Soysal GÜndÜz Özgül, Akar Servet, Solmaz Dilek, Can Gerçek, Önen Fatoş, AkkoÇ Nurullah
Department of Internal Medicine, Division of Rheumatology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey.
Department of Internal Medicine, Division of Rheumatology, Katip Çelebi University, Faculty of Medicine, İzmir, Turkey.
Arch Rheumatol. 2020 Feb 7;35(2):189-195. doi: 10.46497/ArchRheumatol.2020.7323. eCollection 2020 Jun.
This study aims to estimate the prevalence of spondyloarthritis (SpA) among patients who had been surgically treated for lumbar disc herniation (LDH), according to the modified New York (mNY) criteria for the diagnosis of ankylosing spondylitis and Amor, the European Spondyloarthropathy Study Group (ESSG), the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for SpA.
The study included 321 patients (142 males, 179 females; mean age 49±10.8 years; range, 18 to 79 years) who underwent LDH surgery between April 2008 and May 2012 in the neurosurgery clinic of our hospital. Patients were contacted by phone on at least two attempts. Totally, 123 patients accepted to come to the outpatient clinic, while the remaining 198 agreed to be interviewed on the phone. Patients who agreed to come to the outpatient rheumatology clinic underwent clinical examination, and pelvic X-ray and magnetic resonance imaging (MRI) scan of the sacroiliac joints when indicated.
Inflammatory back pain was diagnosed in 108 patients (34%) and 40 patients (13%) according to Calin criteria and the ASAS criteria, respectively. Prevalence of SpA among all patients was estimated as 17.7% according to the ESSG criteria, and 8.7% according to Amor criteria. Five of the 308 pelvic radiographs had definite radiographic sacroiliitis as required by the mNY criteria. Four patients had a characteristic pattern of bone marrow edema on MRI examination in accordance with the ASAS definitions. The overall prevalence of sacroiliitis (MRI sacroiliitis+X-ray sacroiliitis) among the patients who came to the clinic was 7.3% ([4+5]/123).
The relatively increased prevalence of SpA among patients who underwent LDH surgery indicates the necessity of increasing awareness on the new concept of axial SpA for specialists treating patients with low back pain.
本研究旨在依据强直性脊柱炎诊断的改良纽约（mNY）标准、欧洲脊柱关节病研究组（ESSG）标准、脊柱关节炎国际协会（ASAS）分类标准以及阿莫尔标准，评估接受过腰椎间盘突出症（LDH）手术治疗的患者中脊柱关节炎（SpA）的患病率。
本研究纳入了2008年4月至2012年5月期间在我院神经外科门诊接受LDH手术的321例患者（男性142例，女性179例；平均年龄49±10.8岁；年龄范围18至79岁）。至少通过两次电话联系患者。总共有123例患者同意前来门诊，其余198例同意接受电话访谈。同意前来门诊风湿科的患者接受了临床检查，并在必要时进行了骨盆X线检查和骶髂关节磁共振成像（MRI）扫描。
根据卡林标准和ASAS标准，分别有108例患者（34%）和40例患者（13%）被诊断为炎性背痛。根据ESSG标准，所有患者中SpA的患病率估计为17.7%，根据阿莫尔标准为8.7%。在308张骨盆X线片中，有5张符合mNY标准要求的明确的放射学骶髂关节炎表现。4例患者在MRI检查中有符合ASAS定义的特征性骨髓水肿模式。前来门诊的患者中骶髂关节炎（MRI骶髂关节炎+X线骶髂关节炎）的总体患病率为7.3%（[4 + 5]/123）。
接受LDH手术的患者中SpA患病率相对增加，这表明对于治疗腰痛患者的专科医生而言，提高对轴性SpA新概念的认识很有必要。
