Search

Resume Objectifs (1) Montrer que seules les radiographies en faux profil de la hanche controlaterale font apparaitre la partie anterieure de l’interligne articulaire. (2) Fournir des valeurs normales d’epaisseur d’interligne de la hanche sur des radiographies anteroposterieures et en faux profil. (3) Identifier les sites de mesure radiographique de l’interligne articulaire permettant de detecter le mieux une coxarthrose debutante. Methodes Des radiographies anteroposterieures et bilaterales en faux profil ont ete realisees sur un bassin de cadavre, avec des marqueurs autour de la partie anterieure de l’articulation de la hanche. L’epaisseur de l’interligne a ete mesuree en dix sites sur les radiographies anteroposterieures du bassin et des deux hanches en faux profil chez 37 patients n’ayant pas de douleurs de hanche (âge moyen : 59 ans) et 65 patients souffrant de douleurs de hanche (âge moyen : 57,5 ans), dont 30 presentaient des modifications arthrosiques de l’os sous-chondral et 35 en etaient indemnes. Les differences entre les deux groupes concernant l’epaisseur de l’interligne sur chaque site de mesure ont ete evaluees par la methode Anova. Le potentiel de l’interligne a chaque site pour discriminer les groupes de patients a ete analyse par regression logistique. Resultats L’interligne anterieur n’est visible que sur une radiographie controlaterale en faux profil. Des valeurs d’interligne presumees normales ont ete recueillies dans le groupe sans douleurs de hanche. Les interlignes mesures sur les radiographies en faux profil presentaient une difference significative entre les groupes de patients, ce qui n’etait pas le cas des mesures effectuees sur les radiographies de bassin anteroposterieures. Conclusions Par comparaison avec les radiographies de bassin anteroposterieures, les radiographies bilaterales en faux profil montrent l’interligne de la hanche, y compris sa partie anterieure, et differencient mieux les patients avec et sans douleurs de hanche. Le parametre le plus determinant etait le rapport AS/P (anterosuperieur/posterieur) de l’interligne.

Objectives 1. To show that the anterior hip joint space is profiled only on the contralateral false profile radiograph. 2. To provide normal values of hip joint space width on anteroposterior and false profile radiographs. 3. To identify the best sites for joint space radiographic measurements to depict early hip osteoarthritis. Methods Anteroposterior and bilateral false profile radiographs of a cadaveric pelvis with markers around the anterior part of the hip joint were obtained. Joint space width was measured at ten sites on anteroposterior pelvis and bilateral hip false profile radiographs in 37 patients without hip pain (mean age, 59 years) and 65 patients with hip pain (mean age, 57.5 years), including 30 with and 35 without radiographic osteoarthritic subchondral bone changes. Between-groups differences in joint space width at each site were evaluated using ANOVA. The ability of joint space width at each site to discriminate between patients groups was investigated using logistic regression. Results The anterior joint space was only profiled on a contralateral false profile radiograph. Presumably, normal joint space widths were obtained in the group without hip pain. Joint space widths measured on the false profile radiographs differed significantly between the patient groups while measurements on the anteroposterior pelvis radiograph did not. Conclusions Bilateral false profile radiographs profile the entire hip joint space, including its anterior part, and discriminate better between patients with and without hip pain than the anteroposterior pelvis radiograph. The AS/P joint space width ratio (anterosuperior/posterior) was the best parameter.

Resume Introduction Les techniques de reparation des tendons des muscles gluteaux sont multiples, les resultats a long terme sont mal connus et sont le plus souvent rapportes sur un nombre restreint de patients. Les objectifs de ce travail etaient de determiner si (1) une amelioration fonctionnelle etait obtenue, (2) les reparations etaient continues avec controle IRM, (3) des facteurs etaient associes au succes. Hypothese Une technique de reparation de « double-rang » a ciel ouvert est efficace pour traiter les ruptures tendineuses des moyen et petit gluteaux de la hanche. Patients et methode Soixante-sept patients (62 femmes et 5 hommes) ont ete operes de 2003 a 2010. L’evaluation comprenait des tests cliniques fonctionnels et une IRM du bassin et de la hanche. La technique en « double-rang » a ete appliquee a toutes les ruptures independamment du type de la lesion. L’âge, l’indice de masse corporelle (IMC), la degenerescence graisseuse et l’atrophie musculaire ont ete evalues comme possibles facteurs associes au succes. Resultats Le recul moyen etait de 4,6 ans (1–8). Les valeurs moyennes pre- et postoperatoires ont ete respectivement : (1) score de la douleur (EVA) : 8,7 ± 1,1 vs 1,7 ± 2,7 au recul (p Conclusion La technique de double-rang a ciel ouvert a donne 85 % de bons resultats cliniques avec une amelioration significative des symptomes et une disparition des anomalies de l’image magnetique. Cette technique peut etre appliquee a tous types des ruptures, mais avant la survenue d’une amyotrophie. Niveau de preuve IV etude retrospective.

IntroductionAlthough various techniques can be used to repair gluteal tendon tears, the long-term outcome is unclear and published studies typically involve only a small number of patients. The goals of this study were to determine (1) if functional improvement can be obtained, (2) if the repairs are continuous based on MRI, and (3) which factors determine success.HypothesisGluteus medius and minimus tears can be repaired effectively with an open double-row technique.Material and methodsSeventy-three patients were operated on between 2003 and 2010. Of these patients, 67 (62 women, 5 men) were available for review consisting of functional clinical tests and MRI of the hip and pelvis. A double-row repair was performed on all tendon tears, no matter the type of injury. Age, body mass index (BMI), fatty degeneration and muscle atrophy were also evaluated to determine if these variables affected the outcome.ResultsThe average follow-up was 4.6 years (range 1–8). The pre-operative scores had improved at the last follow-up: (1) pain (VAS): 8.7±1.1 versus 1.7±2.7 at the follow-up, (P

Objective To assess the ability of avocado–soybean unsaponifiable—Expanscience (ASU-E) to slow radiographic progression in symptomatic hip osteoarthritis (OA). Methods Prospective, randomised, double blind, parallel group, placebo controlled 3 year trial. Patients with symptomatic (painful ≥1 year, Lequesne Index between 3 and 10) hip OA (American College of Rheumatology criteria) and a minimum joint space width (JSW) of the target hip between 1 and 4 mm on a pelvic radiograph were randomly assigned to 300 mg/day ASU-E or placebo. Standing pelvis, target hip anteroposterior (AP) and oblique views were taken annually. The primary outcome was JSW change at year 3, measured at the narrowest point on pelvic or target hip AP view (manual measure using a 0.1 mm graduated magnifying glass). The full analysis dataset (FAS) included all patients having at least two successive radiographs. An analysis of covariance Mixed Model for Repeated Measurements with Missing at Random (for missing data) was performed to compare adjusted 3 year JSW changes (primary outcome) and the percentages of ‘progressors’ (JSW loss≥0.5 mm) between groups. Results 399 patients were randomised (345 kept in the FAS), aged 62 (35–84) years, 54% women, mean body mass index 27 (SD 4) kg/m 2 , mean symptom duration 4 (SD 5) years, 0–100 normalised Lequesne Index 30 (SD 9) and global pain visual analogue scale 37 (SD 23) mm. Mean baseline JSW was 2.8 (0.9) mm. There was no significant difference on mean JSW loss (−0.638 mm vs −0.672 mm, p=0.72, in the ASU-E and placebo groups, respectively) but there were 20% less progressors in the ASU-E than in the placebo group (40% vs 50%, respectively, p=0.040). No difference was observed on clinical outcomes. Safety was excellent. Conclusions 3 year treatment with ASU-E reduces the percentage of JSW progressors, indicating a potential structure modifying effect in hip OA to be confirmed, and the clinical relevance requires further assessment. Trial registration number on ClinicalTrial.gov NCT01062737

