Yamada Kentaro, Suzuki Akinobu, Takahashi Shinji, Yasuda Hiroyuki, Tada Masahiro, Sugioka Yuko, Okano Tadashi, Koike Tatsuya, Nakamura Hiroaki
Departments of *Orthopaedic Surgery †Rheumatology, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Spinal Disord Tech. 2014 Jun;27(4):E128-35. doi: 10.1097/BSD.0b013e3182a22a34.
A cross-sectional study.
This study was aimed to quantify the extent of lumbar endplate and facet joint erosion in patients with rheumatoid arthritis (RA) using magnetic resonance imaging, to calculate the prevalence of erosion, and sought correlated factors.
Few studies have examined the lumbar spine in RA, especially the relationship between endplate and facet joint erosions and lumbar lesions induced by RA.
A total of 201 patients with RA were enrolled. Lumbar endplate and facet joint erosion were defined as irregularities and low-intensity change on magnetic resonance imaging, and graded utilizing the Rheumatoid Arthritis Magnetic Resonance Imaging Score. Lumbar lesions were defined as scoliosis, spondylolisthesis, and vertebral fracture on plain x-ray. Multivariable logistic regression analysis was used to seek correlations between the erosion and spinal level, RA-related factors and x-ray findings.
Lumbar endplate and facet erosion were detected in 70.6% and 76.6% of individuals, respectively, and at 33.8% and 38.7% of lumbar intervertebral levels, respectively. The severity of erosion in individual patients correlated with lumbar lesions. Endplate and facet erosion at each level correlated with high disease activity, and were most common at mid-lumbar and lower-lumbar levels. Strong correlations were observed between endplate erosion and adjacent vertebral body fracture or disk degeneration, and between facet erosion and spondylolisthesis.
Lumbar endplate and facet erosion are common in RA, and are observed more frequently at mid-low levels and when RA is poorly controlled. This pattern of erosion may play a crucial role in the generation of lumbar lesions in RA.
一项横断面研究。
本研究旨在利用磁共振成像量化类风湿关节炎（RA）患者腰椎终板和小关节侵蚀的程度，计算侵蚀的患病率，并寻找相关因素。
很少有研究对RA患者的腰椎进行检查，尤其是终板和小关节侵蚀与RA引起的腰椎病变之间的关系。
共纳入201例RA患者。腰椎终板和小关节侵蚀定义为磁共振成像上的不规则和低强度变化，并采用类风湿关节炎磁共振成像评分进行分级。腰椎病变定义为X线平片上的脊柱侧凸、椎体滑脱和椎体骨折。采用多变量逻辑回归分析寻找侵蚀与脊柱节段、RA相关因素和X线表现之间的相关性。
分别在70.6%和76.6%的个体中检测到腰椎终板和小关节侵蚀，分别在33.8%和38.7%的腰椎椎间水平检测到。个体患者的侵蚀严重程度与腰椎病变相关。每个节段的终板和小关节侵蚀与高疾病活动度相关，在中腰椎和下腰椎水平最为常见。终板侵蚀与相邻椎体骨折或椎间盘退变之间以及小关节侵蚀与椎体滑脱之间存在强相关性。
腰椎终板和小关节侵蚀在RA中很常见，在中低水平以及RA控制不佳时更频繁出现。这种侵蚀模式可能在RA腰椎病变的发生中起关键作用。
