Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, 05505, Republic of Korea.
Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Rheumatol Int. 2024 Nov;44(11):2591-2597. doi: 10.1007/s00296-023-05468-2. Epub 2023 Sep 21.
We aimed to identify when magnetic resonance imaging (MRI) would be useful to diagnose patients with suspected axial spondyloarthropathy (AxSpA) without evidence of sacroiliitis on radiographs. We retrospectively reviewed electronic medical records of patients who underwent pelvis MRI after radiographs at the rheumatology clinic in a single tertiary center in Korea. Patients underwent imaging from January 2020 to July 2022. We collected data including complete blood count, erythrocyte sedimentation rate, C-reactive protein (CRP), human leukocyte antigen (HLA)-B27, history of acute anterior uveitis (AAU), peripheral arthritis, dactylitis, inflammatory bowel disease (IBD), enthesopathy, and psoriasis. A total of 105 patients who showed no evidence of sacroiliitis on radiographs were included. The median age of patients was 41.0 years, and 44.8% were male. Of them, 34 showed sacroiliitis on MRI (group 1), and 71 showed no evidence of sacroiliitis even on MRI (group 2). Known AxSpA-related clinical features including AAU, peripheral arthritis, dactylitis, IBD, enthesopathy, and psoriasis were not different between the two groups. HLA-B27 positivity (79.4% vs. 40.0%, p < 0.001), median white blood cell count (7700 vs. 6300, p = 0.007), mean platelet count (307.7 ± 69.7 vs. 265.3 ± 68.9 × 10/µL, p = 0.005), and median CRP level (0.38 vs. 0.10, p = 0.001) showed significant differences between the two groups. In a multivariate analysis, HLA-B27 positivity and platelet count were significantly associated with sacroiliitis on MRI. In our cohort, sacroiliitis was observed on MRI in one-third of patients without radiographic evidence. MRI could be recommended to evaluate sacroiliitis in patients with positive HLA-B27 and a high platelet count.
我们旨在确定在没有放射学证据的情况下，磁共振成像（MRI）对诊断疑似中轴型脊柱关节炎（AxSpA）患者的作用。我们回顾性地审查了韩国一家三级中心风湿病诊所的患者的电子病历，这些患者在放射学检查后进行了骨盆 MRI。患者的影像学检查时间为 2020 年 1 月至 2022 年 7 月。我们收集了包括全血细胞计数、红细胞沉降率、C 反应蛋白（CRP）、人类白细胞抗原（HLA）-B27、急性前葡萄膜炎（AAU）、外周关节炎、指（趾）炎、炎症性肠病（IBD）、肌腱端炎和银屑病在内的数据。共纳入 105 例放射学无骶髂关节炎证据的患者。患者的中位年龄为 41.0 岁，44.8%为男性。其中，34 例患者 MRI 显示骶髂关节炎（组 1），71 例患者即使 MRI 也未显示骶髂关节炎（组 2）。两组之间已知的 AxSpA 相关临床特征（包括 AAU、外周关节炎、指（趾）炎、IBD、肌腱端炎和银屑病）无差异。HLA-B27 阳性率（79.4% vs. 40.0%，p<0.001）、中位白细胞计数（7700 与 6300，p=0.007）、平均血小板计数（307.7±69.7 与 265.3±68.9×10/µL，p=0.005）和中位 CRP 水平（0.38 与 0.10，p=0.001）在两组间存在显著差异。多变量分析显示，HLA-B27 阳性和血小板计数与 MRI 上的骶髂关节炎显著相关。在我们的队列中，三分之一的患者放射学上无骶髂关节炎，但 MRI 上观察到骶髂关节炎。对于 HLA-B27 阳性和血小板计数高的患者，建议进行 MRI 评估骶髂关节炎。
