Baraliakos Xenofon, Kuehn Anna, Tsiami Styliani, Kiltz Uta, Fruth Martin, Braun Juergen
Ruhr-University Bochum, Rheumazentrum Ruhrgebiet Herne, Bochum, Germany.
blikk-Radiologie, Herne, Germany.
Rheumatology (Oxford). 2023 Apr 3;62(4):1519-1525. doi: 10.1093/rheumatology/keac505.
To compare the influence of age on inflammatory (bone marrow oedema [BME]) and structural (fat lesions [FL], erosions and ankylosis) MRI lesions in the sacroiliac joints (SIJ) of patients with and without axial spondyloarthritis (axSpA).
In a retrospective study, SIJ MRI (STIR/T1 sequences) of consecutive patients with chronic back pain diagnosed with axSpA or non-SpA were evaluated based on SIJ quadrants (SIJ-Q). Two blinded readers evaluated BME and structural lesions. Reader agreement was evaluated for prevalence of MRI lesions related to age.
MRIs of 309 (175 axSpA, 134 non-SpA) patients were evaluated. Their mean age was 38.5 (11.4) and 43.4 (13.8) years, 67% and 36% were male, CRP was 1.6 (2.4) and 1.1 (2.1) mg/dl and median symptom duration was 48 and 60 months for axSpA and non-SpA, respectively. SIJ-Q with BME and erosions were significantly more frequent in axSpA vs non-SpA patients independent of age, while this difference was seen for FL only in patients ≥50 years. The proportion of patients with ≥1 or ≥3 BME or chronic lesions except for FL increased with age in both groups, and was constantly higher in axSpA vs non-SpA. In univariate analyses, only female sex was significantly associated with more FL.
The proportion of patients with MRI lesions was high in both axSpA and non-SpA patients. However, the prevalence of BME and erosions was significantly more frequent in patients with axSpA, was independent of age and also allowed for discrimination. FL occurred more frequently only in older age groups and were less reliable for discrimination vs non-SpA patients.
比较年龄对有或无轴性脊柱关节炎（axSpA）患者骶髂关节（SIJ）炎症性（骨髓水肿[BME]）和结构性（脂肪病变[FL]、侵蚀和强直）MRI病变的影响。
在一项回顾性研究中，基于SIJ象限（SIJ-Q）对连续诊断为axSpA或非SpA的慢性背痛患者的SIJ MRI（STIR/T1序列）进行评估。两名盲法阅片者评估BME和结构性病变。评估阅片者对与年龄相关的MRI病变患病率的一致性。
对309例患者（175例axSpA，134例非SpA）的MRI进行了评估。他们的平均年龄分别为38.5（11.4）岁和43.4（13.8）岁，男性分别占67%和36%，axSpA和非SpA患者的CRP分别为1.6（2.4）mg/dl和1.1（2.1）mg/dl，中位症状持续时间分别为48个月和60个月。无论年龄如何，axSpA患者中出现BME和侵蚀的SIJ-Q显著多于非SpA患者，而仅在≥50岁的患者中FL存在这种差异。两组中BME或除FL外的慢性病变≥1处或≥3处的患者比例均随年龄增加，且axSpA患者始终高于非SpA患者。在单因素分析中，仅女性与更多的FL显著相关。
axSpA和非SpA患者中MRI病变患者的比例都很高。然而，axSpA患者中BME和侵蚀的患病率显著更高，与年龄无关，也有助于鉴别诊断。FL仅在老年组中更频繁出现，与非SpA患者相比，其鉴别诊断的可靠性较低。
