有脊柱关节炎疑似症状患者的骨矿物质密度
Bone mineral density in patients with symptoms suggestive of spondyloarthritis.
作者信息
Forien M, Moltó A, Etcheto A, Dougados M, Roux C, Briot K
机构信息
Rheumatology Department, Cochin Hospital, INSERM U1153, Paris Descartes University, Paris, France.
出版信息
Osteoporos Int. 2015 May;26(5):1647-53. doi: 10.1007/s00198-015-3044-y. Epub 2015 Jan 28.
UNLABELLED
Patients with axial spondyloarthritis (axSpA) have an increased risk of osteoporosis related to inflammation. We evaluate the performance of low bone mineral density (BMD) in diagnosis of axSpA for patients with symptoms suggestive of the disease. A low BMD (T ≤ -2) could be an additional tool for the diagnosis of axSpA.
INTRODUCTION
Diagnosis of axial spondyloarthritis (axSpA) can be challenging, especially in the absence of radiographic abnormalities. Patients with axSpA have an increased risk of osteoporosis related to inflammation. This study evaluated the performance of low bone mineral density (BMD) in diagnosis of axSpA for patients with symptoms suggestive of the disease.
METHODS
Medical files of patients that visited a tertiary centre for symptoms suggestive of axSpA were reviewed. Two hundred and sixty-seven patients were classified in confirmed axSpA or unconfirmed axSpA according to the diagnosis of a senior rheumatologist. BMD measurements results and percentage of patients with a low BMD (T ≤ -2) at either spine or hip were compared between the two groups. Diagnostic performances of low BMD (specificity, sensitivity, positive, negative predictive values and positive likelihood ratio (LR+)) were assessed.
RESULTS
Compared to patients with unconfirmed axSpA (n = 74), patients with confirmed axSpA (n = 193) had similar age, were more frequently male, with positive HLA B27, higher disease duration and higher C-reactive protein (CRP). Low BMD was more frequent at spine and hip, in patients with confirmed (40.3%) than unconfirmed axSpA (24.6%, p = 0.021). The LR+ of low BMD for an axSpA diagnosis was 2.60 and 3.12 at the spine and hip. In the subgroup of patients without any radiographic abnormalities (n = 128), the LR+ of low BMD for an axSpA diagnosis was 2.90 and 2.54 at the spine and hip.
CONCLUSION
In patients with symptoms suggestive of axSpA, a low BMD (T ≤ -2) could be an additional tool for the diagnosis of axSpA.
未标注
轴性脊柱关节炎（axSpA）患者因炎症导致骨质疏松的风险增加。我们评估低骨密度（BMD）在诊断有该疾病症状提示的axSpA患者中的表现。低骨密度（T≤ -2）可能是诊断axSpA的一项额外工具。
引言
轴性脊柱关节炎（axSpA）的诊断可能具有挑战性，尤其是在没有影像学异常的情况下。axSpA患者因炎症导致骨质疏松的风险增加。本研究评估低骨密度（BMD）在诊断有该疾病症状提示的axSpA患者中的表现。
方法
回顾了因有axSpA症状提示而就诊于三级中心的患者的病历。根据资深风湿病学家的诊断，267例患者被分类为确诊axSpA或未确诊axSpA。比较两组患者的骨密度测量结果以及脊柱或髋部骨密度低（T≤ -2）的患者百分比。评估低骨密度的诊断性能（特异性、敏感性、阳性、阴性预测值和阳性似然比（LR+））。
结果
与未确诊axSpA的患者（n = 74）相比，确诊axSpA的患者（n = 193）年龄相似，男性更常见，HLA B27阳性，病程更长，C反应蛋白（CRP）更高。确诊axSpA的患者中，脊柱和髋部低骨密度更为常见（40.3%），高于未确诊axSpA的患者（24.6%，p = 0.021）。脊柱和髋部低骨密度对axSpA诊断的LR+分别为2.60和3.12。在没有任何影像学异常的患者亚组（n = 128）中，脊柱和髋部低骨密度对axSpA诊断的LR+分别为2.90和2.54。
结论
在有axSpA症状提示的患者中，低骨密度（T≤ -2）可能是诊断axSpA的一项额外工具。
Zotero 插件