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  • Complete Article - Osteoarthritis of The Knee - 1986

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    Satrio Bangun Negoro
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    Complete Article_Osteoarthritis of the Knee - 1986 (1)

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    5 просмотров11 страниц

    Complete Article - Osteoarthritis of The Knee - 1986

    Загружено:

    Satrio Bangun Negoro
    ORTHOPEDI

    Авторское право:

    © All Rights Reserved
    Скачайте в формате PDF или читайте онлайн в Scribd
    Отметить как неприемлемый контент
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    1039 SPECIAL ARTICLE DEVELOPMENT OF CRITERIA FOR THE CLASSIFICATION AND REPORTING OF OSTEOARTHRITIS Classification of Osteoarthritis of the Knee R. ALTMAN, E. ASCH, D. BLOCH, G. BOLE, D. BORENSTEIN, K. BRANDT, W. CHRISTY, T. D. COOKE, R. GREENWALD, M. HOCHBERG, D. HOWELL, D. KAPLAN, W. KOOPMAN, S. LONGLEY, Ill, H. MANKIN, D. J. McSHANE, T. MEDSGER, Jn., R. MEENAN, W. MIKKELSEN, R, MOSKOWITZ, W. MURPHY, B. ROTHSCHILD, M. SEGAL, L. SOKOLOFF, and F. WOLFE For the purposes of classification, it should be specified whether osteoarthritis (OA) of the knee is of unknown origin (idiopathic, primary) or is related to a kanown medical condition or event (secondary). Clinical criteria fr the classification of idiopathic OA ofthe knee were developed through a multicenter study gro Comparison diagnoses included rheumatoid arthritis and other painful conditions of the knee, exclusive of referred of paraarticular pain. Variables from the medical history, physical examination, laboratory tests, From the Subcommittee on Osteoarthritis, a subcommitiee of the Dis CCiteria Commitee ofthe American Rheumatism Associaton Allman, MD: University of Miami School of Medicine, Miami, FL; E. Asch, MD: New York University, New York, NY: . Bloch, PRD: Stanford University. Palo Alto, CA; G. Bole, MD: University of Michigan, Ann Arbor; D. Borenstein, MD: Washingion University Medical Center, Washington, DC; K. Brandt, MD: Indiana University School of Medicine, Indianapolis: 'W. Chiisty, MD: University of Pusburgh, Pitsburah, PA: T. D. Cooke, MD: Queen's University, Kingston, Ontario, Canada; B. Greentrald, MD: Long Island Jewish Medical Center, New Hyde Park, NY; M. Hochberg, MD, MPH: Johns Hopkins University, Baluinore, MD; D. Howell, MD: University of Miami, Miami, FL: D. Kaplan, MD: Downstate Medical Center, Brooklyn, NY: W. Koopman, MID: University of Alabama at Birmingham: S. Longley. TI, MD: University of Florida, Guinesvile; H. Manin, MD: Massachusetts General Hospital, Boston, D. J. McShane, MD: Stanford University. Palo Alto, CA; T, Medsger, Je, MD: Univer: Sity of Pitsburgh, Pittsburgh, PA; R. Meenan, MD. MPH: Boston University School of Medicine, Boston, MA: W. Mikkelsen, MD: University of Michigan, Ann Arbor, R. Moskowitz, MD: Case Western Reserve University, Cleveland, OH; W. Murphy, MD: Mallinckrodt Institute of Radiology, Washington University, St Louis, MO; B. Rothschild, MD: Menorah Medical Center, Kansas Gity, MO; M. Segal, PRD: Stanford University, Palo Alto, CA: L. Sokoloff, MD: State University of New York at Stony Brook: F Wolfe, MD: University of Kansas, Wi “Address reprint requests to Roy D. Altman, MD, Univer sity of Miami, PO Box 016960 (VA 111), Miami, FL 33101 Submitted for publication December 16, 1985: accepted in revised form April 21, 1986, Arthritis and Rheumatism, Vol. 29, No. 8 (August 1986) and radiographs were used to develop sets of criteria that serve different investigative purposes. In contrast to prior criteria, these proposed criteria utilize classifica tion trees, or algorithms, The diagnosis of osteoarthritis (OA) has most ‘often been based on radiographic appearance, rather than clinical features, Radiographic criteria were pro- posed by Keligren and Lawrence in 1957 (1), and those criteria were later accepted by the World Health Organization at a symposium held in Milan in 1961 2). Lequesne has proposed sets of clinical criteria for OA in several specific joints (3,4). In 1981, the American Rheumatism Association asked the Diagnostic and Therapeutic Criteria Com- mittee to establish a subcommittee on OA. The sub- committee accepted as its charge the development of criteria for the classification of OA. The initial objec- tives were to standardize and clarify the clinical defi- nition of OA, in order to promote consistency in the reporting of OA and in the interpretation of research concerning OA. This can be accomplished by 1) de- velopment of a classification of OA that includes recognized subsets; and 2) identification of OA subsets, through the use of a combination of clinical and laboratory features. For the purposes of this report, OA is defined as a heterogenous group of conditions that lead to joint symptoms and signs which are associated with defec- tive integrity of articular cartilage, in addition to related changes in the underlying bone and at the joint margins. Although articular cartilage is poorly inner- vated and defects in cartilage are not, in themselves, symptomatic, a clinical syndrome of symptoms, which often includes pain, may evolve from such defects. 