轴性脊柱关节炎患者脊柱结构损伤对功能的负担：适应介导的解耦？

The Burden of Spine Structural Damage on Function in Patients With Axial Spondyloarthritis: Adaptation-Mediated Uncoupling?

作者信息

Penteado Marcela Paula Santos, Resende Gustavo Gomes, da Cruz Lage Ricardo, Tavares Wilson Campos, de Souza Bueno Filho Júlio Silvio, Ferreira Gilda Aparecida

机构信息

M.P.S. Penteado, MD, MS, Graduate Program in Sciences Applied to Adult Health, Faculdade de Medicina da Universidade Federal de Minas Gerais, and Department of Rheumatology, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte;

G.G. Resende, MD, MS, R. da Cruz Lage, MD, MS, Department of Rheumatology, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte.

出版信息

J Rheumatol. 2024 Aug 1;51(8):765-771. doi: 10.3899/jrheum.2024-0022.

DOI:10.3899/jrheum.2024-0022

PMID:38749558

Abstract

OBJECTIVE

To investigate the association between spinal damage and functional capacity in patients with axial spondyloarthritis (axSpA) and to compare the performance of 2 radiographic scores (modified Stoke Ankylosing Spondylitis Spine Score [mSASSS] and Combined Ankylosing Spondylitis Spine Score [CASSS]).

METHODS

Radiographs from 101 patients with axSpA were scored for cervical facet joints (CFJ) and mSASSS for vertebral bodies. CASSS was calculated as the sum of both scores. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI); disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS); mobility by Bath Ankylosing Spondylitis Metrology Index (BASMI); and quality of life by Ankylosing Spondylitis Quality of Life (ASQOL). Univariate and multivariate analyses were performed to investigate the association between possible explanatory variables and outcomes.

RESULTS

BASFI correlated strongly with ASQOL (Spearman ρ 0.66) and BASDAI (ρ 0.70), moderately with BASMI (ρ 0.46) and ASDAS (ρ 0.59), and weakly with mSASSS (ρ 0.29) and CASSS (ρ 0.28). A best-fit multivariate model for BASFI, adjusted for symptom duration, age, sex, and smoking status, included BASDAI ( 0.76, < 0.001), BASMI ( 0.62, < 0.001), and history of total hip arthroplasty ( 1.22, = 0.05). Radiographic scores were predictors of BASFI only when BASMI was removed from the model (mSASSS: 0.03, = 0.01; CASSS: 0.02, = 0.01).

CONCLUSION

Spinal damage was independently associated with physical function in axSpA, but to a lesser extent than disease activity and mobility. Moreover, incorporating CFJ assessment in the mSASSS did not improve the ability to predict function.

摘要

目的

探讨中轴型脊柱关节炎（axSpA）患者脊柱损伤与功能能力之间的关联，并比较两种影像学评分（改良斯托克强直性脊柱炎脊柱评分[mSASSS]和强直性脊柱炎联合脊柱评分[CASSS]）的表现。

方法

对101例axSpA患者的X线片进行颈椎小关节（CFJ）评分，并对椎体进行mSASSS评分。CASSS计算为两者评分之和。通过巴斯强直性脊柱炎功能指数（BASFI）评估身体功能；通过巴斯强直性脊柱炎疾病活动指数（BASDAI）和强直性脊柱炎疾病活动评分（ASDAS）评估疾病活动度；通过巴斯强直性脊柱炎测量指数（BASMI）评估活动度；通过强直性脊柱炎生活质量（ASQOL）评估生活质量。进行单因素和多因素分析以研究可能的解释变量与结局之间的关联。

结果

BASFI与ASQOL（Spearman ρ 0.66）和BASDAI（ρ 0.70）高度相关，与BASMI（ρ 0.46）和ASDAS（ρ 0.59）中度相关，与mSASSS（ρ 0.29）和CASSS（ρ 0.28）弱相关。针对BASFI的最佳拟合多因素模型，经症状持续时间、年龄、性别和吸烟状况校正后，包括BASDAI（β 0.76，P < 0.001）、BASMI（β 0.62，P < 0.001）和全髋关节置换史（β 1.22，P = 0.05）。仅当从模型中去除BASMI时，影像学评分才是BASFI的预测因素（mSASSS：β 0.03，P = 0.01；CASSS：β 0.02，P = 0.01）。