Service de rhumatologie, CHU de Besançon, 3 boulevard Fleming, 25030, Besançon Cedex, France.
Service de rhumatologie, CHU de Dijon, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France.
Sci Rep. 2023 Oct 20;13(1):17901. doi: 10.1038/s41598-023-45082-7.
Diagnosis of axial spondyloarthritis (axSpA) is nowadays commonly made with the help of pelvic radiography or magnetic resonance imaging (MRI). However, there is an important inter-observer variability in radiography, and MRI is subject to possible false positives and is not the best modality for studying structural lesions. Conversely, pelvic computed tomography (CT) has excellent specificity and appears to be more effective than radiography for the diagnosis of ankylosing spondylitis (AS). However, its findings in patients over 50 years of age have not yet been studied. The objectives of this study were to describe the CT characteristics of sacro-iliac joints (SIJ) and the presence of intra-articular gas in patients with AS aged over 50 years and to compare them with controls of the same age and sex. This two-center, cross-sectional, observational study was performed using the medical records of the rheumatology departments of two University Hospitals. We included patients with a clinical diagnosis of axSpA, who had both definite radiographic sacroiliitis according to the modified New York criteria and met the ASAS 2009 criteria for axSpA (that is, AS), and who had undergone any CT scan including the whole SIJ. Each patient was matched for age and sex to a control randomly selected on the Picture Archiving and Communication System (PACS), symptomatic or asymptomatic, and without spondyloarthritis. For each individual, CT scans were interpreted blindly by two independent rheumatologists and scored for joint space narrowing (JSN), erosions, sclerosis, intra-articular gas, and diffuse idiopathic skeletal hyperostosis (DISH). Ninety patients and 90 controls were included in the study. The rates of positive JSN, erosion, and sclerosis scores were higher in the AS group (91% vs. 21%, p < 0.0001; 31% vs. 2%, p < 0.0001; 27% vs. 13%, p = 0.03, respectively), but the rates of intra-articular gas and DISH were higher in the control group (24% vs. 68%, p < 0.0001; 7% vs. 33%, p < 0.0001, respectively). 58% of patients had complete bilateral ankylosis. A total of 83 (92.2%) patients had a CT scan considered positive for AS, compared with only seven controls (7.8%). Sclerosis and erosions were predominantly on the anterosuperior part and iliac side of the joint in controls and were more diffuse in patients with AS. CT findings in patients with AS over 50 years of age are mostly represented by changes in the joint space; patients with AS have more erosions and sclerosis changes, but less intra-articular gas than controls.
目前，通过骨盆 X 光片或磁共振成像（MRI）来辅助诊断中轴型脊柱关节炎（axSpA）较为常见。然而，X 光片的观察者间差异较大，MRI 可能出现假阳性，并且并非研究结构损伤的最佳方式。相比之下，骨盆 CT（CT）具有出色的特异性，并且似乎比 X 光片更能有效诊断强直性脊柱炎（AS）。但是，尚未对 50 岁以上患者的 CT 表现进行研究。本研究的目的是描述 50 岁以上 AS 患者骶髂关节（SIJ）的 CT 特征和关节内气体的存在，并将其与相同年龄和性别的对照组进行比较。这是一项在两所大学附属医院的风湿病科进行的、以医院为基础的、前瞻性、双盲、对照研究。我们纳入了临床诊断为 axSpA 的患者，这些患者既有改良的纽约标准定义的明确的放射性骶髂关节炎，又符合 ASAS 2009 年 axSpA 标准（即 AS），并且都接受过任何包括整个 SIJ 的 CT 扫描。每个患者均按照年龄和性别与在 Picture Archiving and Communication System（PACS）上随机选择的无症状或有症状、且无脊柱关节炎的对照相匹配。对于每个个体，由两名独立的风湿病学家对 CT 扫描进行盲法解读，并对关节间隙狭窄（JSN）、侵蚀、硬化、关节内气体和弥漫性特发性骨肥厚（DISH）进行评分。研究纳入了 90 名患者和 90 名对照。AS 组的 JSN、侵蚀和硬化评分阳性率更高（91%比 21%，p<0.0001；31%比 2%，p<0.0001；27%比 13%，p=0.03），但对照组的关节内气体和 DISH 阳性率更高（24%比 68%，p<0.0001；7%比 33%，p<0.0001）。58%的患者存在完全性双侧强直性融合。共有 83 名（92.2%）患者的 CT 扫描被认为对 AS 呈阳性，而对照组仅有 7 名（7.8%）。对照组的硬化和侵蚀主要发生在关节的前上部分和髂骨侧，而在 AS 患者中更为弥漫。50 岁以上 AS 患者的 CT 表现主要表现为关节间隙改变；AS 患者的侵蚀和硬化改变更多，但关节内气体比对照组少。
