ACR：并存髌骨疾病可加重胫骨关节炎患者的病情

膝骨关节炎（OA）是老年人中的常见病，可能引起残疾。目前针对膝OA的研究主要针对胫骨(TF)间隙，而对髌骨（PF）关节的研究相对较少。为评估TFOA患者PF共存疾病的严重程度与下肢损伤及功能障碍间的相关性，来自美国宾夕法尼亚州匹兹堡大学的SHAWN FARROKHI博士等研究者进行了一项临床观察。研究结果发表于2013年4月的《关节炎治疗与研究》（Arthritis Care & Research）杂志上。研究认为并存髌骨疾病可加重胫骨关节炎患者的病情。
研究者对167例膝OA患者进行放射学检查，获得其TF和PF间隙、伸膝强度及膝关节活动度。此外，研究者使用西安大略麦克马斯特大学骨关节炎指数（WOMAC）和日常活动能力量表（ADLS）评估膝关节的特殊症状及功能限制。
研究发现，中/重度PFOA与较低的伸膝强度存在相关性（平均值±SD 1.4±0.5 Nm/体重[BW]），而不存在PFOA者的相应值为1.8±0.5 Nm/BW。此外，膝关节整体活动度在那些中/重度PFOA的患者中更差（平均值±SD 120.8°±14.4°），而不存在PFOA的患者的膝关节整体活动度为133.5°±10.7°，轻度PFOA患者的相应值为125.8°±13°。通过WOMAC指数观察到，中/重度PFOA和轻度PFOA均与较小的站立疼痛相关（中重度PFOA：比值比[OR]0.2，95%可信区间[95%CI]0.1-0.7，轻度PFOA：OR 0.2，95%CI 0.1-0.6）。通过ADLS量表观察到，中/重度PFOA与增加的下楼梯困难度存在相关性（OR 2.9 95%CI 1.0-8.1）。
通过对TFOA单独发病或合并轻度PF疾病的患者的观察发现，膝关节如共存重度PF疾病，其表现出的临床特征有所差别。所以对于这部分患者，应针对性的对PF关节调整治疗方案，以缓解特殊的下肢损伤和功能障碍。

与关节炎相关的拓展阅读：

• PNAS：lubricin可能有助于关节炎的治疗
• ARD：银屑病关节炎临床表现存性别差异
• Ann Rheum Dis：日光浴或预防类风湿关节炎
• Rheumatology：类风湿关节炎患者整体肿瘤罹患风险高
• Lancet：依那西普维持治疗可控制类风湿关节炎疾病活动 更多信息请点击：有关关节炎更多资讯

Association of severity of coexisting patellofemoral disease with increased impairments and functional limitations in patients with knee osteoarthritis.
OBJECTIVE
To evaluate the association between severity of coexisting patellofemoral (PF) disease with lower extremity impairments and functional limitations in patients with tibiofemoral (TF) osteoarthritis (OA).
METHODS
Radiographic views of the TF and PF compartments, knee extension strength, and knee range of motion were obtained for 167 patients with knee OA. Additionally, knee-specific symptoms and functional limitations were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Activities of Daily Living Scale (ADLS).
RESULTS
Moderate/severe PFOA was associated with lower knee extension strength (mean ± SD 1.4 ± 0.5 Nm/body weight [BW]) compared to no PFOA (mean ± SD 1.8 ± 0.5 Nm/BW). Additionally, total knee range of motion was significantly lower for patients with moderate/severe PFOA (mean ± SD 120.8° ± 14.4°) compared to no PFOA (mean ± SD 133.5° ± 10.7°) and mild PFOA (mean ± SD 125.8° ± 13.0°). Moderate/severe PFOA and mild PFOA were also associated with less pain while standing (odds ratio [OR] 0.2, 95% confidence interval [95% CI] 0.1-0.7 and OR 0.2, 95% CI 0.1-0.6, respectively) on the WOMAC, and moderate/severe PFOA was associated with greater difficulty with going downstairs (OR 2.9, 95% CI 1.0-8.1) on the ADLS.
CONCLUSION
It appears that knees with more severe coexisting PF disease demonstrate features distinct from those observed in TFOA in isolation or in combination with mild PF disease. Treatment strategies targeting the PF joint may be warranted to mitigate the specific lower extremity impairments and functional problems present in this patient population.