Objectives: To update the EULAR recommendations for management of knee osteoarthritis (OA) by an evidence based medicine and expert opinion approach. Methods: The literature search and guidelines were restricted to treatments for knee OA pertaining to clinical and/or radiological OA of any compartment of the knee. Papers for combined treatment of knee and other types of OA were excluded. Medline and Embase were searched using a combination of subject headings and key words. Searches for those treatments previously investigated were conducted for January 1999 to February 2002 and for those treatments not previously investigated for 1966 to February 2002. The level of evidence found for each treatment was documented. Quality scores were determined for each paper, an effect size comparing the treatment with placebo was calculated, where possible, and a toxicity profile was determined for each treatment modality. Results: 497 new publications were identified by the search. Of these, 103 were intervention trials and included in the overall analysis, and 33 treatment modalities were identified. Previously identified publications which were not exclusively knee OA in the initial analysis were rejected. In total, 545 publications were included. Based on the results of the literature search and expert opinion, 10 recommendations for the treatment of knee OA were devised using a five stage Delphi technique. Based on expert opinion, a further set of 10 items was identified by a five stage Delphi technique as important for future research. Conclusion: The updated recommendations support some of the previous propositions published in 2000 but also include modified statements and new propositions. Although a large number of treatment options for knee OA exist, the evidence based format of the EULAR Recommendations continues to identify key clinical questions that currently are unanswered.

Anterior femoroacetabular impingement can cause early hip osteoarthritis. The typical patient is an adult younger than 50 years of age, often with a history of sporting activities. The main symptom is intermittent pain triggered by static flexion (low seats) or dynamic flexion (during sporting or occupational activities that require repeated hip flexion). The characteristic physical finding is pain triggered by placing the hip in internal rotation and 70 to 110° of flexion. In additional to anteroposterior and false-profile radiographs, lateral Dunn or Ducroquet views should be obtained on both sides to visualize the anterior part of the head-neck junction. Instead of being concave, the head-neck junction is either flat or convex, causing a cam effect that damages the labrum and anterosuperior cartilage. Non-sphericity of the femoral head with an anterior ovoid bulge induces a similar cam effect. In pincer impingement, which is less common, over-coverage by the anterosuperior acetabular rim pinches the labrum between the rim and the femoral head-neck junction when the hip is flexed. Pincer impingement is related to acetabular retroversion or protrusion. Arthrography coupled with computed tomography or magnetic resonance imaging visualizes the morphological abnormalities (e.g., ovoid shape of the femoral head or retroversion of the acetabulum) and detects secondary lesions such as labral tears or separation or damage to the anterosuperior cartilage. Arthroscopy allows removal of the damaged labrum and correction of the morphological abnormalities via femoroplasty to restore the normal concave shape of the neck and/or acetabuloplasty to eliminate over-coverage. Short- or mid-term results are satisfactory in 75 to 80% of patients. However, the presence of degenerative lesions in about two-thirds of patients at the time of arthroplastic surgery limits the probability of achieving good long-term results.

Resume Le conflit anterieur femoro-acetabulaire (CAFA), cause potentielle de coxarthrose precoce, atteint des adultes de moins de 50 ans, souvent sportifs, qui souffrent de douleurs intermittentes declenchees par la flexion statique (sieges bas) ou dynamiques (sports ou metiers avec flexions de hanche repetees). A l’examen, le signe majeur est la douleur en flexion–rotation interne, qui declenche la douleur entre 70° et 110° de flexion. Les radiographies, outre la face et le faux profil du bassin, doivent comporter un profil lateral, type Dunn ou Ducroquet comparatifs, pour visualiser la partie anterieure de la jonction tete–col. Celle-ci n’est plus concave, mais soit plate, soit bombee, ce qui cree en flexion un effet came lesant le labrum et le cartilage antero-superieur. Une tete femorale aspherique, ovoide en avant, agit de meme. Autre mode de conflit, l’effet pince est moins frequent. Le bord antero-superieur du cotyle est trop couvrant et, en flexion, le col y bute prematurement. Il resulte soit d’une protrusion acetabulaire, soit d’une retroversion du cotyle. L’arthroscanner ou l’arthro-IRM precisera certaines dysmorphies (tete ovoide, cotyle retroverse) et montrera les lesions secondaires : fissure ou desinsertion du labrum, chondropathie antero-superieure. Sous arthroscopie, la lesion labrale sera resequee et la dysmorphie corrigee : femoroplastie rendant au col sa concavite anterieure, acetabuloplastie reduisant l’auvent cotyloidien trop couvrant. A court ou moyen terme, les resultats satisfaisants sont de l’ordre de 75–80 % ; mais la coxarthrose est deja presente dans environ les deux tiers des cas et reduit les chances de bon resultat a long terme.

Two hundred and ninety-two patients, aged between 16 and 50years and presenting with mechanical hip pathology, were included in a prospective multicenter study. The descriptive study concerned the clinical examination and analysis of three X-ray views (AP pelvic, Lequesne false profile and lateral axial view). The series comprised 62% males, mean age 35years, with 53% right side and 22% bilateral involvement. Initial trauma was reported in 19% of cases, and direct familial history of hip pathology in 20%. Seventy percent of the patients played sports, 30% were high-level athletes, and 17% played combat sports. The physical impingement sign was present in 18% to 65% of cases depending on the variant studied. On imaging (n=241), 62% of hips showed osteoarthritis, with 25% at the evolved stage. In the series, as a whole, there was a 35% rate of dysplasia, 63% of impingement and 5% of normal X-ray results. The radiologic impingement aspects were 58% cam-type, 19% pincer-type and 23% mixed. Twenty-two percent of dysplasia cases showed signs of associated impingement. Pain experienced exclusively in flexion/internal rotation/adduction on examination showed little sensitivity (20%) but considerable specificity (86%) for the main diagnosis of impingement. The links between impingement and dysplasia are discussed, and an integrative schema of all risk factors is put forward. LEVEL OF EVIDENCE: IV, descriptive epidemiological study. Language: en

