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Joint Space Narrowing and Relationship with Symptoms and Signs in Adults Consulting for Hip Pain in Primary Care
SITA M.A. BIERMA-ZEINSTRA, J. DORINDE OSTER, ROOS M.D. BERNSEN, JAN A.N. VERHAAR, ABIDA Z. GINAI, and ARTHUR M. BOHNEN
ABSTRACT.
Methods. Consecutive patients (n = 220) aged 50 years or older consulting the general practitioner for hip pain and referred for radiological investigation underwent a standardized history, radiological, laboratory, and physical examination. Radiological OA was confirmed with joint space £ 2.5 mm. Additionally, a more stringent definition was used (£ 1.5 mm). The relationship between radiological OA and possible clinical symptoms/signs of OA was tested. Combinations of clinical symptoms/signs that had shown an independent relationship with radiological OA in multivariate analyses were tested for their predictive value. Results. Radiological OA (joint space £ 2.5 mm) of the (more) symptomatic hip was present in 35.5% of the study population and more severe OA (joint space £ 1.5 mm) in 11.4%. Presence of 4 specific symptoms/signs from history and examination showed a positive predictive value (PPV) of 73% (specificity 91%, sensitivity 45%) for radiological OA. When 5 specific symptoms/signs were present, the PPV for the more severe radiological OA was 82% (specificity 98%, sensitivity 72%), and when 6 or 7 specific symptoms/signs were present the PPV was 100% (specificity 100%, sensitivity 40% and 8%, respectively). Negative predictive values were high for almost all combinations. Conclusion. In primary care patients with hip pain, clinical symptoms and signs can to a moderate extent predict radiological OA and to a large extent more severe radiological OA. (J Rheumatol 2002;29:1713-8) Key Indexing Terms:
HIP JOINT
From the Department of General Practice, Department of Rehabilitation Medicine, Department of Orthopaedic Surgery, Department of Radiology, Erasmus University, Rotterdam, The Netherlands. S.M.A. Bierma-Zeinstra, PhD; R.M.D. Bernsen, MSc; A.M. Bohnen, MD, PhD, Department of General Practice; J.D. Oster, MD, Department of Rehabilitation Medicine; J.A.N. Verhaar, MD, PhD, Department of Orthopaedic Surgery; A.Z. Ginai, MD, PhD, Department of Radiology. Address reprint requests to Dr. S.M.A. Bierma-Zeinstra, Department of General Practice, Erasmus University, Room Ff 320, Postbox 1738, 3000 DR Rotterdam, the Netherlands. E-mail: Bierma@hag.fgg.eur.nl Submitted July 23, 2001; revision accepted January 30, 2002. |