半月板损伤的存在是有症状的膝关节骨关节炎中神经性疼痛的有力预测指标：一项横断面试点研究。
The presence of meniscal lesions is a strong predictor of neuropathic pain in symptomatic knee osteoarthritis: a cross-sectional pilot study.
作者信息
Roubille Camille, Raynauld Jean-Pierre, Abram François, Paiement Patrice, Dorais Marc, Delorme Philippe, Bessette Louis, Beaulieu André D, Martel-Pelletier Johanne, Pelletier Jean-Pierre
出版信息
Arthritis Res Ther. 2014 Dec 14;16(6):507. doi: 10.1186/s13075-014-0507-z.
INTRODUCTION
Pain in osteoarthritis (OA) has been classically attributed to joint structural damage. Disparity between the degree of radiographic structural damage and the severity of symptoms implies that factors other than the joint pathology itself contribute to the pain. Peripheral and central sensitization have been suggested as two of the underlying mechanisms that contribute to pain in OA. The aim of this study was to explore in symptomatic knee OA patients, the structural changes assessed by magnetic resonance imaging (MRI) that could be used as markers of neuropathic pain (NP).
METHODS
This cross-sectional observational pilot study included 50 knee OA patients with moderate to severe pain (VAS ≥40) in the target knee. The presence of NP was determined based on the PainDETECT questionnaire. Among the 50 patients included, 25 had PainDETECT score ≤12 (unlikely NP), 9 had PainDETECT score between 13 and 18 (uncertain NP) and 16 had PainDETECT score ≥19 (likely NP). WOMAC, PainDETECT, and VAS pain scores as well as knee MRI were assessed.
RESULTS
Data showed no significant difference in demographic characteristics between the three groups. However, a positive and statistically significant association was found between the WOMAC pain (P <0.001), function (P <0.001), stiffness (P = 0.007) and total (P <0.001) scores as well as higher VAS pain score (P = 0.023), and PainDETECT scores. Although no difference was found in the cartilage volume between groups, the presence of meniscal extrusion in both medial (P = 0.006) and lateral (P = 0.023) compartments, and presence of meniscal tears in the lateral compartment (P = 0.011), were significantly associated with increasing PainDETECT score. Moreover, the presence of bone marrow lesions in the lateral plateau and the extent of the synovial membrane thickness in the lateral recess were associated with increasing PainDETECT scores (P = 0.032, P = 0.027, respectively).
CONCLUSIONS
In this study, meniscal lesions, particularly extrusion, were found to be among the strongest risk factors for NP in knee OA patients.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01733277. Registered 16 November 2012.
引言
骨关节炎（OA）中的疼痛传统上被认为是由关节结构损伤引起的。影像学结构损伤程度与症状严重程度之间的差异表明，除了关节病理本身之外，还有其他因素导致疼痛。外周和中枢敏化被认为是导致OA疼痛的两个潜在机制。本研究的目的是在有症状的膝关节OA患者中，探索通过磁共振成像（MRI）评估的可作为神经性疼痛（NP）标志物的结构变化。
方法
这项横断面观察性试点研究纳入了50例目标膝关节有中度至重度疼痛（视觉模拟评分法[VAS]≥40）的膝关节OA患者。根据疼痛检测问卷确定NP的存在情况。在纳入的50例患者中，25例疼痛检测评分≤12（不太可能为NP），9例疼痛检测评分在13至18之间（NP不确定），16例疼痛检测评分≥19（可能为NP）。评估了西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、疼痛检测、VAS疼痛评分以及膝关节MRI。
结果
数据显示三组患者的人口统计学特征无显著差异。然而，发现WOMAC疼痛（P<0.001）、功能（P<0.001）、僵硬（P = 0.007）和总分（P<0.001）评分以及较高的VAS疼痛评分（P = 0.023）与疼痛检测评分之间存在正相关且具有统计学意义。尽管各组之间软骨体积无差异，但内侧（P = 0.006）和外侧（P = 0.023）半月板挤压的存在以及外侧半月板撕裂的存在（P = 0.011）与疼痛检测评分增加显著相关。此外，外侧平台骨髓损伤的存在以及外侧隐窝滑膜厚度的程度与疼痛检测评分增加相关（分别为P = 0.032，P = 0.027）。
结论
在本研究中，半月板损伤，尤其是挤压，被发现是膝关节OA患者NP的最强危险因素之一。
试验注册
ClinicalTrials.gov NCT01733277。2012年11月16日注册。
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