Department of Rheumatology, HUCA, Central University Hospital of Asturias, Oviedo, Spain.
Scand J Rheumatol. 2013;42(3):220-5. doi: 10.3109/03009742.2012.739637. Epub 2013 Jan 14.
To present two cases of Andersson lesion (AL) as the form of onset of psoriatic arthritis (PsA), to review the form of onset of axial disease in PsA in our area, and to study the prevalence of AL in this series.
Two patients with psoriasis and recent-onset inflammatory back pain (IBP) with no known arthritis are presented. A final diagnosis of AL based on magnetic resonance imaging (MRI) findings was made. The medical records of 120 consecutive patients with axial PsA were reviewed and the most relevant features at disease onset analysed.
Including the two cases presented, an AL prevalence of 5.7% was found in this series. The most common onset forms of axial PsA were: oligoarthritis (30%), IBP (21.7%), enthesitis (17.5%), polyarthritis (16%), gluteal pain (8.3%), dactylitis (3.3%), and distal interphalangeal (DIP) involvement (3.3%). Compared to women, men more frequently showed enthesitis (25% vs. 9%, p = 0.03) and IBP (31% vs. 10.7%, p = 0.007) as onset forms whereas a polyarticular onset was predominant in women (25% vs. 8%, p = 0.01). The polyarticular onset was predictive of radiological damage in the cervical column during follow-up [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.82-6.83, p = 0.01]. Enthesitis (23.6% vs. 8.3%, p = 0.02) and IBP (29.7% vs. 10.4%) were the predominant onset forms in patients with age at disease onset ≤ 40 years and polyarthritis (27% vs. 8.3%, p = 0.009) was predominant in those with disease onset > 40 years.
AL is an uncommon finding in axial PsA and its appearance at disease onset is exceptional. MRI is a key tool in its early recognition.
介绍两例安德森病变（AL）作为银屑病关节炎（PsA）发病形式，回顾本地区脊柱疾病发病形式，研究该系列中 AL 的患病率。
介绍两例银屑病和近期出现炎症性背痛（IBP）且无已知关节炎的患者。根据磁共振成像（MRI）结果作出 AL 的最终诊断。回顾了 120 例连续的轴向 PsA 患者的病历，并分析了发病时最相关的特征。
本系列中发现 AL 的患病率为 5.7%，包括所介绍的两例病例。轴向 PsA 最常见的发病形式为：少关节炎（30%）、IBP（21.7%）、附着点炎（17.5%）、多关节炎（16%）、臀痛（8.3%）、指炎（3.3%）和远端指间关节炎（DIP）（3.3%）。与女性相比，男性更常出现附着点炎（25%比 9%，p=0.03）和 IBP（31%比 10.7%，p=0.007）作为发病形式，而女性则以多关节炎发病为主（25%比 8%，p=0.01）。多关节炎发病与随访时颈椎柱的放射学损伤有关[比值比（OR）2.6，95%置信区间（CI）1.82-6.83，p=0.01]。发病年龄≤40 岁的患者中，附着点炎（23.6%比 8.3%，p=0.02）和 IBP（29.7%比 10.4%）是主要发病形式，而发病年龄>40 岁的患者中，多关节炎（27%比 8.3%，p=0.009）是主要发病形式。
AL 在轴向 PsA 中不常见，其发病形式罕见。MRI 是早期识别的关键工具。
