Maksymowych W P, Wichuk S, Chiowchanwisawakit P, Lambert R G, Pedersen S J
Department of Medicine, Spondyloarthritis Research Consortium of Canada Center, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
RMD Open. 2017 Mar 30;3(1):e000399. doi: 10.1136/rmdopen-2016-000399. eCollection 2017.
We tested the hypothesis that fat metaplasia on MRI of the sacroiliac joints (SIJ) increases the propensity for new bone formation in the spine of patients with spondyloarthritis.
We assessed baseline T1-weighted and short τ inversion recovery SIJ MRIs from patients in the Follow Up Research Cohort in Ankylosing Spondylitis (FORCAST). Radiographic progression was assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Structural and inflammatory lesions were scored using the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ structural and SPARCC SIJ inflammation scores, respectively. Radiographic progression was compared in cases with and without definite MRI lesions (score ≥2 or <2) and the extent of MRI lesions at baseline was compared in patients with and without radiographic progression. The predictive capacity of MRI SIJ lesions for radiographic progression in the spine was assessed in univariate and multivariate regression analyses.
The extent of MRI structural lesions in the SIJ at baseline was significantly greater in those patients who had spinal radiographic progression on follow-up (p=0.003, 0.02, 0.003 for fat metaplasia, backfill and ankylosis, respectively). Also, radiographic progression was significantly greater in cases with definite baseline SIJ ankylosis (p=0.008). In multivariate regression that included all types of MRI lesions and was adjusted for age, sex, symptom duration, duration of follow-up, CRP, baseline mSASSS and treatment, the extent of SIJ fat metaplasia and ankylosis at baseline were independently associated with radiographic progression.
SIJ ankylosis and fat metaplasia but not inflammatory lesions increase the propensity for radiographic progression in the spine.
我们验证了一个假设，即骶髂关节（SIJ）MRI上的脂肪化生会增加脊柱关节炎患者脊柱新骨形成的倾向。
我们评估了强直性脊柱炎随访研究队列（FORCAST）中患者的基线T1加权和短τ反转恢复序列SIJ MRI。使用改良的斯托克强直性脊柱炎脊柱评分（mSASSS）评估放射学进展。分别使用加拿大脊柱关节炎研究联盟（SPARCC）SIJ结构评分和SPARCC SIJ炎症评分对结构和炎症病变进行评分。比较有和无明确MRI病变（评分≥2或<2）的病例的放射学进展，并比较有和无放射学进展的患者基线时MRI病变的程度。在单变量和多变量回归分析中评估MRI SIJ病变对脊柱放射学进展的预测能力。
随访时脊柱有放射学进展的患者，其基线时SIJ的MRI结构病变程度明显更大（脂肪化生、填充和强直分别为p=0.003、0.02、0.003）。此外，基线时有明确SIJ强直的病例放射学进展明显更大（p=0.008）。在包括所有类型MRI病变并根据年龄、性别、症状持续时间、随访时间、CRP、基线mSASSS和治疗进行调整的多变量回归中，基线时SIJ脂肪化生和强直的程度与放射学进展独立相关。
SIJ强直和脂肪化生而非炎症病变会增加脊柱放射学进展的倾向。
