Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care
OBJECTIVE: To study whether clinical symptoms and signs can predict radiological osteoarthritis (OA) of the hip in primary care patients with hip pain. 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 < or = 2.5 mm. Additionally, a more stringent definition was used (< or = 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 < or = 2.5 mm) of the (more) symptomatic hip was present in 35.5% of the study population and more severe OA (joint space < or = 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.
|Keywords||Female, Hip Joint/physiopathology/*radiography, Humans, Male, Middle Aged, Osteoarthritis, Hip/complications/physiopathology/*radiography, Pain/etiology/physiopathology/*radiography, Predictive Value of Tests, Primary Health Care, ROC Curve, Referral and Consultation|
Bierma-Zeinstra, S.M., Oster, J.D., Bernsen, R.M.D., Verhaar, J.A.N., Ginai, A.Z., & Bohnen, A.M.. (2002). Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care. Journal of Rheumatology, 1713–1718. Retrieved from http://hdl.handle.net/1765/15551