Costantino Félicie, Zeboulon Nadine, Said-Nahal Roula, Breban Maxime
Faculty of Health Sciences Simone Veil.
INSERM U1173, University of Versailles Saint-Quentin-en-Yvelines Montigny-le-Bretonneux.
Rheumatology (Oxford). 2017 May 1;56(5):811-817. doi: 10.1093/rheumatology/kew496.
Radiographic sacroiliitis is an important outcome in SpA and is considered a hallmark to ascertain the diagnosis of AS. The aim of the current study was to investigate factors associated with the presence of radiographic sacroiliitis at baseline and the predictors of progression to AS in a family cohort of SpA.
A total of 953 patients fulfilling the Assessment of SpondyloArthritis international Society criteria for SpA and having at least one first- or second-degree SpA-affected relative were included. Pelvic X-rays were examined blindly and independently by two qualified examiners using the modified New York criteria. Of the 446 cases without definite sacroiliitis at inclusion, 145 patients were followed up with new pelvic X-rays for 3-15 years. Regression analysis was used to assess factors associated with definite radiographic sacroiliitis.
Factors independently associated with radiographic sacroiliitis at inclusion were male sex, younger age at disease onset, longer disease duration, inflammatory back pain, uveitis and lack of enthesitis. During the follow-up, 27.3% of the patients with axial SpA developed definite sacroiliitis, whereas there was no progression in patients with peripheral SpA. After 15 years of follow-up, a Kaplan-Meier estimate of the proportion of patients with definite radiographic sacroiliitis reached 68.5%. Factors associated with progression to definite sacroiliitis were a low-grade radiographic sacroiliitis at inclusion, occurrence of buttock pain and the absence of peripheral arthritis during the follow-up period.
These data confirm that progression to radiographic disease occurs most often over time in axial SpA patients.
影像学骶髂关节炎是脊柱关节炎（SpA）的一项重要结局，被视为确诊强直性脊柱炎（AS）的标志。本研究旨在调查SpA家系队列中与基线时影像学骶髂关节炎存在相关的因素以及进展为AS的预测因素。
共纳入953例符合国际脊柱关节炎评估协会SpA标准且至少有一位一级或二级亲属患SpA的患者。由两名合格的检查者采用改良纽约标准对骨盆X线片进行盲法独立检查。在纳入时无明确骶髂关节炎的446例病例中，145例患者接受了新的骨盆X线片随访3至15年。采用回归分析评估与明确影像学骶髂关节炎相关的因素。
纳入时与影像学骶髂关节炎独立相关的因素为男性、发病年龄较小、病程较长、炎性背痛、葡萄膜炎和无附着点炎。随访期间，27.3%的轴向SpA患者出现明确的骶髂关节炎，而外周SpA患者无进展。随访15年后，Kaplan-Meier法估计明确影像学骶髂关节炎患者的比例达到68.5%。与进展为明确骶髂关节炎相关的因素为纳入时低度影像学骶髂关节炎、随访期间出现臀部疼痛以及无外周关节炎。
这些数据证实，轴向SpA患者随着时间推移最常出现影像学疾病进展。