Resume Deux cent quatre-vingt-douze patients âges de 16 a 50 ans et presentant une coxopathie mecanique ont ete inclus dans une etude prospective multicentrique. L’etude descriptive a porte sur l’examen clinique et sur l’analyse de trois cliches radiographiques (bassin de face, faux profil de Lequesne et profil axial). La serie etait composee de 62 % d’hommes, l’atteinte concernait le cote droit dans 53 % des cas et etait bilaterale dans 22 % des cas, l’âge moyen des patients etait 35 ans. Un traumatisme initial etait rapporte dans 19 % des cas, des antecedents familiaux directs de coxarthrose etaient presents dans 20 % des cas. Soixante-dix pour cent des patients etaient sportifs, 30 % etaient sportifs de haut niveau, 17 % pratiquaient des sports de combat. Le signe physique du conflit etait present dans 18 a 65 % des cas selon les variantes etudiees. A l’imagerie (n = 241), 62 % des hanches etaient arthrosiques, 25 % etaient au stade d’arthrose evoluee. Sur la serie globale, on notait 35 % de dysplasies, 63 % de conflits et 5 % de radiographies normales. Les aspects radiologiques de conflit etaient repartis en 58 % de cames pures, 19 % de tenailles pures et 23 % de conflits mixtes. Vingt deux pour cent des dysplasies presentaient des signes de conflit associes. La presence d’une douleur exclusive en flexion rotation interne adduction a l’examen etait peu sensible (20 %) mais assez specifique (86 %) du diagnostic principal de conflit. Les liens entre conflit et dysplasie sont discutes, un schema synthetique integrant l’ensemble des facteurs de risque est propose. Niveau de preuve IV, etude epidemiologique descriptive.

Resume Deux-cent quatre-vingt douze patients âges de moins 50 ans presentant une algie de hanche d’horaire mecanique ont ete inclus dans une etude prospective multicentrique. A ete realise un bilan d’imagerie comprenant dans 241 cas, une radiographie de bassin de face debout, un faux-profil de Lequesne et/ou un profil de hanche dit « axial du col » (Ducroquet, Dunn ou une de leurs variantes). Une imagerie en coupes, arthroscanner et/ou arthro-IRM etaient disponibles dans 81 cas. Ont ete recherches les dysmorphies cotyloidiennes et femorales cervicocephaliques susceptibles de favoriser un CAFA respectivement par effet pince ou par effet came. Les lesions labrales et chondrales correspondent aux lesions secondaires de la coxarthrose et/ou du CAFA. Deux-tiers des patients presentaient une coxarthrose. Seuls 6 % de la serie presentaient un bilan d’imagerie strictement normal. Les CAFA par effet came ont represente plus de la moitie des cas (52 %), dont la moitie etaient des cols osteophytiques avec des osteophytes exuberants et multifocaux (cephaliques, cervicaux et cotyloidiens) dans plus de 90 % des cas. Ces cas ont ete consideres ambigus, du fait de l’incertitude quant a une veritable dysmorphie cervicocephalique constitutionnelle d’origine. En les excluant, les CAFA par effet came surs ne representent plus que 23 % de la serie. Le signe du croisement sur la radiographie de bassin de face debout represente le meilleur critere d’evaluation d’une retroversion du cotyle, dysmorphie cotyloidienne la plus frequente a l’origine d’un CAFA par effet pince. Il faut apprendre a le rechercher. Les lesions secondaires du col ne sont visibles que sur le profil de type axial du col dans 42 % des cas. La realisation de cette incidence doit faire partie du bilan radiographique standard avant 50 ans. L’angle alpha peut etre mesure sur ce type de profil et sur les coupes axiales d’arthroscanner ou d’arthro-IRM. Dans plus de la moitie des cas ou il etait pathologique (> 50°), il s’agissait d’un col osteophytique, donc d’un pseudo-effet came. Niveau de preuve IV, etude epidemiologique descriptive.

Resume Objectif L’objectif de cette etude etait d’estimer la frequence des cas autorapportes de psoriasis dans une cohorte de patients atteints de coxarthrose et un des objectifs secondaires etait d’evaluer l’evolution de la coxarthrose associee a un psoriasis. Methodes L’evaluation de l’effet chondromodulateur de la diacerheine dans la coxarthrose (Echodiah) etait un essai controle, randomise, en double insu, sur trois ans, afin d’evaluer l’utilisation de la diacerheine versus placebo dans le traitement de la coxarthrose. Pendant les 36 mois, l’indice algofonctionnel de Lequesne ainsi qu’une echelle visuelle analogique (EVA) de la douleur et le pincement de l’interligne articulaire (JSW) ont ete mesures tous les trois mois. Entre trois et dix ans, les donnees sur la necessite du recours a une prothese totale de hanche (PTH) ont ete collectees annuellement via un appel telephonique. A la fin des dix annees de suivi, la prevalence des cas autorapportes de psoriasis et de psoriasis familial a ete evaluee retrospectivement par courrier. Resultats Sur les 507 patients inclus dans Echodiah, 279 ont ete suivis sur dix ans ; 192 (68,8 %) ont repondu au questionnaire sur le psoriasis. Vingt-deux (11,4 %) sur 192 avaient un psoriasis declare. Dix-huit patients (9,4 %) avaient des antecedents familiaux de psoriasis. Pour 11 patients (50 %) sur 22, le diagnostic a ete effectue par un dermatologue. Les caracteristiques etaient semblables entre repondants et non-repondants et entre patients atteints ou non de psoriasis. La presence de psoriasis n’influencait pas l’evolution de la maladie, bien que les PTH soient plus frequentes chez les patients atteints de psoriasis (77,2 % apres dix annees) que chez les patients exempts (58,8 %), sans difference statistiquement significative ( p = 0,10). Conclusion La prevalence des cas autorapportes de psoriasis etait elevee dans cette cohorte, presque deux fois plus que la frequence rapportee dans la population generale. La progression de la maladie n’a pas ete modifiee par la presence de psoriasis.

