非創傷性膝蓋疼痛通常在成年時會變成慢性狀況


  【24drs.com】根據線上發表於6月13日關節炎照護研究(Arthritis Care Research)期刊的一篇前瞻世代研究結果,非創傷性膝蓋疼痛通常在成年時會變成慢性狀況。
  
  荷蘭鹿特丹Erasmus MC大學醫學中心綜合實務科的Marlous Kastelein醫師等人寫道,非創傷性膝蓋疼痛病患在綜合實務科相當常見。成人中,荷蘭的這類狀況發生率約為每年每1,000名病患有23例,包括滑囊炎、肌腱炎、骨關節炎(OA)和未特定原因的膝蓋症狀。雖然發病率這麼高,有關自然病程和影響這些症狀之因素的資料很少。
  
  研究目標是評估成人非創傷性膝蓋症狀的病程,研究期間6年,以確認與不佳預後有關的特徵,並對此發展一種臨床預測規則,在6年追蹤期間定義為持久性關節症狀、或進行了膝蓋置換手術。
  
  這篇研究中,偶發非創傷性膝蓋症狀的549名35歲以上成人,予以追蹤6年;使用邏輯回歸分析檢視不佳結果的預後因素,使用接受者操作曲線下之面積(AUC)評估差別能力,研究者使用確認之預後因素發展出一種不佳結果的臨床預測規則。
  
  追蹤6年時,有42.1%的病患為不佳結果;與不佳結果顯著相關的因素為:持續膝蓋症狀(勝算比[OR]為5.31;95%信賴區間[CI]為3.27 - 8.61),追蹤1年時符合美國放射科學院(ACR)的OA臨床準則(OR,2.65;95% CI,1.48 - 4.73),不過,開始時符合ACR的臨床OA準則與不佳結果無關。
  
  中低教育程度、骨骼方面有共病症、膝蓋症狀持續超過3個月、兩側膝蓋症狀、自我報告膝蓋紅腫、開始時有非創傷性膝蓋症狀,都與不佳結果無關;與不佳結果無關的開始時的客觀發現包括,外翻準線、被動式膝蓋彎曲/深診時疼痛,膝關節骨擴大(AUC,0.80)。
  
  研究限制包括,有38.1%的病患失去追蹤,且為相對異質性的研究。
  
  研究作者寫道,成人非創傷性膝蓋症狀顯示,有將近半數患者變成慢性病;發展中的臨床預測規則包括了10個開始時的預後因素,可用來篩選長期結果不佳的高風險病患。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6560&x_classno=0&x_chkdelpoint=Y
  

Nontraumatic Knee Complaints Often Become Chronic in Adults

By Laurie Barclay, MD
Medscape Medical News

June 30, 2011 — Nontraumatic knee complaints often become chronic in adults, according to the results of a prospective cohort study published online June 13 in Arthritis Care Research.

"Patients with non-traumatic knee complaints are common in general practice," write Marlous Kastelein, MD, from the Department of General Practice, Erasmus MC University Medical Center in Rotterdam, the Netherlands, and colleagues. "In adults, the incidence of such complaints reported in Dutch general practice is about 23 per 1000 patients per year, including bursitis, tendinitis, osteoarthritis (OA) and unspecified knee complaints. In spite of this high incidence, few data are available on the natural course and factors influencing the prognosis of these complaints in general practice."

The study goals were to evaluate the course of nontraumatic knee complaints in adults in general practice during a 6-year period, to identify characteristics associated with unfavorable prognosis, and to develop a clinical prediction rule for unfavorable outcome, defined as persistent knee complaints at 6-year follow-up or having undergone knee replacement surgery.

In this study, 549 adults older than 35 years with incident nontraumatic knee complaints were followed-up for 6 years. Prognostic factors associated with an unfavorable outcome were identified using multivariable logistic regression analysis, and discriminative ability was assessed using the area under the receiver operating curve (AUC). The investigators developed a clinical prediction rule for unfavorable outcome, using identified prognostic factors.

Outcome was unfavorable at 6-year follow-up in 42.1% of the patients. Factors significantly associated with unfavorable outcome were having persistent knee complaints (odds ratio [OR], 5.31; 95% confidence interval [CI], 3.27 - 8.61) and meeting clinical American College of Radiology (ACR) criteria for OA (OR, 2.65; 95% CI, 1.48 - 4.73) at 1-year follow-up. However, meeting clinical ACR criteria for OA at baseline was not associated with unfavorable outcome.

Low/middle education level, skeletal system comorbidity, knee complaints lasting longer than 3 months, bilateral knee complaints, self-reported warm knee, and history of nontraumatic knee complaints at baseline were independently associated with an unfavorable outcome. Objective findings at baseline that were independently associated with an unfavorable outcome were valgus alignment, pain at passive knee flexion/extension, and bony enlargement of the knee joint (AUC, 0.80).

Limitations of this study include loss to follow-up of 38.1% of patients and a relatively heterogeneous study group.

"Non-traumatic knee complaints in adults in general practice appear to become a chronic disorder in nearly half of the patients," the study authors write. "The developed clinical prediction rule with 10 baseline prognostic factors can be used to select high-risk patients for an unfavorable outcome at long term."

The Department of General Practice of the Erasmus MC University Medical Centre, Anna Fonds, and the insurance companies TRIAS, Zilveren Kruis, Achmea, and OZ supported this study. The study authors have disclosed no relevant financial relationships.

Arthr Care Res. Published online June 13, 2011.

    
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