RU2558990C1 - Method for prediction of risk of osteoarthrosis in individuals with joint hypermobility - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: range of motions of hand joints is determined by conducting 9 tests: 1 - active ulnar deviation of II-V fingers by metacarpophalangeal and interphalangeal deflexion; 2 - active hyperextension of II-V fingers ≥90°; 3 - nail bone protrusion over an ulnar border of the palm with a thumb fixed across the palm; 4 - passive thumb adduction to the back of the hand; 5 - hyperextension of carpometacarpal joint of the thumb; 6 - active flexion in distal interphalangeal joints of II-V fingers; 7 - transverse finger traction in the opposite direction in the metacarpophalangeal joints of II-III, III-IV fingers; 8 - passive alternating overlap of III, IV, V fingers; 9 - hand rotation through full 360° in shoulder and elbow joints. The past medical history is studied to find the onset of joint pains and to detect a snapping hip symptom. If the individual with the joint hypermobility have the onset of joint pains at the age of 38 years or earlier, while four or more ranges of motion tests appear to be positive, the risk of osteoarthrosis makes 100%. The individuals with the onset of the joint hypermobility at the age of 38 years or later, having two or more ranges of motion tests positive suffer the risk of osteoarthrosis making 69.6%. In the individuals with the onset of the joint hypermobility at the age of 38 years or later having two or more ranges of motion tests positive and suffering the snapping hip symptom, the risk of osteoarthrosis makes 25%. The individuals having the onset of the joint hypermobility at the age of 38 years or later and completed at least two ranges of motion tests with no snapping hip symptom detected suffer the risk of osteoarthrosis making 0%.

EFFECT: method enables increasing an accuracy of predicting the risk of osteoarthrosis in the individuals suffering the joint hypermobility by determining the hand range of motions and the age of the onset of joint pains.

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Description

The present invention relates to medicine, namely to rheumatology. It can be used by rheumatologists, general practitioners, therapists to determine the prognosis of the risk of osteoarthritis in people with joint hypermobility on an outpatient basis.

Joint hypermobility - a condition in which the amplitude of active and / or passive movements in the joints exceeds the conventional average norm [Grahame R. Hypermobility: an important but often neglected area within rheumatology // Nat. Clin. Pract. Rheumatol. - 2008. - Vol.4, No. 10. - P. 522-524]. The most serious complication of hypermobility of the joints is the occurrence of early osteoarthrosis, which is one of the main causes leading to premature disability [Keer R.J. Hypermobility and the hypermobility syndrome // Man. Ther. - 2007. - Vol.12, No. 4. - P. 298-309].

A known method for assessing joint hypermobility using tests of the Beiton scale with a score of the subject's ability to perform 5 movements, 4 paired for limbs and one unpaired for the body: 1. passively bring I finger to the forearm; 2. passively bend back the V finger in the metacarpophalangeal joint by more than 90 °; 3. passively unbend the elbow joint ≥10 °; 4. passively unbend the knee joint ≥10 °; 5. Intensively press your palms to the floor without bending your knees. In this case, 1 point is assigned for each test performed. The test is considered positive if the patient receives 4 or more of the maximum possible 9 points [Beighton P., De Raere Α., Steinmann B. et al. Ehlers-Danlos syndromes: Revised nosology, Villefranche, 1997. American Journal of Medical Genetics 1998; 77 (1): 31-37.9].

The disadvantages of this method include the fact that the determined tests can only diagnose joint hypermobility, but are not prognostic for determining the risk of osteoarthritis.

The prototype of the proposed method is a modification of the Beiton scale proposed by F. Schilling to identify "hypermobility individuals" prone to osteoarthritis. The essence of the modification is to supplement Beiton’s tests with “Paganini syndrome” to determine the range of motion in the joints of the hands (9 tests): 1. active ulnar deviation of the II-V fingers due to deviation in the metacarpophalangeal and interphalangeal joints; 2. active re-extension of the II-V fingers of the hands ≥90 °; 3. re-extension of the carpal-metacarpal joint of the thumb of the hand; 4. the protrusion of the nail phalanx beyond the ulnar edge of the palm while fixing the thumb across the palm; 5. passive adduction of the thumb to the back of the hand; 6. active flexion in the distal interphalangeal joints of the II-V fingers of the hands, which may resemble the “swan neck”; 7. transverse extension of the fingers in the opposite direction in the metacarpophalangeal joints in the form of twine, this test is checked in pairs in the II-III, III-IV fingers of the hand; 8. passive alternate laying of the III, IV, V fingers of the hands on top of each other, “finger-snail”; 9. 360 ° rotation of the arm in the shoulder and elbow joint [Schilling F. Die instabilität der Hand- und Fingergelenke bei der konstitutionellen Hypermobilität: Ein “Paganini-Syndrom” // Akt. Rheumatol. - 2007 .-- Vol.32. -P. 355-357].

