Thumb CMC Biomechanics and Early OA Progression

拇指腕掌(CMC)骨关节炎(OA)是一种广泛存在的致残性疾病 在女性中比男性更常见。这种疾病影响了15%的30岁以上的成年人和三分之二以上的女性 55岁。而骨关节炎的病理生理学被认为是多因素的、异常的关节。 运动学和软骨接触改变被认为是通过产生 非生理性接触应力，进而导致软骨细胞紊乱、坏死和软骨 退化。然而，目前关于正常或正常拇指CMC关节生物力学的数据有限。 随着疾病的进展，没有关于关节生物力学的纵向研究。 因此，这项研究更广泛、更长期的目标是探索生物力学和 拇指基底节骨性关节炎的形态学研究 以及疾病的进展，最终将改善预后和治疗。的具体目标 此应用程序中概述的工作是在现有的拇指队列中纵向跟踪疾病进展 CMC OA患者，在4.5年和6年的随访中获得生物力学、放射学和临床数据 我们的创新技术，作为在基线(0年)、1.5年和3年收集的数据的后续行动，在 上一个资金周期。 生物力学和形态学在拇指基底关节骨性关节炎中的作用将被评估 通过两个具体的目标来实现。Aim 1将评估关节不稳定作为拇指CMC的潜在标志 表现为早期CMC骨性关节炎(疼痛但无疼痛)的现有男女队列中的骨性关节炎进展 粗大的放射学改变)。目标2将确定女性拇指CMC OA进展率是否为 大于男性，如果疾病进展的任何不同速度与相应的 关节不稳定和骨形态改变的差异。这两个目标都将通过长期跟踪评估 85例早期骨性关节炎患者。创新的生物力学标志物和标准化的临床结果衡量标准将是 用于解决每个目标中概述的假设。每次后续访问(4.5年和6年)CMC联合 三个高要求任务中的运动(关节运动学)和不稳定性将使用我们的最新技术进行评估 基于计算机断层扫描的无标记骨骼配准技术。手腕/手控病历和 还将进行体检，以及对拇指活动范围和力量的定量评估， 三套标准化的患者报告功能评估和平片，使用相同的 在上一个供资周期中使用的方案和调查工具。这项提议的意义在于 CMC骨性关节炎进展的长期纵向研究和生物力学标志物的确定。这 信息对未来的基础和临床研究以及创新新技术的合理设计至关重要。 预防和治疗战略。

Thumb carpometacarpal (CMC) osteoarthritis (OA) is a widespread, disabling disease that is far more prevalent in woman than men. The disease affects 15% of adults over age 30, and two-thirds of women over the age of 55. While the pathophysiology of osteoarthritis is considered to be multifactorial, abnormal joint kinematics and altered cartilage contact are believed to trigger and sustain the disease via the production of non-physiologic contact stresses, which in turn lead to chondrocyte derangement, necrosis, and cartilage degradation. However, at this point there is only limited data on thumb CMC joint biomechanics in normal or OA-affected individuals, and there are no longitudinal studies of joint biomechanics as the disease progresses. Accordingly, the broader, long-term objective of this study is to explore the role of biomechanics and morphology in basilar thumb joint osteoarthritis in an effort to identify biomechanical markers for the initiation and progression of the disease that will ultimately improve prognosis and treatment. The specific objective of the work outlined in this application is to follow disease progression longitudinally in a existing cohort of thumb CMC OA patients, acquiring biomechanical, radiographic, and clinical data at 4.5- and 6-year follow-ups using our innovative techniques, as a follow-on to data collected at baseline (0 yr), 1.5 and 3 years, during the previous funding cycle. Evaluation of the role of biomechanics and morphology in basilar thumb joint osteoarthritis will be accomplished via two specific aims. Aim 1 will evaluate joint instability as a potential marker for thumb CMC OA progression in an existing cohort of women and men who presented with early stage CMC OA (pain but no gross radiographic changes). Aim 2 will determine if the rate of thumb CMC OA progression in women is greater than in men, and if any differential rate of disease progression is associated with corresponding differences in joint instability and bone shape changes. Both aims will be evaluated via long-term follow-up of 85 early OA patients. Innovative biomechanical markers and standardized clinical outcome measures will be used to address the hypotheses outlined in each aim. At each follow-up visit (years 4.5 and 6) CMC joint motion (arthrokinematics) and instability during three high-demand tasks will be assessed with our state-of-art computed tomography-based markerless bone registration techniques. Wrist/hand-directed histories and physical exams will also be obtained, as will quantitative assessments of thumb range of motion and strength, three sets of standardized patient-reported functional assessments, and plain radiographs, using the same protocols and survey instruments used during the previous funding cycle. The significance of this proposal is the long-term longitudinal study and the identification of biomechanical markers for CMC OA progression. This information is crucial for future basic and clinical research studies and for the rational design of innovative new strategies for prevention and treatment.