Resume Objectifs L’Osteoarthritis Research Society International (OARSI) a publie des recommandations internationales sur la prise en charge de la gonarthrose et de la coxarthrose fondees sur la preuve scientifique et les avis d’experts. Nous proposons une traduction de ces recommandations, ainsi que des commentaires tenant compte des pratiques medicales en vigueur en France, Belgique et Suisse francophone. Ce travail a ete realise par les membres de la section Arthrose de la Societe francaise de rhumatologie. Methodes La traduction a ete effectuee par une societe specialisee dans la traduction d’articles medicaux, avec la collaboration d’un groupe multidisciplinaire d’experts francais, belges et suisses. Le document final est le resultat d’un processus de traduction/contre-traduction et d’une comparaison des documents intermediaires entre eux et avec le document original. La traduction concernait la liste des 25 recommandations et non l’ensemble du document publie par l’OARSI. Il s’agit d’un abrege du document original. Le detail des methodes et l’analyse des resultats publies dans le document original n’ont pas ete traduits dans leur integralite. Resultats Ce document presente la version francaise des 25 recommandations de l’OARSI. Elles concernent les traitements pharmacologiques, non pharmacologiques et chirurgicaux de la coxarthrose et de la gonarthrose. Ces recommandations ont ete commentees par des experts francophones, en tenant compte des pratiques medicales regionales et nationales. Conclusions La traduction en francais, selon une methodologie rigoureuse, des 25 recommandations proposees par l’OARSI, a pour but de servir d’aide aux professionnels de sante, ainsi qu’aux patients et aux decideurs politiques dans la prise en charge des patients souffrant de coxarthrose et de gonarthrose.

Resume Objectifs (1) decrire les images IRM des ruptures des tendons gluteaux controlees de visu ; (2) evaluer les resultats de la suture chirurgicale. Methodes Tous les patients consecutifs vus entre 2002 et 2006, par un seul clinicien ont ete operes s’ils presentaient (1) des signes physiques de tendinobursite ; (2) une gene douloureuse importante persistante depuis plus de six mois ; (3) en IRM, un hypersignal intense en ponderation T2 dans l’aire tendineuse du gluteus medius et/ou minimus ; (4) sans atrophie ou degenerescence graisseuse importante du muscle. Deux radiologistes ont interprete les coupes IRM par consensus. Un seul chirurgien est intervenu. Resultats Huit patientes repondaient a ces criteres : femmes, de 71,1 ans ± 9,4 ans, souffrant depuis, 14,3 ± 11,8 mois. Operees, elles presentaient toutes une rupture de la lame laterale du gluteus medius, lesion bien vue en IRM. Une rupture conjointe du gluteus minimus fut trouvee chez cinq patientes en chirurgie, meconnue trois fois en IRM. La bursite etait constante en IRM et chirurgie. La suture determina une remission complete de la douleur spontanee et provoquee (examen) chez sept patientes et incomplete chez une (recul : 29,4 ± 16,3 mois). Les six IRM de controle au recul de 20 ± 12 mois etaient normalisees au site opere. Conclusion Les huit images magnetiques de rupture de la lame laterale du gluteus medius ont ete confirmees chirurgicalement. Trois des cinq ruptures associees du gluteus minimus furent meconnues en IRM. La suture a donne un tres bon resultat durable dans sept cas, assez bon dans un cas.

Objectives (1) To compare MRI and surgical findings in patients with refractory greater trochanter pain syndrome and (2) to assess surgical outcomes. Methods All consecutive patients seen between 2002 and 2006 by a single clinician were selected for surgical treatment according to the following criteria: (1) tendinopathy confirmed by physical tests; (2) painful disability persisting for at least 6 months despite treatment; (3) on MRI: area of high signal intensity on T2-weighted images, in the area of gluteus medius and/or minimus tendon; and (4) absence of marked muscle atrophy or fatty degeneration. Two musculoskeletal radiologists interpreted images by consensus. A single surgeon operated on all patients. Results Eight patients met the criteria for surgery. All were women, aged 71.1 (SD: 9.4). Mean symptoms duration before surgery: 14.3 months (11.8). Surgery confirmed the presence of a tear of the lateral part of the gluteus medius tendon in all eight patients, with an associated tear of its main tendon in one patient, all tears revealed on MRI. An associated tear of the gluteus minimus tendon was present at surgery in five patients, of which three were not seen on MRI (false negative). Bursitis was confirmed in all eight patients. Steady complete remission of spontaneous and provoked (physical examination) pain was observed in seven patients and partial remission in one (mean follow-up: 22.4 months (SD: 16.3)). Six MRIs performed after 20 ± 12 months showed good reinsertion of the sutured tendon. Conclusion The eight MR images of tear of the lateral part of the gluteus medius tendon were all confirmed at surgery. Three of five associated tendon tears (gluteus minimus only) were not seen on MRI. Surgical treatment was very effective in all patients but one.

Proximal arterial stenosis (bifurcation of the aortic, common iliac and especially hypogastric or hip arteries) can cause misleading 'hip' or buttock pain (two thirds of these cases involve the area of the trochanter, groin, or thigh). Their essential characteristic is that they cause patients to stop walking, improve in a minute or two and reappear when the patient starts walking again. Neither articular complications nor periarthritis of the hip fit this pattern, and physical examination and imaging exclude them. Neurogenic intermittent claudication is more difficult to rule out: it is 'often accompanied by paresthesia and anteflexion of the trunk to relieve the pain. A radiologic image of lumbar canal stenosis alone does not indicate that it is responsible for the pain: the stenosis may be asymptomatic and only fortuitously associated with the pain. The usual reduction in femoral pulse or ankle pressure index is absent if the stenosis is located on the hypogastric or gluteal artery and there is not substantial damage to the aorta-iliac axis. Arterial stenosis is confirmed by Doppler ultrasound. Arteriography is an examination performed during treatment, to guide angioplasty. It is indicated when medical treatment fails, as it frequently does.

Objectives. – To show that helical computed tomography arthrograms (HCTA) with multiplanar reformations can document cartilage lesions and their characteristics in patients with suspected hip osteoarthritis and normal or inconclusive hip radiographs. Methods. – We retrospectively reviewed abnormal HCTAs from patients with mechanical hip pain and normal findings on anteroposterior and oblique (“faux profil”) radiographs of the pelvis. HCTA in all patients consisted in acquiring 1 mm transverse slices and obtaining coronal and sagittal reformations. Radiographs and HCTAs were read separately by two experienced radiologists, who then worked together to reach a consensus. Results. – We identified 18 patients with abnormal HCTA findings and a full set of imaging studies. Mean age was 47.8 years, and there were 14 women and four men. Acetabular cartilage lesions were found consistently; they were often deep and predominated in the anterosuperior region. A labral fissure was noted in 12 patients. The sagittal and coronal reformations proved more informative than the acquired transverse slices. Interobserver reproducibility was excellent for the HCTA diagnosis of cartilage lesions. Conclusions. – In patients with hip pain and normal radiographs, HCTA can provide a diagnosis of hip osteoarthritis by showing cartilage lesions, which are usually located in the anterosuperior part of the acetabulum.

