關節的過度活動可保護手部防止罹患骨關節炎


  July 7, 2004 - 一項以家庭為基礎所做的試驗結果顯示,關節過度活動可以防止手部骨關節炎(OA)的產生,該項試驗結果刊載於七月號的關節炎與風濕病(Arthritis & Rheumatism)期刊中。
  
  杜克大學醫學院的Kraus醫師指出,一般認為,早期的OA可能是過度活動所導致的後果,然而很少研究會針對人體關節的過度活動,及放射線(期)OA之間的關聯作評估。
  
  Genetics of Generalized OA的研究人員以家庭為基礎,召集了1,043位試驗者參與試驗,這些試驗者在各自的家庭裡都有兩位以上患有放射線OA 的同輩患者,病源最少都有3個關節點,病徵皆為雙向分佈,分佈點包含遠端指節間 (DIP)、近端指節間 (PIP)或腕掌的(CMC)關節群,以及最少1個OA DIP 關節點;放射線(期) OA的評估標準使用Kellgren/Lawrence指數,患者的病徵指數最少為2。
  
  過度活動的定義為,Beighton指數最少為4 (級數為,0-9);根據目前的診斷,符合過度活動定義的患者有3.7%,而根據童年病例調查,有7.4%符合。
  
  過度活動組罹患PIP 關節OA 的風險比較低(目前的風險比 [OR] 為0.34;95%信心水準 [CI],0.16 - 0.71;過去的OR值為0.43; 95% CI,0.24 - 0.78);經過年齡及性別等因素的調整以後,過度活動組的PIP OA風險率還是比較低。
  
  該項研究的限制因素,包括男性試驗者太少,這可能是為什麼只有過度活動的女性顯示出較低的PIP OA OR值;過度活動對DIP 關節會有什麼影響,無法做出結論;童年期的過度活動資料,可能會有誤差。
  
  研究人員表示,對PIP關節的放射線OA而言,本試驗顯示,過度活動對關節的保護效果;相較於過去有關過度活動及CMC OA的研究,本試驗顯示,關節的過度活動,並不會增加手部關節的OA罹患率。

Articular Hypermobility Protec

By Laurie Barclay, MD
Medscape Medical News

July 7, 2004 — Articular hypermobility protects against hand osteoarthritis (OA), according to the results of a family-based study published in the July issue of Arthritis & Rheumatism.

“It is widely believed that premature OA may be a direct consequence of hypermobility,” write V. B. Kraus, MD, PhD, from Duke University Medical Center in Durham, North Carolina, and colleagues. “Very few studies have evaluated the association of articular hypermobility and radiographic OA in humans.”

Investigators in the Genetics of Generalized OA study enrolled 1,043 individuals from families with two or more siblings with radiographic OA involving at least three joints, distributed bilaterally, from the distal interphalangeal (DIP), proximal interphalangeal (PIP) or carpometacarpal (CMC) joint groups, and OA in at least one DIP joint. The criterion for radiographic OA was a score of at least 2 on the Kellgren/Lawrence scale.

Hypermobility, defined as a Beighton score of at least 4 (total score range, 0-9), occurred in 3.7% of subjects on the present examination and in 7.4% of subjects based on recall of past mobility in childhood.

The risk of OA in the PIP joints was lower in subjects with hypermobility (odds ratio [OR] for present, 0.34; 95% confidence interval [CI], 0.16 - 0.71; OR for past, 0.43; 95% CI, 0.24 - 0.78). After adjusting for sex and age, the lower odds of PIP OA with hypermobility were significant.

Study limitations include smaller proportion of men, which might explain why the lower odds of PIP OA with hypermobility was significant only in women; inability to make conclusions regarding the effects of hypermobility on DIP joints; and possible recall bias concerning past hypermobility.

“This study demonstrated a joint-protective effect of hypermobility for radiographic OA of PIP joints,” the authors write. “In contrast to previous studies showing an association of hypermobility and CMC OA, in this cohort there was no evidence for increased odds of OA in any joint group of the hand in association with articular hypermobility.”

GlaxoSmithKline and the National Institutes of Health supported this study. Four of the authors received remuneration for directing the scientific work of the Genetics of Generalized OA Consortium.

Arthritis Rheum. 2004;50:2178-2183

Reviewed by Gary D. Vogin, MD

    
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