1040 Until a diagnostic method is developed that will integrate the clinical findings with etiologic, biochem- ical, biomechanical, and histologic abnormalities of the syndrome we call OA, the subcommittee is com- pelled to employ commonly available diagnostic tech~ nigues in developing the classification criteria. This report details the subcommittees approach to the classification of idiopathic (primary) osteoarthritis of 1 joint, the knee, utilizing findings from the medical history, physical examination, laboratory testing, and radiography. METHODS ‘lassification of subsets of osteoarthritis. The subcom- ritee's first objective was to develop a classification of OA subsets. There have been seVeral published classifications of OA. The subcommittee proposes 2 classification system that separates patients with OA into 2 categories: 1) those with no presently knovin prior event or disease related tothe OA, (Gaiopathicy: and 2) those with known events of disease associated with OA (secondary) (5) (Table 1). The classifi ‘ation is further divided according to anatomic (idiopathic) OF etiologic (secondary) conditions. Classifiations presented in textbooks have generally followed this proposed pattern (6-8); each emphasizes cer- tain aspects of OA. An ideal classification would include histologic findings, but issue from the joint affected With OA js infrequently availabe. The classification proposed in 1977 by Mitchell and Cruess (9) is unigue in that diagnostic groups are defined by the status of the cartilage matrix. Although their method focuses on etiologic factors, it omits clinically identiable syndromes, especially those related to involve- ‘ent of the spine and interphalangeal joints. “The proposed clasication (Table 1) recognizes that OA may involve virtually any joint, and some of the less common siles of involvement are noted. It also takes into fccount tha all OA may be secondary to phenomena not yet discovered: hence, the term “idiopathic OA" is used in iew ofthe term “primary OA.” For example, if itis discovered that interphalangeal OA’ has a distinct etiology, separate from other forms of OA, it may be readily repositioned in the secondary OA section Tis difeult to place calcium deposition diseases within ths classification System because these diseases may be idiopathic or secondary. We have elected to classify the calcium deposition diseases as a form of secondary OA, although this decision is admittedly arbitrary. Forestier’ s ankylosing hyperostosis (difluse idiopathic skeletal hyper- Osiosis, DISH) is empirically classified as an idiopathic OA Variant. Further research may establish this as a separate disease Criteria selection. Because ofdiferences inthe elin- ical presentation of OA in different joins, the subcommittee initially focused on idiopathic OA ef the knee. Twenty-three historical physical, and laboratory features were considered worthy of further evaluation (5). The sensitivity and speci ficty of these variables were initially determined by the “Delphi technique of opinion sampling (10,11) The Delphi procedure was selected Recause itis designed to generate a ALTMAN ET AL Table 1. Classification for subsets of osteoarthitist 1. Kdiopathie A. Localized Bands: e., Heberden's and Bouchard's nodes (nodal) erosive interphalangeal arthritis (non-nodal), seapho- ‘metacarpal, scaphotrapezial 2, Feet: ed, hallux valgus, hallux rigs, contracted toes (rammerfcockup tos), talonavicular 3, Knee’ ‘2. Medial compartment '. Lateral compartment €. Patelofemoral compartment (e.g, chondromalacis) 4. Hip 4. Bocentre (superion) . Concentric (axial, medial) «. Diffuse (coxae seals) 5. Spine (particulary cervical and lumber) ‘a. Apophyseal bi Intervertebral (ise) © Spondylosis osteophytes) 4. Ligamentous (hyperostoss (Foretir’s disease, oF DISH) 6. Other single sites: eg, shoulder, temporomandibulr, sacroiliac, ankle, wrist, acromioclevicuar B. Generalized: includes 3 of more areas listed above (Kell ‘ren Moore, see ref. 18) 1. Small (peripheral) and spine 2. Large (central) and spine 3. Mixed (peripheral and central) and spine ML. Secondary |. Post-traumatic 'B. Congenital or developmental diseases 1. Localized a. Hip diseases: eg, Legg-Calve-Perthes, congenital hip dislocation, slipped capital femoral epiphysis shallow aeetabulum '. Mechanical and local factors: e.g. obesity (2), une ‘equal lower extremity length, extreme valgus/varus

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