目前ASAS关于阳性家族史的专家定义在识别轴性脊柱关节炎方面是否有用？来自SPACE和DESIR队列的结果。
Is the current ASAS expert definition of a positive family history useful in identifying axial spondyloarthritis? Results from the SPACE and DESIR cohorts.
作者信息
Ez-Zaitouni Zineb, Hilkens Andrea, Gossec Laure, Berg Inger Jorid, Landewé Robert, Ramonda Roberta, Dougados Maxime, van der Heijde Désirée, van Gaalen Floris
机构信息
Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Sorbonne Universités, UPMC Univ Paris 06, GRC-08, Paris, France.
出版信息
Arthritis Res Ther. 2017 May 31;19(1):118. doi: 10.1186/s13075-017-1335-8.
BACKGROUND
The Assessment of SpondyloArthritis international Society (ASAS) definition of a positive family history (PFH) of spondyloarthritis (SpA) includes the following diseases in first- or second-degree relatives: ankylosing spondylitis (AS), acute anterior uveitis (AAU), reactive arthritis (ReA), inflammatory bowel disease (IBD), and psoriasis. However, it is not known if a PFH for each of these diseases contributes to making a diagnosis of axSpA, sacroiliitis on imaging, or fulfilling the ASAS criteria in patients presenting with chronic back pain (CBP). Therefore, the aim of this study was to assess which SpA diseases in family members are associated with human leukocyte antigen B27 (HLA-B27) and axial spondyloarthritis (axSpA) in CBP patients.
METHODS
CBP patients suspected of axSpA from the SPACE (n = 438) and the DESIR (n = 647) cohort were asked about the presence of SpA diseases in first- or second-degree relatives (AS, AAU, ReA, IBD, and psoriasis). The associations between a PFH and HLA-B27, sacroiliitis on imaging (magnetic resonance imaging (MRI) or radiographs), axSpA diagnosis, and ASAS classification in CBP patients were assessed.
RESULTS
In the SPACE and the DESIR cohort, a PFH of AS (odds ratio (OR) 5.9 (95% confidence interval (CI) 3.5-9.9), and OR 3.3 (95% CI 2.1-5.2)) and a PFH of AAU (OR 9.8 (95% CI 3.3-28.9) and OR 21.6 (95% CI 2.9-160.1)) were significantly associated with presence of HLA-B27. Furthermore, in both cohorts a PFH of AS and a PFH of AAU were positively associated with fulfilment of the ASAS criteria, but not with sacroiliitis on imaging. In SPACE but not in DESIR a PFH of AAU was positively associated with axSpA diagnosis. In both cohorts a PFH of ReA, IBD, or psoriasis was not positively associated with HLA-B27 positivity, sacroiliitis on imaging, axSpA diagnosis, or meeting the ASAS criteria for axSpA.
CONCLUSIONS
In our cohorts, a PFH of AS or AAU is useful for case-finding of axSpA as this is correlated with HLA-B27 carriership. However, as a PFH of ReA, IBD, or psoriasis does not contribute to identifying axSpA in CBP patients, these data suggest that the widely used ASAS definition of a PFH of SpA should be updated.
TRIAL REGISTRATION
Trial registration number, NCT01648907 . Registered on 20 July 2012.
背景
脊柱关节炎国际协会（ASAS）对脊柱关节炎（SpA）阳性家族史（PFH）的定义包括一级或二级亲属中的以下疾病：强直性脊柱炎（AS）、急性前葡萄膜炎（AAU）、反应性关节炎（ReA）、炎症性肠病（IBD）和银屑病。然而，尚不清楚这些疾病中的每一种的PFH是否有助于对慢性背痛（CBP）患者做出轴性SpA诊断、影像学骶髂关节炎诊断或满足ASAS标准。因此，本研究的目的是评估家庭成员中的哪些SpA疾病与CBP患者的人类白细胞抗原B27（HLA - B27）和轴性脊柱关节炎（axSpA）相关。
方法
询问来自SPACE队列（n = 438）和DESIR队列（n = 647）中疑似axSpA的CBP患者一级或二级亲属中SpA疾病（AS、AAU、ReA、IBD和银屑病）的存在情况。评估CBP患者中PFH与HLA - B27、影像学骶髂关节炎（磁共振成像（MRI）或X线片）、axSpA诊断和ASAS分类之间的关联。
结果
在SPACE和DESIR队列中，AS的PFH（优势比（OR）5.9（95%置信区间（CI）3.5 - 9.9），以及OR 3.3（95%CI 2.1 - 5.2））和AAU的PFH（OR 9.8（95%CI 3.3 - 28.9）和OR 21.6（95%CI 2.9 - 160.1））与HLA - B27的存在显著相关。此外，在两个队列中，AS的PFH和AAU的PFH与满足ASAS标准呈正相关，但与影像学骶髂关节炎无关。在SPACE队列而非DESIR队列中，AAU的PFH与axSpA诊断呈正相关。在两个队列中，ReA、IBD或银屑病的PFH与HLA - B27阳性、影像学骶髂关节炎、axSpA诊断或满足axSpA的ASAS标准均无正相关。
结论
在我们的队列中，AS或AAU的PFH对axSpA的病例发现有用，因为这与HLA - B27携带相关。然而，由于ReA、IBD或银屑病的PFH对识别CBP患者中的axSpA没有帮助，这些数据表明广泛使用的ASAS对SpA的PFH定义应更新。
试验注册
试验注册号，NCT01648907。于2012年7月20日注册。
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