Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy.
Radiology Unit, Padova University Hospital, Padova, Italy.
Scand J Rheumatol. 2023 Sep;52(5):519-529. doi: 10.1080/03009742.2023.2169990. Epub 2023 Feb 27.
To assess the association between sex and clinical and disease activity indices, and X-rays and magnetic resonance imaging (MRI) features, in early-stage axial spondyloarthritis (axSpA).
Baseline data analysis was conducted on the Italian SPACE cohort, including patients with chronic back pain (duration ≥ 3 months and ≤ 2 years; onset < 45 years). Patients underwent MRI and X-rays of the sacroiliac joints (SIJs) to establish the diagnosis of axSpA, according to Assessment of SpondyloArthritis international Society criteria and physician's judgement. Clinical features, disease activity and functional indices, and images were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRI images were scored by two readers following Spondyloarthritis Research Consortium of Canada (SPARCC), modified Stoke Ankylosing Spondylitis Spinal Score, and modified New York criteria. Characteristics of axSpA patients according to sex (male/female) were compared over time using descriptive statistics.
Ninety-one patients had axSpA (83.5% non-radiographic; 16.5% radiographic); 47.3% were male. Males were younger, with shorter duration of axial symptoms, and more frequently had HLA-B27 positivity, radiographic sacroiliitis with a bilateral/symmetric pattern, and more signs of spondylitis. Females more frequently showed peripheral/entheseal involvement and the non-radiographic phenotype. Males showed increased pelvic/spinal radiographic progression and more often had active sacroiliitis on MRI. Although the frequency of inflammatory corner lesions did not differ between males and females, localization varied, with more cervical/thoracic MRI-spine lesions in females and more lumbar lesions in males. We observed a significant downward trend of SPARCC SIJ/spine scores in all patients, irrespective of sex. More fat lesions were observed on MRI-spine in females and on MRI-SIJ in males.
Sex was associated with distinct axSpA features: females showed low-grade radiographic sacroiliitis and spinal progression, and a higher prevalence of cervical and thoracic spine MRI signs.
评估性别与早期中轴型脊柱关节炎（axSpA）的临床和疾病活动指数，以及 X 射线和磁共振成像（MRI）特征之间的关系。
对意大利 SPACE 队列进行基线数据分析，纳入慢性背痛患者（病程≥3 个月且≤2 年；发病年龄<45 岁）。根据评估脊柱关节炎国际协会（ASAS）标准和医生判断，对患者进行骶髂关节（SIJ）MRI 和 X 射线检查，以确立 axSpA 的诊断。在 48 个月的时间内，收集基线和每年的临床特征、疾病活动和功能指数以及影像学资料。由两名观察者按照加拿大脊柱关节炎研究协会（SPARCC）、改良 Stoke 强直性脊柱炎脊柱评分和改良纽约标准对脊柱和 SIJ X 射线和 MRI 图像进行评分。采用描述性统计方法比较不同性别（男性/女性）axSpA 患者的特征。
91 例患者患有 axSpA（83.5%非放射性；16.5%放射性）；47.3%为男性。男性患者更年轻，轴向症状持续时间更短，HLA-B27 阳性率更高，放射影像学显示双侧/对称的骶髂关节炎，且脊柱炎征象更多。女性患者更常出现外周/附着点受累和非放射性表型。男性患者骨盆/脊柱放射影像学进展更明显，且 MRI 上更常出现活动性骶髂关节炎。尽管男性和女性的炎症角状病变频率无差异，但病变部位不同，女性颈椎/胸椎 MRI 脊柱病变更多，男性腰椎病变更多。我们观察到所有患者的 SPARCC SIJ/脊柱评分均呈显著下降趋势，与性别无关。女性 MRI 脊柱上的脂肪病变更多，男性 MRI-SIJ 上的脂肪病变更多。
性别与 axSpA 的不同特征相关：女性表现为低度放射性骶髂关节炎和脊柱进展，且颈椎和胸椎 MRI 征象更为常见。