Resume Objectifs. – Montrer que l'arthroscanner helicoidal avec reconstructions multiplanaires met en evidence des atteintes cartilagineuses et analyser les caracteristiques de celles-ci, chez des patients suspects de coxarthrose et dont les radiographies etaient normales ou non probantes. Methodes. – Nous avons realise une etude retrospective des arthroscanners de hanches pathologiques de patients presentant une douleur de hanche d'horaire mecanique et des radiographies normales de face et en faux profil de Lequesne. Ces arthroscanners etaient realises en coupes axiales natives millimetriques avec des reconstructions millimetriques dans les plans coronal et sagittal. Les radiographies et arthrographies ont ete lues de maniere consensuelle et les arthroscanners lus separement puis en consensus par deux radiologues experimentes. Resultats. – Dix-huit patients ayant un dossier radiologique complet et presentant des anomalies sur l'arthroscanner ont ete retenus pour l'etude ; l'âge moyen etait de 47,8 ans, le sex-ratio de 14 femmes pour quatre hommes. Nous avons observe que l'atteinte cartilagineuse, souvent profonde, touchait l'acetabulum chez tous nos patients, plus precisement en region anterosuperieure. Dans 67 % des cas coexistait une fissure du bourrelet acetabulaire. Les reconstructions faites dans les plans sagittal et coronal etaient plus informatives que les coupes axiales natives. La reproductibilite interobservateurs etait tres bonne pour le diagnostic des atteintes cartilagineuses en arthroscanner. Conclusions. – Dans la hanche douloureuse a radiographies normales, l'arthroscanner helicoidal permet de porter un diagnostic de coxarthrose en montrant des lesions cartilagineuses situees le plus souvent a la partie anterosuperieure de l'acetabulum.

Objective Computerized measurement of changes in joint space width (JSW) on serial radiographs of the knee in the semiflexed, anteroposterior (SF-AP) view has been used recently as a primary outcome measure in clinical trials of disease-modifying osteoarthritis drugs (DMOADs). In the use of fluoroscopy to achieve reproducible alignment of the medial tibial plateau and x-ray beam, the SF-AP radiographic protocol affords greater sensitivity in the detection of joint space narrowing (JSN) than that achieved by conventional radiographic positioning techniques. However, the utility of the SF-AP view is compromised by the variation in x-ray penetration in each examination, which may confound the correction of the automated measurement of JSW for the radiographic magnification inherent in an AP view of the knee. A recent DMOAD trial using the SF-AP protocol showed an improbable increase in JSW of ≥0.50 mm (i.e., greater than the measurement error). The present report provides an analysis of this problem, and the study aim was to demonstrate that substitution of the automated estimates of JSW with precise manual measurements can markedly reduce the problem attributable to radiographic magnification. Methods SF-AP radiographs were obtained at baseline and at 16 months and 30 months thereafter from subjects enrolled in a 6-center DMOAD trial. For each examination, a 6.35-mm steel ball was affixed to the skin over the head of the fibula to permit estimation of the percentage of radiographic magnification (%Mag) and correction of JSW measurements. Measurements of the minimum interbone distance (IBD) in the medial tibiofemoral compartment and the %Mag were obtained by an automated method (edge detection) and manually. Combinations of automated and manual measurements of the IBD and %Mag in estimates of magnification-corrected JSW were compared with respect to their reproducibility, agreement, and sensitivity to JSN. Results With fully automated measurements, variations in x-ray penetration in analog radiographs and edge enhancement in digital radiographs resulted in the computer “seeing” a metal ball whose diameter was artifactually reduced, resulting in an inflated measurement of JSW. Use of manual measurement of the IBD and %Mag largely eliminated these problems and reduced, from 16% to 2%, the frequency of knees exhibiting an increase in JSW ≥0.50 mm. In 14 of the 15 knees in which a significant increase in JSW was noted with the manual method, this increase in JSW could be explained by the development of significant lateral compartment narrowing during the study or poor alignment of the medial plateau. Conclusion Although automated and manual methods of JSW measurement of the knee in the SF-AP view possess comparable intrareader reproducibility, the manual method is less susceptible to technical factors that affect the correction of raw JSW estimates for radiographic magnification. Until we can identify practical, effective solutions to these technical problems, use of any radiographic protocol involving AP imaging of the knee in a DMOAD trial must be viewed with caution.

Evaluation of hip, knee and hand osteoarthritis (OA) involves clinical and radiological outcome measures. Clinical, mainly visual analog scale (VAS) for pain, algofunctional or Lequesne's indices for hip and knee OA, Western Ontario and Mac Master Universities OA Index (WOMAC) for hip and knee OA, Dreiser's functional index for hand OA and some quality-of-life (QoL) indices are presented and discussed. Their utility is considered according to various uses: assessment of OA severity and course in therapeutic trials, in daily practice, as a help for surgical decision, and with regard to QoL as instruments for establishing the place of OA among differing chronic rheumatic conditions. Radiological assessment methods, especially for potential structure-modifying drug trials, mainly involve either manual measurement of joint space narrowing on radiographs over a period of several years, or measurement on X-ray digitized images. Last but not least, to conclude this review, we propose a selection of the most rapid and practical instruments allowing OA assessment in daily practice, with appropriate comments.

Resume Contexte et but. L’arthrose primitive est generalement selectionnee ou stratifiee dans les etudes epidemiologiques ou therapeutiques. Ceci implique des exclusions, notamment celles des arthroses secondaires a des vices architecturaux, dont pronostic et traitement different. Les parametres des dysmorphies doivent etre mesures, et ceci, aujourd’hui, sur radiographies numerisees reduites aussi bien que standard. Methodes. Nous avons cree un arthrometre dessine sur film transparent pour etre place sur les radiographies ; il comporte des rapporteurs adaptes et des reglettes millimetrees, celles-ci dans les proportions de 100 %, 75 % et 66 % de la taille standard. L’instrument a ete teste sur 112 cliches (60 hanches, 35 genoux, 17 pieds) de tailles (reductions) variees et comportant tous les types de dysmorphies courantes. Resultats. Les mesures voulues ont ete faites aisement sur la gamme des cliches depuis la taille standard jusqu’a la reduction de 50 %. L’arthrometre a permis de connaitre et de mesurer, notamment dans leur forme moderee, non evidente, les dysmorphies congenitales ou acquises suivantes : dysplasie et subluxation congenitales de la hanche, coxa valga, protrusion acetabulaire, caput varum ; pour le genou : genu varum ou valgum, anomalies de niveau et desequilibres de la rotule, angle trochleen insuffisant, enfin pied creux ou plat. Angles et quotients (index ratio) ne changent pas sur film reduit alors que les segments doivent evidemment etre convertis selon l’echelle utilisee. Les valeurs normales et « limites » sont mentionnees. Conclusion. L’arthrometre a pour but de mesurer directement tous les parametres des dysmorphies classiques sans tracer de lignes sur les cliches. Il est applicable aux radiographies reduites courantes actuelles aussi bien qu’aux films standards. Cependant, il s’agit ici d’une presentation de l’instrument et de son emploi. L’etude de la reproductibilite des mesures reste a faire, notamment concernant les interlignes.

