Maksymowych Walter P, Wichuk Stephanie, Dougados Maxime, Jones Heather, Szumski Annette, Bukowski Jack F, Marshall Lisa, Lambert Robert G
Department of Medicine, University of Alberta, 568 Heritage Medical Research Building, Edmonton, AB, T6G 2S2, Canada.
Paris Descartes University; Department of Rheumatology - Hôpital Cochin, Assistance Publique - Hôpitaux de Paris; INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France.
Arthritis Res Ther. 2017 Jun 6;19(1):126. doi: 10.1186/s13075-017-1342-9.
Studies have shown that structural lesions may be present in patients with non-radiographic axial spondyloarthritis (nr-axSpA). However, the relevance of structural lesions in these patients is unclear, particularly without signs of inflammation on magnetic resonance imaging (MRI). We assessed the presence of structural lesions at baseline on MRI in the sacroiliac joints (SIJ) of patients with nr-axSpA with and without SIJ inflammation on MRI.
Bone marrow edema (BME) was assessed on short tau inversion recovery (STIR) scans from 185 patients with nr-axSpA, by two independent readers at baseline using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Structural lesions were evaluated on T1 weighted spin echo scans, with readers blinded to STIR scans, using the SPARCC MRI SIJ structural score. Disease characteristics and structural lesions were compared in patients with SIJ BME (score ≥2) and without SIJ BME (score <2).
Both SIJ BME and structural lesions scores were available for 183 patients; 128/183 (69.9%) patients had SIJ BME scores ≥2 and 55/183 (30.1%) had scores <2. Frequencies of MRI structural lesions in patients with vs without SIJ BME were: erosions (45.3% vs 10.9%, P < 0.001), backfill (20.3% vs 0%, P < 0.001), fat metaplasia (10.9% vs 1.8%, P = 0.04), and ankylosis (2.3% vs 1.8%, P = ns). Significantly more patients with both SIJ BME and structural lesions were male and/or HLA-B27 positive than patients with only SIJ BME. Mean (SD) spinal scores (23 discovertebral units) were significantly higher in patients with SIJ structural lesions than without: 6.5 (11.5) vs 3.3 (5.1), respectively, P = 0.01.
In patients with nr-axSpA, SIJ structural lesions, particularly erosions, may be present on MRI when radiographs are normal or inconclusive, even in patients negative for MRI SIJ inflammation. They may reflect more severe disease with greater spinal inflammation.
ClinicalTrials.gov, NCT01258738 . Registered on 9 December 2010.
研究表明，非放射学轴向脊柱关节炎（nr-axSpA）患者可能存在结构损伤。然而，这些患者中结构损伤的相关性尚不清楚，尤其是在磁共振成像（MRI）上没有炎症迹象的情况下。我们评估了nr-axSpA患者骶髂关节（SIJ）在MRI基线时有无SIJ炎症的结构损伤情况。
对185例nr-axSpA患者的短tau反转恢复（STIR）扫描图像进行骨髓水肿（BME）评估，由两名独立阅片者在基线时使用加拿大脊柱关节炎研究联盟（SPARCC）评分。在T1加权自旋回波扫描图像上评估结构损伤，阅片者对STIR扫描图像结果不知情，使用SPARCC MRI SIJ结构评分。比较有SIJ BME（评分≥2）和无SIJ BME（评分<2）患者的疾病特征和结构损伤情况。
183例患者同时有SIJ BME和结构损伤评分数据；128/183（69.9%）例患者SIJ BME评分≥2，55/183（30.1%）例患者评分<2。有与无SIJ BME患者MRI结构损伤的发生率分别为：侵蚀（45.3%对10.9%，P<0.001）、骨质填充（20.3%对0%，P<0.001）、脂肪化生（10.9%对1.8%，P=0.04）和强直（2.3%对1.8%，P=无显著差异）。同时有SIJ BME和结构损伤的患者中男性和/或HLA-B27阳性的比例显著高于仅有SIJ BME的患者。有SIJ结构损伤患者的平均（标准差）脊柱评分（23个椎间盘单位）显著高于无损伤患者：分别为6.5（11.5）和为3.3（5.1），P=0.01。
在nr-axSpA患者中，即使MRI上SIJ炎症阴性，当X线片正常或不确定时，MRI上可能存在SIJ结构损伤，尤其是侵蚀。它们可能反映了更严重的疾病和更严重的脊柱炎症。
ClinicalTrials.gov，NCT01258738。于2010年12月9日注册。
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