Kilic Gamze, Senol Serkan, Baspinar Sevgi, Kilic Erkan, Ozgocmen Salih
Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey.
Department of Radiology, Sevgi Hospital, Kayseri, Turkey.
Clin Rheumatol. 2023 Jan;42(1):111-116. doi: 10.1007/s10067-022-06321-w. Epub 2022 Aug 3.
The objective of this study was to assess degenerative changes (DCs) on magnetic resonance imaging (MRI) of lumbar spine in axial spondyloarthritis (axSpA) and non-specific mechanical low back pain (mLBP). Patients were consecutively recruited and all underwent MRI of the lumbar spine in this cross-sectional study. Disk degeneration (DD, Pfirrmann classification), endplate changes (Modic, types 1, 2, and 3), annular fissure, disk bulging, and protrusion or extrusion at each lumbar spinal level were assessed using anonymized images. Patients with axSpA were assessed for disease activity, functioning, and quality of life. Univariate and subsequent multivariate logistic regression analyses with adjustments of various covariates were used to assess association between MRI findings and clinical variables. One hundred twenty-three patients had non-radiographic (nr-axSpA) and 144 had radiographic axSpA/ankylosing spondylitis (AS). Degenerative changes were more prevalent in patients with mLBP (n = 105) than axSpA. Disk degeneration was the most prevalent MRI finding, followed by annular fissure, disk herniation (protrusion or extrusion), and Modic changes (MCs) in axSpA. Disk herniation was more prevalent in patients with nr-axSpA compared to AS. Modic changes (OR = 6.455), lumbar disk herniation (OR = 2.278), annular fissure (OR = 2.842), conventional synthetic or biologic disease-modifying antirheumatic drugs (csDMARDs) non-users (OR = 2.225), and advanced age (OR = 31.556) were factors associated with an increased risk of DD in axSpA. Coexisting DD increased the burden of disease in axSpA. A considerable proportion of patients with axSpA had DD at the lumbar spine. These degenerative changes might explain some of the complaints and should not been overlooked in patients with axSpA. Key Points • Lumbar herniated nucleus pulposus (LHNP) is more frequent in nr-axSpA while MC is more frequent in AS. • DD may cause an increase in BASFI and BASMI scores in axSpA. • Spinal DCs might be an alternative explanation for low back complaints and should not been overlooked in patients with axSpA.
本研究的目的是评估轴向型脊柱关节炎（axSpA）和非特异性机械性下腰痛（mLBP）患者腰椎磁共振成像（MRI）上的退变改变（DCs）。在这项横断面研究中，连续招募患者并对所有患者进行腰椎MRI检查。使用匿名图像评估每个腰椎节段的椎间盘退变（DD，Pfirrmann分级）、终板改变（Modic 1、2和3型）、椎间盘裂隙、椎间盘膨出以及突出或脱出情况。对axSpA患者进行疾病活动度、功能和生活质量评估。采用单因素及随后的多因素逻辑回归分析，并对各种协变量进行调整，以评估MRI表现与临床变量之间的关联。123例患者为非放射学axSpA（nr-axSpA），144例为放射学axSpA/强直性脊柱炎（AS）。mLBP患者（n = 105）的退变改变比axSpA患者更常见。在axSpA中，椎间盘退变是最常见的MRI表现，其次是椎间盘裂隙、椎间盘突出（脱出或挤出）和Modic改变（MCs）。与AS相比，nr-axSpA患者的椎间盘突出更常见。Modic改变（OR = 6.455）、腰椎间盘突出（OR = 2.278）、椎间盘裂隙（OR = 2.842）、未使用传统合成或生物改善病情抗风湿药物（csDMARDs）（OR = 2.225）以及高龄（OR = 31.556）是axSpA中与DD风险增加相关的因素。并存的DD增加了axSpA的疾病负担。相当一部分axSpA患者腰椎存在DD。这些退变改变可能解释了部分症状，在axSpA患者中不应被忽视。要点 • nr-axSpA中腰椎间盘突出症（LHNP）更常见，而AS中MC更常见。 • DD可能导致axSpA患者的BASFI和BASMI评分升高。 • 脊柱DCs可能是下腰痛症状的另一种解释，在axSpA患者中不应被忽视。
