Ruhr-Universität Bochum, Bochum, Germany.
Rheumazentrum Ruhrgebiet, Herne Claudiusstr 45, 44649, Herne, Germany.
Arthritis Res Ther. 2024 Jul 25;26(1):138. doi: 10.1186/s13075-024-03377-8.
Define the prevalence and location of inflammatory and structural lesions on magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) and radiographic axial spondyloarthritis (r-axSpA) with neck pain as leading clinical symptom.
Patients with diagnosis of RA and r-axSpA were consecutively included if they had chronic (> 3 months) neck pain. Clinical assessment, neck pain questionnaires and MRIs of the cervical spine (CS) were performed.
107 patients (59 RA and 48 r-axSpA) were included. While there was no difference in the Northwick-Park-Neck-Pain-questionnaire, patients with RA reported higher neck pain compared to r-axSpA on a numeric rating scale (5.0 ± 3.6 vs. 3.0 ± 3.1; p = 0.003). Inflammatory lesions occurred predominantly in the craniocervical area in RA and in the lower CS segments in r-axSpA. Bone marrow edema (BME) was more frequent in axSpA (BME-score axSpA/RA: 0.35vs0.17; p < 0.001) while synovitis was visible in both but was more prevalent in RA (synovitis-score axSpA/RA: 0.02vs0.1; p < 0.001). BME was found in 8 (13.6%) vertebral corner vs. 9 (18.8%), in 2 (3.4%) facet joints vs. 7 (14.6%) and in 1 (1.7%) spinous processes vs. 9 (18.8%) in patients with RA/r-axSpA. In contrast, more patients with RA (30.5% vs6.3%) showed erosive osteochondrosis with endplate BME (p = 0.002).
While involvement of upper cervical inflammation was typically present in RA, r-axSpA patients showed more BME in lower CS segments, vertebral corners, facet joints and spinous processes. Neck pain is linked to upper and lower inflammatory and structural lesions of the CS in both diseases.
定义以颈痛为主要临床症状的类风湿关节炎（RA）和放射学中轴型脊柱关节炎（r-axSpA）患者的磁共振成像（MRI）上炎症和结构病变的患病率和位置。
连续纳入诊断为 RA 和 r-axSpA 且有慢性（>3 个月）颈痛的患者。进行临床评估、颈痛问卷和颈椎（CS）MRI。
共纳入 107 例患者（59 例 RA 和 48 例 r-axSpA）。尽管 Northwick-Park-Neck-Pain-questionnaire 无差异，但 RA 患者的数字评分量表上颈痛评分高于 r-axSpA（5.0±3.6 比 3.0±3.1；p=0.003）。RA 患者的炎症病变主要发生在颅颈区，r-axSpA 患者的炎症病变主要发生在 CS 下段。骨髓水肿（BME）在 axSpA 中更常见（BME 评分 axSpA/RA：0.35 比 0.17；p<0.001），而滑膜炎在两者中均可见，但在 RA 中更为常见（滑膜炎评分 axSpA/RA：0.02 比 0.1；p<0.001）。RA 患者中，8 例（13.6%）椎体角出现 BME，9 例（18.8%）；2 例（3.4%）小关节出现 BME，7 例（14.6%）；1 例（1.7%）棘突出现 BME，9 例（18.8%）。相比之下，更多 RA 患者（30.5%比 6.3%）出现伴终板 BME 的侵蚀性骨软骨病（p=0.002）。
RA 患者以颅颈炎症受累为特征，而 r-axSpA 患者以 CS 下段、椎体角、小关节和棘突更常见 BME。两种疾病的颈痛均与 CS 的上、下炎症和结构病变有关。
