Leiden University Medical Center, Leiden, The Netherlands.
Arthritis Rheumatol. 2014 Mar;66(3):667-73. doi: 10.1002/art.38283.
To evaluate the presence of spinal inflammation with and without sacroiliac (SI) joint inflammation on magnetic resonance imaging (MRI) in patients with active nonradiographic axial spondyloarthritis (SpA), and to compare the disease characteristics of these subgroups.
ABILITY-1 is a multicenter, randomized, controlled trial of adalimumab versus placebo in patients with nonradiographic axial SpA classified using the Assessment of SpondyloArthritis international Society axial SpA criteria. Baseline MRIs were centrally scored independently by 2 readers using the Spondyloarthritis Research Consortium of Canada (SPARCC) method for the SI joints and the SPARCC 6-discovertebral unit method for the spine. Positive evidence of inflammation on MRI was defined as a SPARCC score of ≥2 for either the SI joints or the spine.
Among patients with baseline SPARCC scores, 40% had an SI joint score of ≥2 and 52% had a spine score of ≥2. Forty-nine percent of patients with baseline SI joint scores of <2, and 58% of those with baseline SI joint scores of ≥2, had a spine score of ≥2. Comparison of baseline disease characteristics by baseline SI joint and spine scores showed that a greater proportion of patients in the subgroup with a baseline SPARCC score of ≥2 for both SI joints and spine were male, and patients with spine and SI joint scores of <2 were younger and had shorter symptom duration. SPARCC spine scores correlated with baseline symptom duration, and SI joint scores correlated negatively with the baseline Bath Ankylosing Spondylitis Disease Activity Index, but neither correlated with the baseline Ankylosing Spondylitis Disease Activity Score, total back pain, the patient's global assessment of disease activity, the Bath Ankylosing Spondylitis Functional Index, morning stiffness, nocturnal pain, or C-reactive protein level.
Assessment by experienced readers showed that spinal inflammation on MRI might be observed in half of patients with nonradiographic axial SpA without SI joint inflammation.
评估活动期非放射学中轴型脊柱关节炎（SpA）患者的磁共振成像（MRI）是否存在脊柱和/或骶髂（SI）关节炎症，并比较这些亚组的疾病特征。
ABILITY-1 是一项多中心、随机、安慰剂对照临床试验，研究对象为符合评估脊柱关节炎国际协会中轴型 SpA 标准的非放射学中轴型 SpA 患者，使用加拿大脊柱关节炎研究协会（SPARCC）方法对 SI 关节进行评分，使用 SPARCC 6 个椎体方法对脊柱进行评分。MRI 上存在炎症的阳性证据定义为 SI 关节或脊柱的 SPARCC 评分≥2。
在基线 SPARCC 评分的患者中，40%的患者 SI 关节评分≥2，52%的患者脊柱评分≥2。基线 SI 关节评分<2 的患者中，49%的患者脊柱评分≥2，而基线 SI 关节评分≥2 的患者中，58%的患者脊柱评分≥2。根据基线 SI 关节和脊柱评分比较基线疾病特征，结果显示，基线 SI 关节和脊柱评分均≥2 的亚组中，更多的患者为男性，而 SI 关节和脊柱评分<2 的患者年龄更小，病程更短。SPARCC 脊柱评分与基线症状持续时间相关，SI 关节评分与基线 Bath 强直性脊柱炎疾病活动指数呈负相关，但均与基线强直性脊柱炎疾病活动评分、总背痛、患者对疾病活动的总体评估、Bath 强直性脊柱炎功能指数、晨僵、夜间疼痛或 C 反应蛋白水平不相关。
有经验的阅读者评估结果显示，半数非放射学中轴型 SpA 患者可能存在脊柱炎症，而无 SI 关节炎症。