Background. Primary osteoarthritis is usually selected in either epidemiological or therapeutic studies. This implies exclusions. Among cases of secondary osteoarthritis considered for either stratification or exclusion – or for prognosis and treatment in daily practice – are those due to architectural defects. Parameters of the latter should be measured to ascertain diagnosis. At present, measurements have to be performed either on digitized reduced films or standard radiographs. Objective. To finalize an instrument capable of measuring the main angles and segments characteristic of the main dysmorphisms of the hip, knee and foot on different sizes of films. Methods. An arthrometer drawn on transparent material to be placed on radiographs was designed, involving several appropriate protractors and millimetric scales; it was tested on 60 hip, 35 knee and 17 foot radiographs with various architectural defects. Angles and segments most often used according to literature were measured. Reduction rates of films were various, reflecting the range of radiograph sizes currently used in everyday practice. Results . Measurements were easily performed on radiographs from standard (100%) up to 50% of reduction rate. So the arthrometer allows the recognition, especially in moderate, not obvious forms, of the following developmental or acquired dysmorphisms: hip congenital dysplasia and subluxation, including coxa valga and neck excess of anteversion; acetabular protrusion and coxa vara; tilt deformity; knee: patellar height abnormalities, patellar maltracking, trochlear depth insufficiency; foot: pes cavus, flat foot. Angle and segment ratios do not change in reduced film, whereas segments (absolute lengths) obviously should be converted according to the reduction rate for retrieving the classical values established for decades. Conclusion. The arthrometer allows us to measure the relevant parameters of various dysmorphisms without drawing lines over the films themselves. It is suitable to reduced as well to standard radiographs. However, only the instrument and its ability to be used in various films sizes are here presented. Study of reproducibility of measurements – especially concerning the joint space width – remain to be performed.

To evaluate the structural effect of avocado/soybean unsaponifiables (ASU) in the treatment of patients with symptomatic osteoarthritis (OA) of the hip.Patients with regular painful primary OA of the hip (European League Against Rheumatism 1980 criteria) and a joint space stillor = 1 mm (Kellgren grade 1 to 3, assessed by an independent observer prior to inclusion) entered a prospective, multicenter, randomized, parallel group, double-blind, placebo-controlled trial of 2 years duration. Patients had at least a 6-month history of regular pain and an algofunctional index (AFI)or = 4. The primary assessment criterion was a decrease of the joint space width (JSW) on plain anteroposterior radiographs of the pelvis performed in standing position, measured at the narrowest points by 2 independent readers, previously tested and selected and blinded to both the treatment and the time sequence. Secondary criteria were standard clinical outcome measurements (AFI, pain on a visual analog scale, consumption of nonsteroidal antiinflammatory drugs and patient's and investigator's global assessments).One hundred sixty-three patients were included: 102 men and 61 women (mean age 63.2 +/- 8.7 years). A total of 108 patients (72 men and 36 women; mean age 64 +/- 7.9 years) were radiologically evaluable at 23.7 +/- 2.6 months (ASU group; n = 55) and 23.7 +/- 3.2 months (placebo group; n = 53). Overall comparison of the evolution of JSW showed no difference between the ASU and placebo groups, from 2.35 +/- 0.93 to 1.87 +/- 1.10 mm and from 2.5 +/- 0.94 to 1.9 +/- 1.33 mm, respectively (intergroup P value at end point = 0.9). When patients were divided into 2 subgroups according to the median value of the baseline JSW (2.45 mm), the joint space loss in the most severely affected subgroup of patients (baseline JSWor = median) was significantly greater in the placebo group than in the ASU group: from 1.69 +/- 0.58 to 0.84 +/- 0.77 mm (-0.86 +/- 0.62 mm) and from 1.66 +/- 0.42 to 1.22 +/- 0.7 mm (-0.43 +/- 0.51 mm), respectively (P0.01). The JSW decrease was identical, with no difference in ASU and placebo groups, in the less severely affected subgroup of patients (baseline JSWmedian). Clinical parameters in the 2 groups did not differ significantly throughout the study.This pilot randomized, double-blind, placebo-controlled trial failed to demonstrate a structural effect of ASU in hip OA. However, in a post-hoc analysis, ASU significantly reduced the progression of joint space loss as compared with placebo in the subgroup of patients with advanced joint space narrowing. These results suggest that ASU could have a structural effect but require confirmation in a larger placebo-controlled study in hip OA.

Resume Un groupe de travail du Comite directeur des essais therapeutiques de l’EULAR a determine, a partir des donnees etablies, des directives pour le traitement de la gonarthrose. Methodes. La premiere etape selectionnait les modalites therapeutiques a prendre en consideration. La deuxieme etape etait une recherche bibliographique concernant toutes les publications en langues europeennes. La qualite de chaque etude a ete notee. Lorsque cela etait possible, il a ete calcule pour chaque traitement etudie le nombre de patients a traiter pour en ameliorer un et l’importance de l’effet therapeutique. La troisieme etape a defini des recommandations de base ; ces definitions ont ete etablies par consensus d’experts, par votes successifs (approche Delphi ). L’etape finale a consiste a classer ces propositions selon les donnees scientifiques disponibles. Le groupe d’experts a egalement developpe une deuxieme serie de propositions relatives aux axes de recherche futurs. Resultats. Sept cent quarante-quatre etudes concernaient les traitements de la gonarthrose. L’analyse quantitative de l’effet therapeutique n’a ete possible que dans 61 etudes. Neanmoins, des recommandations pour la prise en charge de la gonarthrose reposant sur les donnees actuellement disponibles et l’avis des experts ont pu etre etablies, de meme que des propositions relatives aux axes de recherche futurs. Conclusion. Ces directives cliniques sur le traitement de la gonarthrose sont les premieres a combiner une approche fondee sur des donnees scientifiques et une approche consensuelle fondee sur l’avis d’experts, pour evaluer differentes modalites therapeutiques. Il apparait que seules certaines propositions sont corroborees par des donnees scientifiques etablies. Ce constat souligne le besoin urgent de conduire des essais bien concus afin d’obtenir des reponses a des questions cliniques majeures.

Objective To determine the most relevant method of measurement of the radiographic hip joint space width (JSW). Design Seventy hips were examined from 36 patients of the ECHODIAH study having had one to four X-rays of the pelvis during the 3-year course of the study. Minimum interbone distance (MIDc), mean width of both the whole joint space (MJSWL) and a region of interest of the joint space (MJSWroi) were measured using computerized analysis of digitized radiographs. MID was also measured using a graduated eyepiece (MIDge). Reproducibility of the measurement was assessed by the intraclass coefficient of correlation. Sensitivity to change was evaluated by the standardized response mean. Results The intraobserver intraclass coefficient of correlation of MIDc and MJSWroi was 0.98 and 0.94, respectively. The mean value°S.D. of MJSWL, MJSWroi, MIDc and MIDge was 3.3°0.9, 2.6°0.9, 2.4°0.9 and 2.6°1.2mm, respectively. MIDge was significantly larger than MIDc (mean difference: 0.21°0.62mm, P 0.001), in both normal and osteoarthritic hips. However, the difference between MIDge and MIDc varied largely when considering topography of femoral head migration. Whatever the method was, a significant ( P 0.001) mean decrease of nearly 0.5mm was found in osteoarthritic hips over the 3 year follow-up. The standardized response mean for MJSWL, MJSWroi, MIDge and MIDc was 0.73, 0.75, 0.79 and 0.85, respectively. Superiority of MIDc, in term of sensitivity to change, was mainly seen in osteoarthritic hips showing a superomedial or a concentric migration of the femoral head. Conclusion Minimum interbone distance measured with a computer assisted method is suggested as the most suitable method for the evaluation of hip osteoarthritis (OA) progression.

