Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Nordrhein-Westfalen, Germany
Institute of Community Medicine, University of Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
Ann Rheum Dis. 2021 Apr;80(4):469-474. doi: 10.1136/annrheumdis-2020-218669. Epub 2020 Nov 25.
Identify factors associated with presence and extension of spinal and sacroiliac joints (SIJ)-MRI lesions suggestive of axial spondyloarthritis (axSpA) in a population-based cohort (Study of Health in Pomerania) aged <45 years.
Spinal (sagittal T1/T2) and SIJ (semicoronal STIR sequences) MRIs were evaluated by two trained blinded readers. The presence (yes/no) and extension (Berlin MRI Score) of bone marrow oedema (BME) were captured. Degenerative spinal lesions were excluded and discrepancies resolved by consensus. Cross-sectional associations between clinical factors and presence/extension of BME were analysed by logistic/negative binomial regression. Record linkage of claims data was applied to identify participants with axSpA.
MRIs of 793 volunteers were evaluated. The presence of SIJ-BME (odds ratio) was strongly associated delivery during the last year (4.47, 1.49-13.41). For SIJ-BME extension, associations (incidence rate ratios, 95% CI) were found for delivery ((during last year) 4.52, 1.48-13.84), human leucocyte antigen (HLA)-B27+ (2.32, 1.30-4.14), body mass index (25-30 vs <25 kg/m²; 1.86 (1.19-2.89)) and back pain ((last 3 months) 1.55, 1.04-2.31), while for spinal BME, associations were found for age per decade (1.46, 1.13-1.90) and physically demanding work (1.46, 1.06-2.00). Record linkage was available for 694 (87.5%) participants and 9/694 (1.3%) had a record of axSpA (ICD M45.09).
These population-based data support the hypothesis of mechanic strain contributing to BME in the general population aged <45 years and the role of HLA-B27+ as a severity rather than a susceptibility factor for SIJ-BME.
在年龄<45 岁的人群中（波罗的海健康研究），确定与脊柱和骶髂关节（SIJ）MRI 病变提示轴性脊柱关节炎（axSpA）的存在和范围相关的因素。
由两位经过培训的盲法读者评估脊柱（矢状 T1/T2）和 SIJ（半冠状 STIR 序列）MRI。记录骨髓水肿（BME）的存在（有/无）和范围（柏林 MRI 评分）。排除退行性脊柱病变，并通过共识解决差异。通过逻辑/负二项回归分析横断面临床因素与 BME 存在/范围之间的关系。应用索赔数据的记录链接来识别 axSpA 患者。
共评估了 793 名志愿者的 MRI。SIJ-BME 的存在（比值比）与分娩密切相关（去年）（4.47，1.49-13.41）。对于 SIJ-BME 扩展，发现与分娩（（去年）4.52，1.48-13.84）、人类白细胞抗原（HLA）-B27+（2.32，1.30-4.14）、体质量指数（25-30 与<25kg/m²；1.86（1.19-2.89））和腰痛（（过去 3 个月）1.55，1.04-2.31）相关，而对于脊柱 BME，与年龄每十年（1.46，1.13-1.90）和体力要求高的工作（1.46，1.06-2.00）相关。对于 694 名（87.5%）参与者进行了记录链接，其中 9/694（1.3%）有 axSpA（ICD M45.09）的记录。
这些基于人群的数据支持机械应变导致<45 岁人群中 BME 的假说，以及 HLA-B27+ 作为严重程度而不是 SIJ-BME 易感性的因素。