The disadvantage of this modification is that they do not accept any numerical gradations and combinations of defined tests to predict the risk of osteoarthritis in hypermobilized individuals.

An analogue is a method for predicting complications of joint hypermobility syndrome in adolescents by determining risk factors from a history of life and clinical indicators. The risk factors included the gender of the subject, the age of the mother at the time of birth of the subject, the intensity of physical activity. In this method, gradations and numerical values of the parameters used were established. The prognostic factors F1 and F2 were determined. With an F1 value less than F2, a low risk of developing complications of hypermobility syndrome is predicted, with an F1 greater than F2, a high risk [Dats LS, Menshikova LV, Dats AV, Babanskaya EB Prediction of complications of joint hypermobility syndrome in adolescents. Siberian Medical Journal No. 6 September 2012 volume 113. P.38-40].

The disadvantages of this method include the fact that it gives a forecast only of dislocations and subluxations of joints exclusively in adolescence. The risk of developing osteoarthritis is determined in this way indirectly in the presence of dislocations, subluxations of the joints as predictors of its development, persons of other age categories are not taken into account. In this method, the risk is defined only as high or low, without indicating other possible levels of risk. It is also necessary to determine the values of prognostic coefficients by formulas, which requires the doctor at the reception to resort to their calculation using a computer with additional time.

An object of the invention is the development of a highly sensitive, highly specific and easily interpreted as an outpatient physician rheumatologist method for predicting the risk of osteoarthritis in patients with joint hypermobility.

The method is as follows.

The method includes determining the range of motion in the joints of the hands (during 9 tests): 1 - active ulnar deviation of the II-V fingers of the hand (due to deviations in the metacarpophalangeal and interphalangeal joints), 2 - active re-extension of the II-V fingers of the hands ≥90 °; 3 - protrusions of the nail phalanx beyond the ulnar edge of the palm when fixing the thumb across the palm; 4 - passive reduction of the thumb to the back of the hand; 5 - re-extension of the carpal-metacarpal joint of the thumb of the hand; 6 - active flexion in the distal interphalangeal joints of the II-V fingers of the hands; 7 - transverse extension of the fingers in the opposite direction in the metacarpophalangeal joints in the II-III, III-IV fingers of the hand; 8 - passive alternating laying of the III, IV, V fingers of the hands on each other; 9 - rotation of the arm 360 ° in the shoulder and elbow joint. Additionally, the age of the onset of joint pain is determined from the history of life and the presence of the symptom of a “snapping” hip is determined (a clicking sensation in the hip joint that occurs systematically when standing up, walking or rotating the legs) [Wahl CJ et al: Internal coxa saltans (snapping hip) as a result of overtraining: a report of 3 cases in professional athletes with a review of causes and the role of ultrasound in early diagnosis and management. Am J Sports Med 2004; 32 (5): 1302]. Based on a combination of all the above indicators, the percentage of the risk of developing osteoarthritis (high, medium, low risk) in people with joint hypermobility is determined. If people with joint hypermobility have joint pain debut before the age of 38 years and four or more tests for the range of motion in the joints of the hands, the risk of osteoarthritis is 100%. In persons with joint hypermobility, the onset of joint pain at the age of 38 years or more, the presence of two or more tests for the range of motion in the joints of the hands, the risk of osteoarthritis is 69.6%. In patients with joint hypermobility, the onset of joint pain at the age of 38 years or more, performing less than two tests for range of motion in the joints of the hands and the presence of a “clicking” hip symptom, the risk of osteoarthritis is 25%. In persons with joint hypermobility, the onset of joint pain at the age of 38 years and more, performing less than two tests on the range of motion in the joints of the hands in the absence of a symptom of a “clicking” hip, the risk of developing osteoarthritis is 0%. A method for predicting the risk of osteoarthritis in people with joint hypermobility was developed using the classification tree method based on a combination of tests performed for the amount of movement in the joints of the hand, the age of the onset of joint pain, and the symptom of a “clicking” hip (table 1).

Effect: the proposed method improves the accuracy of predicting the risk of osteoarthritis in individuals with hypermobility of the joints. Clinical observations indicate that the use of the proposed technical solution allows us to predict the risk of osteoarthritis in people with hypermobility of the joints in percentage terms. When conducting a ROC analysis of the quality assessment of the proposed model for predicting the risk of osteoarthritis in patients with joint hypermobility, the diagnostic sensitivity was 82.0%), specificity was 88.3%, and efficiency was 85.2% (Figure 1).

