School of Physical Education, Sport and Exercise Science, University of Otago, Dunedin, New Zealand.
Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Int J Rheum Dis. 2019 Aug;22(8):1521-1528. doi: 10.1111/1756-185X.13606. Epub 2019 May 27.
Magnetic resonance imaging (MRI) can be used to identify sacroiliac joint (SIJ) inflammation and provide an earlier diagnosis of nonradiographic axial spondyloarthritis (nrAxSpA). However, MRI is frequently a resource-limited examination. Our aim was to assess if a set of physical clinical tests can identify SIJ inflammation in patients with nrAxSpA.
Twenty participants with nrAxSpA underwent two functional tests (active straight leg raise, and stork test on the support side) and four pain provocation tests (Gaenslen's, posterior pelvic pain provocation, Patrick's Faber and palpation of the long dorsal SIJ ligament) for the SIJ, and then proceeded to a contemporaneous reference standard MRI. The Spondyloarthritis Research Consortium of Canada scoring system (SPARCC) was used to score MRI. Specificity, sensitivity, and likelihood ratios (LR) were calculated for individual clinical tests, and for the composite of tests.
Pain provocation tests were superior to functional tests, which showed poor accuracy. The Patrick's Faber test was the best performing procedure (sensitivity 71%, specificity 75%, positive LR 2.9, negative LR 0.4). When combining the provocation tests, a positive test in one out of two tests demonstrated the strongest predictive value (sensitivity 86%, specificity 62%, positive LR 2.2, negative LR 0.2).
Sacroiliac joint pain provocation tests correlate modestly with inflammation. The Patrick's Faber test showed the greater LR to identify SIJ inflammation in patients with nrAxSpA. SIJ pain provocation tests may offer a simple and cost-effective way of identifying patients with nrAxSpA who are most likely to have MRI evidence of inflammation.
磁共振成像（MRI）可用于识别骶髂关节（SIJ）炎症，并对非放射性轴性脊柱关节炎（nrAxSpA）提供更早的诊断。然而，MRI 通常是一种资源有限的检查。我们的目的是评估一组物理临床检查是否可以识别 nrAxSpA 患者的 SIJ 炎症。
20 名 nrAxSpA 患者接受了两项功能测试（主动直腿抬高和支撑侧的鹳式测试）和四项疼痛激发测试（Gaenslen 试验、后骨盆疼痛激发、Patrick 的 Faber 试验和长背侧 SIJ 韧带触诊），然后进行同期参考标准 MRI。采用加拿大脊柱关节炎研究协会评分系统（SPARCC）对 MRI 进行评分。计算了各个临床测试以及测试组合的特异性、敏感性和似然比（LR）。
疼痛激发测试优于功能测试，后者准确性较差。Patrick 的 Faber 试验是表现最佳的程序（敏感性 71%，特异性 75%，阳性 LR 2.9，阴性 LR 0.4）。当结合激发测试时，两项测试中有一项阳性的预测价值最强（敏感性 86%，特异性 62%，阳性 LR 2.2，阴性 LR 0.2）。
SIJ 疼痛激发测试与炎症中度相关。Patrick 的 Faber 试验对识别 nrAxSpA 患者的 SIJ 炎症具有更大的 LR。SIJ 疼痛激发测试可能为识别最有可能具有炎症性 MRI 证据的 nrAxSpA 患者提供一种简单且具有成本效益的方法。