Objective To evaluate the ability of diacerein, an interleukin-1β inhibitor, to slow the progressive decrease in joint space width observed in patients with hip osteoarthritis (OA). Methods In this randomized, double-blind, placebo-controlled 3-year study, 507 patients with primary OA of the hip (by the American College of Rheumatology criteria) received diacerein (50 mg twice a day) or placebo. The minimal hip joint space width was measured by a central reader on yearly pelvic radiographs, using a 0.1-mm–graduated magnifying glass. Results Baseline characteristics were comparable in the 2 treatment groups (255 patients receiving diacerein, 252 receiving placebo); 238 patients (47%) discontinued the study, mainly because of adverse events in the diacerein group (25% versus 12% with placebo) and because of inefficacy in the placebo group (14% versus 7% with diacerein). The percentage of patients with radiographic progression, defined by a joint space loss of at least 0.5 mm, was significantly lower in patients receiving diacerein than in patients receiving placebo, both in the intent-to-treat analysis and in the completer analysis (50.7% versus 60.4% [P = 0.036] and 47.3% versus 62.3% [P = 0.007], respectively). In those patients who completed 3 years of treatment, the rate of joint space narrowing was significantly lower with diacerein (mean ± SD 0.18 ± 0.25 mm/year versus 0.23 ± 0.23 mm/year with placebo; P = 0.042). Diacerein had no evident effect on the symptoms of OA in this study. However, a post hoc covariate analysis that took into account the use of analgesics and antiinflammatory drugs showed an effect of diacerein on the Lequesne functional index. Diacerein was well tolerated during the 3-year study. The most frequent adverse events were transient changes in bowel habits. Conclusion This study confirms previous clinical findings indicating that the demonstration of a structure-modifying effect in hip OA is feasible, and shows, for the first time, that treatment with diacerein for 3 years has a significant structure-modifying effect as compared with placebo, coupled with a good safety profile. The clinical relevance of these findings requires further investigation.

H. Summary H.1. symptom modifying drugs The primary outcome variable is a specific aspect of joint pain, although a ‘signal' symptom or some measure of function may also be studied. Trials of drugs with a rapid onset of effect can be as short as 1–4 weeks but may be as long as 12 weeks. Longer trials (up to 2 years) may be needed to evaluate longer-term toxicity, determine optimal long-term dosing regimens, or establish long-term benefit. Supplemental escape analgesia should be minimized, monitored and discontinued prior to evaluation of efficacy. Some agents that provide symptom relief may not provide benefit until weeks after initiation of therapy. Under these circumstances, trials will vary from 3–12 months in length. If the agent is administered in courses, episodic readministration of the drug may be needed in long-term trials. Longer trials (up to 2 years) may be required to exclude toxicity or establish long-term benefit. H.2. structure modifying drugs These drugs are intended to prevent, retard, stabilize or reverse development of the morphologic changes of OA. Although this has been called ‘chondroprotection', the term is misleading and should be avoided, because all structures of the joint are involved in OA, not articular cartilage alone. The benefits of disease modifying therapy may not be apparent until years after the onset of treatment. The selection of high-risk groups may shorten the time of investigation. Improvement in symptoms (i.e., joint pain) is not a requisite for the efficacy of a drug in this category. In these studies, it may be necessary to permit concomitant use of drugs for relief of symptoms (NSAIDs, analgesics). The confounding effects of glucocorticoids and NSAIDs in these trials is not yet understood and very restricted use of IA depocorticosteroids is recommended. Demonstration of structure modification will require the use of direct measures of joint anatomy, such as radiography, particularly measurement of the radiographic joint space. As stated above, the plain radiograph is presently the most reproducible and readily available method for assessment of disease modification. Studies are needed to validate surrogate markers of disease activity, since they may help shorten Phase 2 structure modifying drug trials. As an alternative to radiography, some trials may utilize arthroscopy. As we approach the beginning of the twenty-first century, concepts of clinical trials of OA drugs are changing. Methodology and techniques for the evaluation of new agents for OA have been refined dramatically over the last decade. We look forward to the future with excitement as we anticipate the development of new agents that may alter the symptoms and course of OA. The above recommendations are intended to help us ascertain which of these new agents are effective.

Several indices have recently been constructed by rheumatologists for the assessment of clinical status in osteoarthritis of the extremities. These include the algofunctional indices for the hip and knee (Lequesne), the Western Ontario and McMasters Universities (WOMAC) index (Bellamy), patients and investigator's overall opinion (results of drug trials), global evaluation of change in handicap (self-assessment), and articular index of physical examination in nature (Doyle et al). Each of the above indices have been validated by their respective authors. Presently, we propose to further validate the disease-activity indices.

Objective To evaluate the value (sensitivity and specificity) of 2 modified physical tests for the diagnosis of gluteal tendinopathy in patients with refractory greater trochanter pain syndrome (GTPS). Methods The 2 tests were prospectively evaluated by a single physician in all consecutive patients with persistent (≥4 months) GTPS and no hip joint arthropathy seen on radiography between 2002 and 2006. The 2 tests evaluated the occurrence of pain similar to spontaneous pain during a single-leg stance held for 30 seconds and resisted external derotation in a supine position (hip flexed 90°) then prone position (hip extended). A matched control population without hip pain was examined similarly. Tendinitis, tendon tear, and associated bursitis in the target group were documented by magnetic resonance imaging (MRI) in transverse, coronal, and sagittal planes, with MRI serving as the gold standard. Results Seventeen patients completed the study (mean ± SD age 68.1 ± 10.8 years, mean duration of symptoms 13 months). MRI revealed tendinopathy and/or bursitis of the gluteus medius and/or minimus tendons in all patients, with evidence of tearing in 15. Sensitivity and specificity were 100% and 97.3%, respectively, for the single-leg stance test and 88% and 97.3%, respectively, for the resisted external derotation test in the supine position. Conclusion The 30-second single-leg stance and resisted external derotation tests had very good sensitivity and specificity for the diagnosis of tendinous lesion and bursitis in patients with MRI-documented refractory GTPS.

