Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
Physical Medicine and Rheumatology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
Skeletal Radiol. 2021 Aug;50(8):1617-1628. doi: 10.1007/s00256-020-03700-9. Epub 2021 Jan 21.
To investigate long-term effects of pregnancy/childbirth on bone marrow edema (BME) and subchondral sclerosis of sacroiliac joints (SIJ) in comparison to MRI changes caused by spondyloarthritis (SpA) and assess the influence of birth method and number of children on SIJ-MRI changes.
This is a retrospective cohort study with 349 women (mean age 47 ± 14 years) suffering low back pain. Four subgroups were formed based on SpA diagnosis and childbirth (CB) history. Two musculoskeletal radiologists scored the presence of BME and sclerosis on SIJ-MRI using the Berlin method. Further, an 11-point "global assessment score" representing the overall confidence of SpA diagnosis based on MRI was evaluated in addition to the ASAS (Assessment of Spondyloarthritis International Society) criterion of "positive MRI" for sacroiliitis.
CB did not correlate with BME score (p = 0.38), whereas SpA diagnosis was associated with a higher BME score (r = 0.31, p < 0.001). Both CB (r = 0.21, p < 0.001) and SpA diagnosis (r = 0.33, p < 0.001) were correlated with a higher sclerosis score. CB was not associated with a higher confidence level in diagnosing SpA based on MRI (p = 0.07), whereas SpA diagnosis was associated with a higher score (r = 0.61, p < 0.001). Both CB (phi = 0.13, p = 0.02) and SpA diagnosis (phi = 0.23, p < 0.001) were significantly associated with a positive ASAS criterion for sacroiliitis. In non-SpA patients with CB, number of children (p = 0.001) was an independent predictor of sclerosis score, while birth method yielded no significant effect (p = 0.75).
Pregnancy/CB has no impact on long-term BME on SIJ, however, may cause long-term subchondral sclerosis-similar to SpA-associated sclerosis. Number of children is positively correlated with SIJ sclerosis. Birth method yields no effect on SIJ sclerosis.
与脊柱关节炎（SpA）引起的 MRI 变化相比，研究妊娠/分娩对骶髂关节（SIJ）骨髓水肿（BME）和软骨下硬化的长期影响，并评估分娩方式和生育子女数量对 SIJ-MRI 变化的影响。
这是一项回顾性队列研究，纳入 349 名（平均年龄 47±14 岁）患有下腰痛的女性。根据 SpA 诊断和分娩（CB）史将患者分为 4 个亚组。两名肌肉骨骼放射科医生使用柏林方法对 SIJ-MRI 上的 BME 和硬化程度进行评分。此外，还评估了基于 MRI 的 SpA 诊断整体置信度的 11 分“整体评估评分”，以及骶髂关节炎的 ASAS（评估脊柱关节炎国际协会）标准“阳性 MRI”。
CB 与 BME 评分无关（p=0.38），而 SpA 诊断与较高的 BME 评分相关（r=0.31，p＜0.001）。CB（r=0.21，p＜0.001）和 SpA 诊断（r=0.33，p＜0.001）均与较高的硬化评分相关。CB 与基于 MRI 诊断 SpA 的置信度水平升高无关（p=0.07），而 SpA 诊断与评分升高相关（r=0.61，p＜0.001）。CB（phi=0.13，p=0.02）和 SpA 诊断（phi=0.23，p＜0.001）均与 ASAS 骶髂关节炎阳性标准显著相关。在患有 CB 的非 SpA 患者中，生育子女数量（p=0.001）是硬化评分的独立预测因素，而分娩方式无显著影响（p=0.75）。
妊娠/分娩对 SIJ 的长期 BME 没有影响，但可能导致与 SpA 相关的硬化相似的长期软骨下硬化。生育子女数量与 SIJ 硬化呈正相关。分娩方式对 SIJ 硬化无影响。
