Rheumatology Unit, CHU Brest, BP 824, F-29609 Brest Cedex, France.
Radiology Unit, CHU brest, Brest 29609, France.
Semin Arthritis Rheum. 2020 Feb;50(1):48-53. doi: 10.1016/j.semarthrit.2019.06.008. Epub 2019 Jun 13.
Scoliosis may impact the mechanical loading and cause secondary changes of the sacroiliac joints and lumbar spine. Our goal was to look how lumbar scoliosis modify the clinical and imaging-study in patients with recent-onset inflammatory back pain (IBP) suggesting axial spondyloarthritis (axSpA).
Baseline weight-bearing lumbar-spine radiographs obtained in the DESIR cohort of patients aged 18-50 years and having IBP for at least 3 months but less than 3 years suggesting axSpA were studied. After training on scoliosis detection based on Cobb's angle>10° plus Nash-Moe grade≥1, readers blinded to patient data measured spine lumbar scoliosis, sacral horizontal angle, lumbosacral angle and lumbar lordosis on the radiograph of the lumbar and scored sacroiliitis on the radiograph of the pelvis. Baseline MRIs T1 and STIR of the lumbar spine and sacroiliac joints were evaluated for respectively degenerative changes and signs of axSpA.
Of the 360 patients (50.8% females) 88.7% had lumbar pain and 69.3% met ASAS criteria for axSpA. Mean Cobb's angle was 3.2°±5.0° and 28 (7.7%) patients had lumbar scoliosis. No statistical differences were observed for radiographic sacroiliitis, MRI sacroiliitis, modified Stoke Ankylosing Spondylitis Spinal Score, Pfirmmann score, high-intensity zone, protrusion, extrusion, MODIC score between patients with and without scoliosis. In both groups, degenerative changes by MRI were rare and predominated at L4-L5 and L5-S1.
In patients with early IBP suggesting axSpA, lumbar scoliosis was not associated with inflammatory or degenerative changes.
脊柱侧凸可能会影响机械负荷，并导致骶髂关节和腰椎的继发性变化。我们的目标是观察腰椎侧凸如何改变近期发病的炎症性背痛（IBP）提示中轴型脊柱关节炎（axSpA）患者的临床和影像学研究。
研究了 DESIR 队列中年龄在 18-50 岁之间、IBP 至少 3 个月但不超过 3 年、提示 axSpA 的患者的基线负重腰椎 X 线片。在基于 Cobb 角>10°和 Nash-Moe 分级≥1 的脊柱侧凸检测训练后，读者对 X 线片上的腰椎脊柱侧凸、骶骨水平角、腰骶角和腰椎前凸进行了测量，并对骨盆 X 线片上的骶髂关节炎进行了评分。对腰椎和骶髂关节的基线 MRI T1 和 STIR 进行了评估，分别评估退行性变化和 axSpA 的征象。
在 360 名患者中（50.8%为女性），88.7%有腰痛，69.3%符合 ASAS 轴型脊柱关节炎标准。平均 Cobb 角为 3.2°±5.0°，28 名（7.7%）患者有腰椎侧凸。有或没有脊柱侧凸的患者在放射学骶髂关节炎、MRI 骶髂关节炎、改良 Stoke 强直性脊柱炎脊柱评分、Pfirrmann 评分、高信号区、突出、挤压、MODIC 评分方面无统计学差异。在两组中，MRI 显示的退行性变化均较少，主要发生在 L4-L5 和 L5-S1。
在早期 IBP 提示 axSpA 的患者中，腰椎侧凸与炎症或退行性变化无关。