Proximal arterial stenosis (bifurcation of the aortic, common iliac and especially hypogastric or hip arteries) can cause misleading 'hip' or buttock pain (two thirds of these cases involve the area of the trochanter, groin, or thigh). Their essential characteristic is that they cause patients to stop walking, improve in a minute or two and reappear when the patient starts walking again. Neither articular complications nor periarthritis of the hip fit this pattern, and physical examination and imaging exclude them. Neurogenic intermittent claudication is more difficult to rule out: it is 'often accompanied by paresthesia and anteflexion of the trunk to relieve the pain. A radiologic image of lumbar canal stenosis alone does not indicate that it is responsible for the pain: the stenosis may be asymptomatic and only fortuitously associated with the pain. The usual reduction in femoral pulse or ankle pressure index is absent if the stenosis is located on the hypogastric or gluteal artery and there is not substantial damage to the aorta-iliac axis. Arterial stenosis is confirmed by Doppler ultrasound. Arteriography is an examination performed during treatment, to guide angioplasty. It is indicated when medical treatment fails, as it frequently does.

Osteoarthritis (OA) is the most common articular rheumatic disease. A Task Force addressed the (1) present status of osteoarthritis referable to diagnosis, outcome measures, and therapy and (2) the gaps in our knowledge and future research priorities referable to epidemiology, risk factors, prospects for prevention, basic sciences, measurable outcomes, and therapeutics. There has been dramatic improvement in our understanding of the etiopathogenesis and methods of measuring progression in OA, with a clear separation in the goals of therapy into symptom and structure modification. The future is opening to a new era of diagnostics with the prospect of altering the course of the disease.

To determine whether systemic markers of bone, cartilage, and synovium can predict structural progression of osteoarthritis (OA).Patients with painful hip OA were treated with diacerein or placebo in a multicentre, prospective, double blind, 3 year follow up trial. The following information was collected at entry: demographics, characteristics of hip OA, and 10 markers: N-propeptides of collagen types I and III, cartilage oligomeric matrix protein, YKL-40, hyaluronan (sHA), matrix metalloproteinases-1 and -3, C reactive protein, C-terminal crosslinking telopeptides of collagen types I and II (uCTX-II). Radiographs were obtained at entry and every year. Structural progression was defined as a joint space decreaseor =0.5 mm or requirement for total hip replacement. Grouped survival analysis was performed with time to structural progression as dependent variable, and clinical data, radiographic findings, treatment groups (diacerein versus placebo), and markers as explanatory measures.In the 333 patients in whom all markers were measured, high functional impairment, a joint space width2 mm, and lateral migration of the femoral head at baseline increased the risk of progression, but diacerein had a protective effect (relative risk = 0.75; 95% confidence interval (CI) 0.54 to 0.96). In addition, patients in whom uCTX-II and sHA were in the upper tertile had a relative risk of progression of 3.73 (95% CI 2.48 to 5.61) compared with patients with markers in the two lower tertiles.In this large cohort, combined measurements of uCTX-II and sHA were a new predictor of the structural progression of hip OA.

To investigate the associations of molecular markers of joint tissue turnover with clinical and radiological variables in patients with hip osteoarthritis (OA).Patients of the ECHODIAH trial cohort (60% female; mean age 63 yrs, disease duration 5 yrs) fulfilling the American College of Rheumatology criteria for hip OA were studied. Pain was assessed using a 100 mm visual analog scale, and the presence of night pain and morning stiffness was observed as the index of joint inflammation. Joint space width (JSW) and subchondral bone sclerosis were assessed on hip radiographs. Ten markers were measured, 8 in serum: N-propeptides of collagen type I (PINP) and type III (PIIINP), cartilage oligomeric matrix protein (COMP), YKL-40, hyaluronan (HA), matrix metalloproteases (MMP1 and MMP3), and ultrasensitive C-reactive protein (CRP); and 2 in urine: C-terminal crosslinking telopeptides of collagen type I (CTX-I) and type II (CTX-II). Analyses of 376 patients with measurements of all the markers included principal component analyses to identify independent clusters of markers; followed by stepwise multivariate regressions to determine associations between markers, clinical variables, and radiographic signs of joint damage.Markers could be segregated into independent clusters: CTX-II, PINP, and CTX-I for cartilage degradation and bone turnover; COMP, PIIINP, and HA as potential markers of synovitis; and CRP and YKL-40, which are likely to indicate systemic inflammation; plus MMP1 and MMP3. After adjustment for age, sex, and body mass index, pain was significantly associated with CTX-II (p = 0.0095) and CRP (p = 0.046) and joint inflammation with COMP (p = 0.013). Radiographic signs of joint damage were associated with CTX-II (p = 0.001 for JSW; p = 0.007 for bone sclerosis).This cross-sectional study of OA molecular markers in a large cohort may provide biological evidence of different pathophysiological processes involved in hip OA. Among the markers measured, CTX-II showed the most consistent association with the symptoms and joint damage of OA.

Objective: To evaluate sex differences in the clinical and structural presentation, and natural history of hip OA. Methods: A multicentre, prospective, longitudinal, five year follow up study of 508 patients (302 women, 206 men, mean age 63 (7) years) with painful hip OA. Data collected were baseline demographics, symptomatic, therapeutic, and structural variables; symptomatic variables and changes in joint space width (JSW) during the first year's follow up; requirement for total hip arthroplasty (THA) between the end of the first and fifth years. Statistical analysis: evaluation of sex differences (a) at baseline, in the main characteristics of hip OA using multivariate logistic regression; (b) during the first year of follow up, in the radiological progression of the disease; (c) during the five years of follow up, in the requirement for THA using Kaplan-Meier curves and the log rank test, and of the parameters related to THA, using a multivariate Cox analysis. Results: At entry, women presented more frequently than men with polyarticular OA (mean (SD) articular score 306 (162) v 235 (127)), and superomedial migration of the femoral head (40% v 19%), and had more severe symptomatic disease (patient's overall assessment 46 (23) v 40 (26)). The change in JSW did not differ between women and men after one year, but a greater proportion of women had rapid structural progression (OR=2.34, 95% CI 1.1 to 5.2). THA was performed more often in women. Multivariate analysis suggested that the decision to perform surgery was related more closely to the symptomatic and structural severity of the disease than to the sex of the patient. Conclusion: Hip OA in women is more frequently part of a polyarticular OA, and displays greater symptomatic and structural severity.

If all the etiological factors are taken into consideration, idiopathic coxarthrosis is less prevalent than formerly. Three factors are new or reappraised: sport practice (more than 10 years in competition), certain occupations (dancer, heavy load worker) and heritability. Three are classical and yet present: developmental dysplasias, acquired dysmorphias and traumas. Hip osteoarthritis should be followed up with the help of pain intensity measured on visual analog scale, algofunctional index and self-assessment of handicap. These 3 parameters--and not the X-ray image--are the basis of the decision for total hip replacement. However, the latter could be foreseen as necessary within the next 1-4 years when a rapid joint space narrowing is observed (about 5-7% of cases).