Severe Joint Space Narrowing Research Articles

Defining radiographic osteoarthritis for the whole knee

To determine in the knee which individual radiographic feature or combination of features in the patellofemoral and tibiofemoral joints correlate best with a nonradiographic definition of clinical osteoarthritis in order to recommend a definition of radiographic osteoarthritis for use in studies. Using data from the Framingham Osteoarthritis Study, we tested the correlation of clinical OA, defined as frequent knee pain plus crepitus, with a variety of definitions of radiographic OA including those based on individual radiographic features, e.g. > or = grade 2 osteophyte 0-3 scale, and new definitions that included alternative combinations of features, [e.g. either > or = grade 2 osteophyte or joint space narrowing > or = grade 2 (0-3 scale) with a bone feature (such as cyst, sclerosis, or grade 1 osteophyte)]. We performed analyses looking at participants who had obtained both weight-bearing anteroposterior (AP) and lateral radiographs of both knees. In 519 participants, we found that the definitions of radiographic osteoarthritis best correlated with clinical OA were definite osteophyte > or = grade 2' (efficiency 62.4-67.1%) and an 'alternate definition' of either osteophytes > or = grade 2 or joint space narrowing > or = grade 2 with a bony feature of OA (efficiency 62.8-68.1%). A recursive partitioning analysis selected the 'alternate definition' as best. Also, we found that adding lateral views to the AP view improved the diagnostic test performance of the best performing radiographic definitions. We suggest that a knee should be characterized as having radiographic OA if there is either an osteophyte of grade 2 or greater severity (0-3 scale) present or the presence of moderate to severe joint space narrowing (> or = 2 on a 0.3 scale) with co-occurrence of a bony feature in the compartment affected.

Hip osteoarthritis and dysplasia in Chinese men.

To estimate the prevalence of hip osteoarthritis (OA hip) and hip dysplasia in a sample of Hong Kong men who were unselected with respect to hip symptoms. The postmicturition films of 999 men aged 60-75 years, consecutive attenders for intravenous urography between 1987 and 1990 at a regional hospital, were reviewed. OA hip was diagnosed as the occurrence of two or more features of OA using a modified version of the Kellgren and Lawrence scale, or a minimal joint space of 1.5 mm or less. Hip dysplasia was defined as a centre-edge angle of less than 25 degrees, or an acetabular depth of less than 9 mm. The results were compared with British data obtained by similar methods. In the Hong Kong sample, the proportion of men with two or more features of osteoarthritis in at least one hip was about 50% that of the men in the British study (5.4% and 11.0%, respectively). Severe joint space narrowing (of 1.5 mm or less) occurred in 0.7% of the hips in Hong Kong men, compared with 2% in the British men. The proportion of hips with centre-edge angles less than 25 degrees was 4.5% in Hong Kong, compared with 3.6% in Britain, and the prevalence of shallow acetabular depth was greater in Chinese (14.5%) than in the British (2.1%). Radiographic measures of hip dysplasia were not associated with minimal joint space. Our results have confirmed the lower prevalence of radiographic hip osteoarthritis in Hong Kong men compared with British men. However, acetabular dysplasia was as prevalent among Chinese men as in the British sample. This is evidence against the hypothesis that variations in the frequency of hip osteoarthritis are caused by differences in the occurrence of hip dysplasia.

IS THE HIP INVOLVED IN GENERALIZED OSTEOARTHRITIS?

The authors examined the association of hip osteoarthritis with the presence of Heberden's nodes in a case-control study. Subjects were men aged 60-75 years who had undergone intravenous urography as out-patients. An examination of the hands was carried out in 240 patients who had a hip replacement for osteoarthritis or a joint space less than or equal to 2.5 mm, and in 290 controls whose joint space was greater than or equal to 3.5 mm in both hips. The presence of Heberden's nodes was associated with an increased risk of radiological hip osteoarthritis, the relationship being stronger in the 51 cases with severe joint-space narrowing (odds ratio = 3.4, 95% confidence interval 1.3-9.1). There was no evidence that this association differed according to the site of joint space narrowing within the hip. The finding provides further evidence that osteoarthritis of the hip can occur as part of a generalized process and does not only result from local damage to the joints.

Hand radiographic changes in patients with primary and secondary Sjögren's syndrome.

Unselected hand radiographs from 37 primary Sjögren's syndrome patients (pSS), 19 patients with rheumatoid arthritis (RA) and Sjögren's syndrome (secondary SS) and 29 patients with RA only were evaluated blind by osteoradiologists, using reference radiographs for scoring joint space narrowing and erosion at the proximal interphalangeal joints, the metacarpophalangeal joints and the wrists. A history of arthralgias and/or arthritis of the above joints was taken from the patients charts. It is shown that pSS patients suffer from transient episodes of arthralgias and/or arthritis, while both secondary SS and RA patients had a history of chronic arthritis of the small joints of the hand. Evaluation of the hand radiographs showed that pSS patients exhibited mild joint space narrowing but no erosions, whereas the other two groups of patients presented with more severe joint space narrowing and varying degrees of erosions. Finally, RA patients without SS had more advanced radiographic changes than secondary SS patients. Thus hand X-rays can be used in addition to the previously described clinical differences in the differentiation of primary and secondary SS.