Lee Tae-Han, Lee Seunghun, Koo Bon San, Joo Kyung Bin, Kim Tae-Hwan
Department of Rheumatology, Keimyung University Dongsan Hospital, Daegu, South Korea.
Department of Radiology, Hanyang University Hospital, Seoul, South Korea.
BMC Rheumatol. 2023 Jun 7;7(1):11. doi: 10.1186/s41927-023-00334-x.
The inability to assess structural changes in facet joints is a limitation of established radiographic scoring systems for ankylosing spondylitis (AS). We compared radiographic evidence of ankylosis in cervical facet joints and cervical vertebral bodies in patients with AS.
We analysed longitudinal data collected from 1106 AS patients and assessed 4984 spinal radiographs obtained up to 16 years of follow-up. Comparisons between cervical facet joints and cervical vertebral bodies focused on the presence of ankylosis, which was defined by at least one facet joint exhibiting complete ankylosis (according to the method of de Vlam) or at least one vertebral body with a bridging syndesmophyte (according to the modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS]). Ankylosis was assessed over time using spinal radiographs collected during follow-up periods stratified in 4-year increments.
Patients with cervical facet joint ankylosis had higher cervical mSASSS, sacroiliitis grades, and inflammatory markers, with more prevalent hip involvement and uveitis. Overall, the numbers of spinal radiographs indicating ankylosis were comparable between cervical facet joints (17.8%) and cervical vertebral bodies (16.8%), and they usually presented together (13.5%). We observed similar proportions of radiographs with ankylosis only in cervical facet joints (4.3%) and cervical vertebral bodies (3.3%). As damage progressed, configurations with both cervical facet joint ankylosis and bridging syndesmophytes became more predominant with longer follow-up times, while configurations with cervical facet joint ankylosis only or bridging syndesmophytes only were less frequently observed.
Evidence of cervical facet joint ankylosis appears as often as bridging syndesmophytes on routine AS spinal radiographs. Presence of cervical facet joint ankylosis should be considered because it may have a higher disease burden.
无法评估小关节的结构变化是强直性脊柱炎（AS）现有放射学评分系统的一个局限性。我们比较了AS患者颈椎小关节和颈椎椎体的融合影像学证据。
我们分析了从1106例AS患者收集的纵向数据，并评估了随访长达16年期间获得的4984张脊柱X光片。颈椎小关节和颈椎椎体之间的比较重点在于融合的存在情况，融合的定义为至少一个小关节表现出完全融合（根据德弗拉姆方法）或至少一个椎体有桥接性骨桥（根据改良斯托克强直性脊柱炎脊柱评分[mSASSS]）。使用随访期间以4年为增量分层收集的脊柱X光片随时间评估融合情况。
颈椎小关节融合的患者颈椎mSASSS、骶髂关节炎分级和炎症标志物更高，髋关节受累和葡萄膜炎更常见。总体而言，显示融合的脊柱X光片数量在颈椎小关节（17.8%）和颈椎椎体（16.8%）之间相当，且它们通常同时出现（13.5%）。我们观察到仅在颈椎小关节（4.3%）和颈椎椎体（3.3%）出现融合的X光片比例相似。随着损伤进展，颈椎小关节融合和桥接性骨桥同时存在的情况在随访时间延长时变得更为主导，而仅颈椎小关节融合或仅桥接性骨桥的情况较少见。
在常规AS脊柱X光片上，颈椎小关节融合的证据与桥接性骨桥出现的频率相同。应考虑颈椎小关节融合的存在，因为它可能具有更高的疾病负担。
