Rheumatology, Allergology and clinical immunology, University of Rome Tor Vergata, Rome, Italy.
Unit of Allergology, Immunology and Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Italy.
Clin Exp Rheumatol. 2020 Jan-Feb;38(1):88-93. Epub 2019 May 22.
Axial spondyloarthritides (axSpA) are a group of disorders that share similar pathogenetic mechanisms and clinical picture. The aim of this retrospective multicentric study was to evaluate demographic and clinical differences between ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) patients.
Patients from 7 rheumatological centres in the Lazio region of Italy were included from January 1st, 2010 to April 1st, 2018, if they had undergone pelvic and/or spine radiographs or magnetic resonance imaging (MRI). Images were evaluated by one experienced radiologist in each centre who already had the clinical suspicion of axSpA. Clinical and therapeutic data were collected at the last observation visit. Categorical variables were presented with percentages and analysed by Chi squared test. Continuous variables were expressed as mean ± standard deviation and compared using the parametric unpaired t-test or the non-parametric Mann-Whitney U-test, when appropriate. p-values <0.05 were considered significant.
210 axSpA patients were included: 65.2% with AS and 34.7% with nr-axSpA. When comparing the two groups, AS patients had longer disease duration, were older, were more frequently males, had a greater diagnostic delay and a higher body mass index than the nr-axSpA patients (p<0.0001, p<0.0001, p=0.003 p=0.007, and p=0.04, respectively). The peripheral joints of the nr-axSpA patients were more frequently involved, had higher frequency of inflammatory bowel disease, higher C-reactive protein levels and lower frequency of HLA-B27 positivity (p=0.005, p=0.007, p=0.01, and p=0.01, respectively). TNF inhibitors were used in 87.8% patients with AS and 78.3% with nr-axSpA (p=0.04). More fat metaplasia was observed on MRI in the nr-axSpA group than in the AS group at sacroiliac joints (p=0.003), and more backfills were detected in the AS group on spine-MRI (p=0.003). Spine-bone marrow oedema was more prevalent in AS than in nr-axSpA (p=0.04), and more sclerosis and backfill were found in AS (p=0.003 and p=0.01, respectively).
In clinical practice, distinctive features in AS and nr-axSpA patients emerged. Imaging is crucial in guiding the choice of treatment in order to control disease activity and inflammation.
强直性脊柱炎（AS）和非放射学中轴型脊柱关节炎（nr-axSpA）同属一组具有相似发病机制和临床表现的疾病。本回顾性多中心研究旨在评估 AS 和 nr-axSpA 患者的人口统计学和临床差异。
2010 年 1 月 1 日至 2018 年 4 月 1 日期间，意大利拉齐奥地区 7 个风湿病中心的患者纳入本研究，这些患者接受了骨盆和/或脊柱 X 线或磁共振成像（MRI）检查。每个中心的一名有经验的放射科医生对图像进行评估，该放射科医生已经对 axSpA 有临床怀疑。收集最后一次就诊时的临床和治疗数据。分类变量用百分比表示，用卡方检验进行分析。连续变量用平均值±标准差表示，当合适时，使用参数配对 t 检验或非参数曼-惠特尼 U 检验进行比较。p 值<0.05 被认为具有统计学意义。
共纳入 210 例 axSpA 患者：65.2%为 AS，34.7%为 nr-axSpA。与 nr-axSpA 患者相比，AS 患者的疾病病程更长，年龄更大，男性更多，诊断延迟更长，体重指数更高（p<0.0001，p<0.0001，p=0.003，p=0.007，p=0.04）。nr-axSpA 患者外周关节受累更常见，炎症性肠病、C 反应蛋白水平更高、HLA-B27 阳性率更低（p=0.005，p=0.007，p=0.01，p=0.01）。87.8%的 AS 患者和 78.3%的 nr-axSpA 患者使用 TNF 抑制剂（p=0.04）。nr-axSpA 组在骶髂关节的 MRI 上观察到更多的脂肪化生，而 AS 组在脊柱 MRI 上观察到更多的后填充（p=0.003）。AS 患者的脊柱骨髓水肿比 nr-axSpA 患者更常见（p=0.04），AS 患者的硬化和后填充更常见（p=0.003 和 p=0.01）。
在临床实践中，AS 和 nr-axSpA 患者存在不同的特征。影像学对于指导治疗选择以控制疾病活动和炎症至关重要。
