Zwolak Robert, Suszek Dorota, Graca Aleksandra, Mazurek Marcin, Majdan Maria
Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland.
Wiad Lek. 2019;72(9 cz 1):1607-1610.
Introduction: The probability of development of axial spondyloarthritis (axSpA) is estimated to be above 90% among patients with chronic back pain, presence of HLA B27 antigen and positive family history of ankylosing spondylitis (AS), psoriasis, reactive arthritis, inflammatory bowel disease or uveitis. The nonradiographic axSpA and ankylosing spondylitis diseases' activity has a comparable impact on the patients' quality of life and from the practical point of view the approach to treatment of each of them is the same. The aim: The attempt to identify the reasons of diagnostic delays of AS among patients hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin and to suggest the ways of improving the accuracy of diagnostic track among other healthcare providers than rheumatologists.
Material and methods: We performed a retrospective analysis of the records of 82 patients' with the established diagnosis of AS, hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin in 2000-2019, and of 45 years of age and older.
Results: From among 82 patients (28 women and 54 men) the diagnosis of AS after 45 years of age was established in 25 patients (10 women and 15 men) - group t, and in the other 57 patients (group n) the diagnosis was established before 45 years of age. On average the age at the time of diagnosis in the whole group (t+n) was 40,7±10,2 (18-76) years, the age at the beginning of inflammatory back pain (age of axial symptoms) was 30,9±8,5 (13-51) years and the diagnostic delay (period between first axial symptoms and diagnosis establishment) was 9,75±9,5 (0-46) years. We did not find any statistically significant associations between sex and age at the moment of diagnosis, age of the beginning of axial symptoms and the time of diagnostic delay. There was no significant difference of incidence of enthesitis, uveitis, arthritis, prevalence of family history of spondyloarthritis and CRP level between group t and n. Antigen HLA B27 was more frequently present in group t.
Conclusions: Instead of the recognition progress and worldwide popularization of knowledge about axSpA, the diagnostic delays in this field are still estimated to last many years, the patients are looking for other specialists' help, and they can be not knowledgeable of the inflammatory back pain criteria. Currently, HLA B27 antigen and C-reactive protein are the two most commonly used biomarkers for diagnostic and disease activity monitoring purposes of axSpA and magnetic resonance is the only "imaging biomarker". The presence of extra-axial symptoms does not improve the diagnostic sensitivity.
引言：在患有慢性背痛、存在HLA - B27抗原且有强直性脊柱炎（AS）、银屑病、反应性关节炎、炎性肠病或葡萄膜炎家族史的患者中，轴性脊柱关节炎（axSpA）的发病概率估计超过90%。非放射学axSpA和强直性脊柱炎疾病的活动对患者生活质量有类似影响，且从实际角度看，对它们的治疗方法相同。目的：试图找出在卢布林风湿病与结缔组织病科住院的AS患者诊断延迟的原因，并提出提高除风湿病学家之外的其他医疗服务提供者诊断准确性的方法。
材料与方法：我们对2000 - 2019年在卢布林风湿病与结缔组织病科住院、年龄在45岁及以上且确诊为AS的82例患者的病历进行了回顾性分析。
结果：在82例患者（28例女性和54例男性）中，45岁及以后确诊AS的有25例患者（10例女性和15例男性）——t组，另外57例患者（n组）在45岁之前确诊。整个组（t + n）诊断时的平均年龄为40.7±10.2（18 - 76）岁，炎性背痛开始时的年龄（轴性症状出现年龄）为30.9±8.5（13 - 51）岁，诊断延迟时间（首次出现轴性症状到确诊之间的时间段）为9.75±9.5（0 - 46）年。我们未发现诊断时的性别与年龄、轴性症状开始年龄以及诊断延迟时间之间存在任何统计学上的显著关联。t组和n组在附着点炎、葡萄膜炎、关节炎的发病率、脊柱关节炎家族史患病率以及CRP水平方面没有显著差异。抗原HLA - B27在t组中更常见。
结论：尽管关于axSpA的认识有所进步且相关知识在全球得到普及，但该领域的诊断延迟估计仍会持续多年，患者会寻求其他专科医生的帮助，并且他们可能不了解炎性背痛的标准。目前，HLA - B27抗原和C反应蛋白是axSpA诊断及疾病活动监测最常用的两种生物标志物，而磁共振是唯一的“影像生物标志物”。轴外症状的存在并未提高诊断敏感性。
