Division of Rheumatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Joint Bone Spine. 2023 Jul;90(4):105546. doi: 10.1016/j.jbspin.2023.105546. Epub 2023 Feb 15.
To evaluate costovertebral joint involvement in patients with axial spondyloarthritis (axSpA) and to assess its association with disease features.
We included 150 patients from the Incheon Saint Mary's axSpA observational cohort who underwent whole spine low-dose computed tomography (ldCT). Costovertebral joint abnormalities were scored by two readers on a scale of 0-48 based on the presence or absence of erosion, syndesmophyte, and ankylosis. The interobserver reliability of costovertebral joint abnormalities was assessed using intraclass correlation coefficients (ICCs). Associations between costovertebral joint abnormality scores and clinical variables were evaluated using a generalized linear model.
Two independent readers found costovertebral joint abnormalities in 74 (49%) patients and 108 (72%) patients. The ICCs of scores for erosion, syndesmophyte, ankylosis, and total abnormality were 0.85, 0.77, 0.93, and 0.95, respectively. For both readers, total abnormality score was correlated with age, symptom duration, Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath AS functional index (BASFI), CT syndesmophyte score (CTSS), and number of bridging spines. Multivariate analyses showed age, ASDAS, CTSS to be independently associated with total abnormality scores in both readers. The frequency of ankylosed costovertebral joint was 10.2% (reader 1) and 17.0% (reader 2) in patients without radiographic syndesmophytes (n=62), and 10.3% (reader 1) and 17.2% (reader 2) in patients without radiographic sacroiliitis (n=29).
Costovertebral joint involvement was common in patients with axSpA, even in the absence of radiographic damage. LdCT is recommended for evaluating structural damage in patients with clinically suspected costovertebral joint involvement.
评估中轴型脊柱关节炎（axSpA）患者肋椎关节受累情况，并评估其与疾病特征的关系。
我们纳入了 150 名来自仁川圣玛丽 axSpA 观察队列的患者，这些患者接受了全脊柱低剂量计算机断层扫描（ldCT）。根据有无侵蚀、骨桥和强直，两位读者对肋椎关节异常进行 0-48 分评分。使用组内相关系数（ICC）评估肋椎关节异常的观察者间可靠性。使用广义线性模型评估肋椎关节异常评分与临床变量之间的关系。
两位独立的读者在 74 名（49%）患者和 108 名（72%）患者中发现肋椎关节异常。侵蚀、骨桥、强直和总异常评分的 ICC 分别为 0.85、0.77、0.93 和 0.95。对于两位读者，总异常评分与年龄、症状持续时间、强直性脊柱炎疾病活动评分（ASDAS）、巴斯功能指数（BASFI）、CT 骨桥评分（CTSS）和融合脊柱数量相关。多变量分析显示，年龄、ASDAS 和 CTSS 是两位读者总异常评分的独立相关因素。在无放射学骨桥的患者（n=62）中，强直的肋椎关节的发生率为 10.2%（读者 1）和 17.0%（读者 2），在无放射学骶髂关节炎的患者（n=29）中，发生率为 10.3%（读者 1）和 17.2%（读者 2）。
即使在没有放射学损伤的情况下，axSpA 患者的肋椎关节受累也很常见。对于临床怀疑肋椎关节受累的患者，推荐使用 ldCT 评估结构损伤。
