Vinje O, Dale K, Møller P
Scand J Rheumatol. 1985;14(2):119-32. doi: 10.3109/03009748509165493.
One hundred and twenty-two hospitalized patients, 35 years or more of age with confirmed bilateral sacro-iliitis and 239 first-degree relatives, 25 years or more of age, were examined. All but 3 of the patients had confirmed ankylosing spondylitis (AS) in accordance with established criteria. The sacro-iliac joints were scored by a recently developed grading system. The prevalence of grade V sacro-iliits--extensive ankylosis--was greater in HLA B27-positive than in HLA B27-negative patients, and ankylosis of apophyseal joints, ossification of the interspinous ligament, or block vertebrae were not seen in HLA B27-negative patients. Shining corners and/or squared vertebrae were the most frequent findings of the dorsolumbar spine in patients with a disease course of less than 10 years. Mixed osteophytes were rare in patients below 40 years of age. All radiographic inflammatory changes scored in the spine-except for shining corners--were most often seen in patients with a disease history exceeding 20 years. Syndesmophytes and/or ankylosed apophyseal joints were less extensive in female than in male patients. No differences in the severity of radiographic changes in sacro-iliac joints or in frequency, severity or localization of different radiographic changes of the dorsolumbar spine were observed between HLA B27-positive patients with and those without psoriasis or acute anterior uveitis. Definite sacro-iliitis was restricted to HLA B27-positive relatives of HLA B27-positive probands and demonstrated in one-fifth of them. Shining corners and/or squared vertebrae were frequent findings in relatives with sacro-iliitis (45%), whereas apophyseal joint ankylosis, ossification of the interspinous ligament, block vertebrae and bridging syndesmophytes were not seen. Our results support the view that AS is not a defined disease entity and should be regarded as a syndrome. AS is an improper name for all patients fulfilling the Rome and/or New York criteria for definite AS, since many of them will probably never develop ankylosis of the spine or sacro-iliac joints.
对122例年龄在35岁及以上、确诊为双侧骶髂关节炎的住院患者以及239例年龄在25岁及以上的一级亲属进行了检查。除3例患者外，所有患者均根据既定标准确诊为强直性脊柱炎（AS）。骶髂关节采用最近开发的分级系统进行评分。V级骶髂关节炎（广泛强直）在HLA B27阳性患者中的患病率高于HLA B27阴性患者，且在HLA B27阴性患者中未发现关节突关节强直、棘间韧带骨化或椎体融合。在病程少于10年的患者中，椎体角闪亮和/或椎体方形化是胸腰椎最常见的表现。40岁以下患者中混合型骨赘罕见。脊柱上所有影像学炎症改变（除椎体角闪亮外）最常出现在病程超过20年的患者中。女性患者的韧带骨赘和/或关节突关节强直程度不如男性患者广泛。在有或无银屑病或急性前葡萄膜炎的HLA B27阳性患者之间，骶髂关节影像学改变的严重程度以及胸腰椎不同影像学改变的频率、严重程度或部位均未观察到差异。明确的骶髂关节炎仅限于HLA B27阳性先证者的HLA B27阳性亲属，其中五分之一有此表现。椎体角闪亮和/或椎体方形化在有骶髂关节炎的亲属中很常见（45%），而未发现关节突关节强直、棘间韧带骨化、椎体融合和桥接韧带骨赘。我们的结果支持这样一种观点，即AS不是一个明确的疾病实体，而应被视为一种综合征。对于所有符合罗马和/或纽约明确AS标准的患者来说，AS是一个不恰当的名称，因为他们中的许多人可能永远不会发展为脊柱或骶髂关节强直。
