1.74-3.27]）和Heberden结节（OR，2.66 [95% CI，1.46-8.84]）。我们的最佳证据综合显示，内翻对线、血清透明质酸和肿瘤坏死因子-α与膝关节OA进展相关。有强有力的证据表明，性别、既往膝关节损伤、股四头肌力量、吸烟、跑步和定期运动与膝关节OA进展无关。然而，大多数确定的关联的证据是有限的，相互矛盾的，或不确定的。基线膝关节疼痛、存在Heberden淋巴结、内翻对线以及高水平血清标志物透明质酸和肿瘤坏死因子-α可预测膝关节OA进展。性别、膝关节损伤和股四头肌力量等因素不能预测膝关节OA的进展。膝关节OA和膝关节OA进展的定义仍存在较大差异。临床研究应使用更一致的定义，这些因素，以促进数据汇集的未来荟萃分析。本文的在线版本（doi：10.1007/s11999-015-4349-z）包含补充材料，可供授权用户使用。
A previous systematic review on prognostic factors for knee osteoarthritis (OA) progression showed associations for generalized OA and hyaluronic acid levels. Knee pain, radiographic severity, sex, quadriceps strength, knee injury, and regular sport activities were not associated. It has been a decade since the literature search of that review and many studies have been performed since then investigating prognostic factors for radiographic knee OA progression. The purpose of this study is to provide an updated systematic review of available evidence regarding prognostic factors for radiographic knee OA progression. We searched for observational studies in MEDLINE and EMBASE. Key words were: knee, osteoarthritis (or arthritis, or arthrosis, or degenerative joint disease), progression (or prognosis, or precipitate, or predictive), and case-control (or cohort, or longitudinal, or follow-up). Studies fulfilling the inclusion criteria were assessed for methodologic quality according to established criteria for reviews on prognostic factors in musculoskeletal disorders. Data were extracted and results were pooled if possible or summarized according to a best-evidence synthesis. A total of 1912 additional articles were identified; 43 met our inclusion criteria. The previous review contained 36 articles, thus providing a new total of 79 articles. Seventy-two of the included articles were scored high quality, the remaining seven were low quality. The pooled odds ratio (OR) of two determinants showed associations with knee OA progression: baseline knee pain (OR, 2.38 [95% CI, 1.74–3.27) and Heberden nodes (OR, 2.66 [95% CI, 1.46–8.84]). Our best-evidence synthesis showed strong evidence that varus alignment, serum hyaluronic acid, and tumor necrosis factor-α are associated with knee OA progression. There is strong evidence that sex, former knee injury, quadriceps strength, smoking, running, and regular performance of sports are not associated with knee OA progression. Evidence for the majority of determined associations, however, was limited, conflicting, or inconclusive. Baseline knee pain, presence of Heberden nodes, varus alignment, and high levels of serum markers hyaluronic acid and tumor necrosis factor-α predict knee OA progression. Sex, knee injury, and quadriceps strength, among others, did not predict knee OA progression. Large variation remains in definitions of knee OA and knee OA progression. Clinical studies should use more consistent definitions of these factors to facilitate data pooling by future meta-analyses. The online version of this article (doi:10.1007/s11999-015-4349-z) contains supplementary material, which is available to authorized users.