Fortis Hospital, Noida, India
Fortis Flt Lt Rajan Dhall Hospital, New Delhi, India.
Clin Med (Lond). 2020 May;20(3):e24-e25. doi: 10.7861/clinmed.2020-0070.
Presence of human leucocyte antigen (HLA) B27 in a patient with lower-back pain should not be considered synonymous with axial spondyloarthritis. Other causes of back pain should be ruled-out by careful evaluation. Lumbosacral transitional vertebra is a common congenital malformation of spine which frequently leads to mechanical back pain. We present a young man with lower-back pain who had HLA B27. He was labelled with axial spondyloarthritis elsewhere and was given etanercept without benefit. Further evaluation revealed that he had lumbosacral transitional vertebra and spina bifida occulta. No evidence of sacroiliitis was found. Etanercept was stopped and he was started on physiotherapy protocol for transitional vertebra, with which he improved remarkably. This case highlights the need for greater awareness among clinicians about lumbosacral transitional vertebra, a finding which is frequently missed. Presence of HLA B27 can be coincidental, as in our case.
患者出现下腰痛，伴有人类白细胞抗原（HLA）B27 阳性，不应视为与中轴型脊柱关节炎同义。应通过仔细评估排除其他导致腰痛的原因。腰骶部移行椎是脊柱常见的先天性畸形，常导致机械性腰痛。我们介绍了一位下腰痛的年轻男性，他 HLA B27 阳性。他在其他地方被诊断为中轴型脊柱关节炎，并接受依那西普治疗，但没有获益。进一步评估发现他有腰骶部移行椎和隐性脊柱裂。未发现骶髂关节炎的证据。停用依那西普，开始接受针对移行椎的物理治疗方案，他的病情显著改善。本病例强调了临床医生需要提高对腰骶部移行椎的认识，因为这种情况经常被漏诊。如本病例所示，HLA B27 阳性可能是偶然发现。
