Service de Rhumatologie, Hôpital Henri Mondor, Créteil, France.
Rheumatology (Oxford). 2013 Sep;52(9):1686-93. doi: 10.1093/rheumatology/ket207. Epub 2013 Jun 13.
To assess whether factors such as inflammation by laboratory tests and MRI differ between early axial SpA with and without radiographic lesions.
Cross-sectional analysis of baseline data from Devenir des Spondylarthropathies Indifferenciées Récentes (DESIR) cohort patients having recent-onset inflammatory back pain and meeting Assessment of SpondyloArthritis international Society criteria. The baseline evaluation included radiographs and MRI of the SI joints (SIJs) and spine. Patients were classified as having radiographic lesions if they had at least one obvious sacroiliitis, grade 2 for at least one vertebral corner or grade 1 for at least two vertebral corners (at the cervical or lumbar level, according to the modified Stoke Ankylosing Spondylitis Spine Score). Associations between baseline characteristics and the presence of radiographic lesions were evaluated by estimating multi-adjusted odd ratios (aORs) and their 95% CIs using a logistic regression model.
Of 475 patients, 180 (37.9%) had radiographic lesions. Factors positively associated with radiographic lesions were alcohol use (aOR 2.42; 95% CI 1.31, 4.44; P = 0.005), CRP level (aOR 1.44; 95% CI 1.13, 1.84; P = 0.003) and SIJ inflammation by MRI (aOR 2.25; 95% CI 1.40, 3.60; P = 0.001); negative associations occurred with good NSAID responsiveness (aOR 0.44; 95% CI 0.24, 0.81; P = 0.008); spinal MRI inflammation was associated with radiographic lesions only in smokers (aOR 1.99; 95% CI 1.01, 3.92; P = 0.048).
Alcohol use, poor responsiveness to NSAIDs, CRP elevation, SIJ MRI inflammation and spinal MRI inflammation in smokers were independently associated with radiographic lesions in early axial SpA.
评估实验室检查和 MRI 显示的炎症等因素在早期无放射学病变和有放射学病变的中轴型脊柱关节炎（axSpA）患者中是否存在差异。
对近期出现炎症性背痛且符合脊柱关节炎国际协会（ASAS）诊断标准的新近发病的 Devenir des Spondylarthropathies Indifferenciées Récentes（DESIR）队列患者的基线数据进行横断面分析。基线评估包括骶髂关节（SIJ）和脊柱的 X 线和 MRI。如果患者至少有一处明显的骶髂关节炎，至少一处椎体角为 2 级或至少两处椎体角（颈椎或腰椎水平，根据改良 Stoke 强直性脊柱炎脊柱评分）为 1 级，则将其归类为存在放射学病变。使用逻辑回归模型估计多调整后的优势比（aOR）及其 95%置信区间（CI），以评估基线特征与放射学病变之间的相关性。
在 475 名患者中，180 名（37.9%）存在放射学病变。与放射学病变呈正相关的因素包括饮酒（aOR 2.42；95%CI 1.31，4.44；P = 0.005）、C 反应蛋白（CRP）水平（aOR 1.44；95%CI 1.13，1.84；P = 0.003）和 MRI 显示的 SIJ 炎症（aOR 2.25；95%CI 1.40，3.60；P = 0.001）；与放射学病变呈负相关的因素包括 NSAID 反应良好（aOR 0.44；95%CI 0.24，0.81；P = 0.008）；只有在吸烟者中，脊柱 MRI 炎症与放射学病变相关（aOR 1.99；95%CI 1.01，3.92；P = 0.048）。
饮酒、对 NSAID 反应差、CRP 升高、SIJ MRI 炎症和吸烟者的脊柱 MRI 炎症与早期中轴型 SpA 的放射学病变独立相关。