The proposed method for predicting the risk of osteoarthritis in individuals with joint hypermobility is illustrated by clinical examples.

Example 1. Patient Ε., 29 years old. Diagnosis: Bilateral gonarthrosis, Rg art. I, FN I against the background of joint hypermobility (7 points on the Beiton scale) From the amnesia of life, it was determined that pain in the knee joints has been bothering since 20 years. An objective examination of the symptom of a snapping thigh is negative. When determining the additional range of motion in the hands of nine tests, four were performed: active re-extension of the II-V fingers of the hands ≥90 °; passive adduction of the thumb to the back of the hand; active flexion in the distal interphalangeal joints of the II-V fingers of the hands; passive alternating laying of the III, IV, V fingers of the hands on each other. Based on the clinical examination and the history of life, the following combination of signs was revealed: age of debut of pain in the joints <38 years, performance of ≥4 tests for range of motion in the joints of the hands. Thus, the risk of osteoarthritis by the proposed method is 100%. At 27 years of age with an X-ray examination of the knee joints, osteoarthrosis of Rg art. I.

Example 2. Patient N, 40 years. Actively does not make complaints. On examination, hypermobility of the joints was revealed (7 points on the Beiton scale). From the anamnesis of life, the patient denies the presence of pain in the joints. An objective examination of the symptom of a snapping thigh is negative. When determining the additional range of motion in the hands, one test was performed - the protrusion of the nail phalanx beyond the ulnar edge of the palm while fixing the thumb across the palm of the hand. Based on the clinical examination and the anamnesis, the following combination of signs was revealed: performing <2 tests on the range of motion in the joints of the hands, the absence of a “clicking” hip symptom, thus, the risk of osteoarthritis by the proposed method is 0%. An X-ray examination of the knee joints showed no signs of osteoarthrosis.

Clinical studies of the proposed method were carried out from 2011 to 2014 on the basis of the clinic of a budgetary health institution in the Omsk Region (BUZOO) "City Clinical Hospital No. 1 named after Kabanova A.N. A total of 61 patients with hypermobility of the joints aged 21 to 61 years were examined. To predict the risk of osteoarthritis in patients with joint hypermobility, the classification tree method was used. The classification tree allows you to build groups of patients with different levels of risk of developing osteoarthritis (high-, medium-, low-risk classes) based on a combination of significant indicators. The classification tree is a simple intuitive structure in the form of a dendrogram on which the size of the selected group and the risk of osteoarthritis are indicated on each node (Figure 2).

The method allows patients from high and medium risk groups to timely prevent osteoarthritis.

Claims (1)

A method for predicting the risk of osteoarthritis in people with hypermobility of the joints, including determining the range of motion in the joints of the hands during 9 tests: 1 - active ulnar deviation of the II-V fingers, due to deviations in the metacarpophalangeal and interphalangeal joints, 2 - active overextension II -V fingers of the hands ≥90 °; 3 - protrusions of the nail phalanx beyond the ulnar edge of the palm when fixing the thumb across the palm; 4 - passive reduction of the thumb to the back of the hand; 5 - re-extension of the carpal-metacarpal joint of the thumb of the hand; 6 - active flexion in the distal interphalangeal joints of the II-V fingers of the hands; 7 - transverse extension of the fingers in the opposite direction in the metacarpophalangeal joints in the II-III, III-IV fingers of the hand; 8 - passive alternating laying of the III, IV, V fingers of the hands on each other; 9 - 360 ° rotation of the arm in the shoulder and elbow joints, characterized in that it additionally reveals the age of onset of joint pain from a medical history and determines the presence of a symptom of a “snapping” hip, while in patients with hypermobility joints joint debut of joint pain under the age of 38 years and four or more tests performed on the range of motion in the joints of the hands, the risk of osteoarthritis is 100%, in patients with joint hypermobility, debut of joint pain aged 38 years or more, the presence of two or more tests performed the rate of osteoarthritis in the joints of the hands is 69.6%; in patients with joint hypermobility, the onset of joint pain is 38 years or more, less than two tests for the range of motion in the joints of the hands and the presence of a “clicking” hip symptom osteoarthritis is 25%, in people with joint hypermobility, debility of joint pain aged 38 years or more, performing less than two tests on the range of motion in the joints of the hands in the absence of the symptom of a “clicking” hip is at risk of osteoa htrosa is 0%.

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