Baraliakos Xenofon, Heldmann Frank, Callhoff Johanna, Suppiah Ravi, McQueen Fiona Marion, Krause Dietmar, Klink Claudia, Schmitz-Bortz Elmar, Igelmann Manfred, Kalthoff Ludwig, Kiltz Uta, Schmuedderich Anna, Braun Juergen
From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand.
X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet.
J Rheumatol. 2016 Dec;43(12):2131-2135. doi: 10.3899/jrheum.150553. Epub 2016 Oct 15.
Neck pain is common in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). We investigated the correlation of bone marrow edema (BME) on magnetic resonance imaging (MRI) in RA and AS and its association with clinical complaints of neck pain.
Cervical spine short-tau inversion recovery-MRI and T1w-MRI of 34 patients with RA and 6 patients with AS complaining about neck pain were obtained. Clinical and laboratory data were available. BME was scored by 2 blinded readers using a modification of a published score, including various cervical sites. Degenerative changes were also quantified.
Patients were predominantly women (82.5%), and mean ± SD age was 57.5 ± 11.8 years, C-reactive protein (CRP) was 0.8 ± 1.3 mg/dl, and pain score was 46.0 ± 17.5. BME was detected in 24/40 patients (60%) involving the atlantoaxial region (21%), vertebral bodies (75%), facet joints (29%), and spinous processes (46%). Degenerative changes were identified in 21/40 patients (52.5%), 13 (62%) of whom also had BME in vertebral bodies. No differences were found between patients with versus without cervical BME for clinical assessments: numeric rating scale pain (median ± interquartile range) 5.5 ± 3.0 vs 6.0 ± 4.0 (p = 0.69), Funktionsfragebogen Hannover 68.2 ± 41.0 vs 42.0 ± 55.5 (p = 0.19), Northwick pain score 44.4 ± 21.8 vs 47.2 ± 27.0 (p = 0.83), or CRP 0.40 ± 0.80 vs 0.60 ± 0.66 (p = 0.94). For patients with degenerative changes, symptom duration was longer than for patients without (10 ± 12.5 vs 5.0 ± 18.0 yrs, p = 0.73).
In this small study of patients with RA and AS complaining about neck pain, BME was found in many different cervical sites, including the facet joints and the spinous processes. However, the occurrence and severity of BME did not correlate with the severity of neck pain.
颈部疼痛在类风湿关节炎（RA）和强直性脊柱炎（AS）中很常见。我们研究了RA和AS患者磁共振成像（MRI）上骨髓水肿（BME）的相关性及其与颈部疼痛临床症状的关联。
获取了34例抱怨颈部疼痛的RA患者和6例AS患者的颈椎短tau反转恢复序列MRI及T1加权MRI图像。有临床和实验室数据。由2名盲法阅片者使用已发表评分的改良版对BME进行评分，包括不同的颈椎部位。还对退变改变进行了量化。
患者以女性为主（82.5%），平均年龄±标准差为57.5±11.8岁，C反应蛋白（CRP）为0.8±1.3mg/dl，疼痛评分为46.0±17.5。40例患者中有24例（60%）检测到BME，累及寰枢椎区域（21%）、椎体（75%）、小关节（29%）和棘突（46%）。40例患者中有21例（52.5%）发现退变改变，其中13例（62%）椎体也有BME。有或无颈椎BME的患者在临床评估方面无差异：数字评分法疼痛评分（中位数±四分位间距）5.5±3.0对6.0±4.0（p=0.69），汉诺威功能问卷评分68.2±41.0对42.0±55.5（p=0.19），诺斯威克疼痛评分44.4±21.8对47.2±27.0（p=0.83），或CRP 0.40±0.80对0.60±0.66（p=0.94）。对于有退变改变的患者，症状持续时间比无退变改变的患者长（10±12.5对5.0±18.0年，p=0.73）。
在这项针对抱怨颈部疼痛的RA和AS患者的小型研究中，在许多不同的颈椎部位发现了BME，包括小关节和棘突。然而，BME的发生和严重程度与颈部疼痛的严重程度无关。
