Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Department of Internal Medicine, Sheba Medical Center, Tel Hashomer, Israel.
Semin Arthritis Rheum. 2022 Aug;55:151991. doi: 10.1016/j.semarthrit.2022.151991. Epub 2022 Mar 9.
Facet joints' (FJ) ankylosis was reported in patients with radiographic axial spondyloarthritis (r-AxSpA). However, a detailed FJ evaluation over the whole spectrum of AxSpA was not performed. We aimed to analyze structural lesions in the FJ of patients with different forms of AxSpA, using computed tomography (CT).
CT studies of the cervical/thoracic/lumbar spine, or of the chest/abdomen of patients with r-AxSpA or non-radiographic AxSpA (nr-AxSpA) (age ≤ 50 years) were analyzed for the presence of erosions, ankylosis, joint-space narrowing, osteophytes, subchondral sclerosis, subchondral cysts and vacuum phenomenon. Age- and gender-matched subjects without known rheumatic disease who performed spinal CT, formed the control group. Findings were compared between groups, separately for each spinal segment. Further, FJ findings between three subgroups of the axSpA subjects, including r-AxSpA with or without syndesmophytes, and nr-AxSpA, were compared.
959/666 FJs (49/44 patients) were assessed in the AxSpA/control group patients, respectively. The study group consisted of 16 r-AxSpA patients with syndesmophytes and 22 r-AxSpA patients without syndesmophytes, and 11 nr-AxSpA patients. FJ ankylosis was significantly more prevalent in all spinal segments of the r-AxSpA patients with syndesmophytes. Erosions were seen almost exclusively in patients with r-AxSpA. Joint-space narrowing and osteophytes were noted in all segments and all subgroups of AxSpA patients, including those with nrAxSpA.
Disease-specific FJ changes present almost exclusively in patients with r-AxSpA, while degenerative FJ changes are prevalent in all spinal segments and all AxSpA subgroups, suggesting that FJs can be affected early in the disease course.
影像学轴性脊柱关节炎（r-AxSpA）患者可出现小关节（FJ）强直。然而，AxSpA 各型患者的 FJ 尚未进行详细评估。我们旨在通过 CT 分析不同 AxSpA 患者 FJ 的结构病变。
对 r-AxSpA 或非放射学 AxSpA（nr-AxSpA）（年龄≤50 岁）的颈椎/胸椎/腰椎或胸/腹部 CT 研究进行分析，评估侵蚀、强直、关节间隙变窄、骨赘、软骨下硬化、软骨下囊肿和真空现象的存在。无已知风湿性疾病、年龄和性别匹配、行脊柱 CT 的患者为对照组。比较各组之间、各脊柱节段之间的发现。此外，比较 AxSpA 受试者的三个亚组（r-AxSpA 伴或不伴骨桥、nr-AxSpA）之间的 FJ 发现。
AxSpA/对照组患者分别评估了 959/666 个 FJ（49/44 例）。研究组包括 16 例伴骨桥的 r-AxSpA 患者和 22 例不伴骨桥的 r-AxSpA 患者，以及 11 例 nr-AxSpA 患者。伴骨桥的 r-AxSpA 患者所有脊柱节段的 FJ 强直均明显更常见。侵蚀几乎仅见于 r-AxSpA 患者。r-AxSpA 患者所有节段和所有亚组均出现关节间隙狭窄和骨赘，包括 nrAxSpA 患者。
r-AxSpA 患者中几乎仅存在疾病特异性 FJ 改变，而退行性 FJ 改变在所有脊柱节段和所有 AxSpA 亚组中均较常见，提示 FJ 可在疾病早期受到影响。
