Hotel-Dieu De France, Saint Joseph University, Beirut, Lebanon.
Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany.
Arthritis Res Ther. 2024 Aug 3;26(1):147. doi: 10.1186/s13075-024-03359-w.
Differentiating between degenerative disc disease (DDD), diffuse idiopathic skeletal hyperostosis (DISH), and axial spondyloarthritis (axSpA) represents a diagnostic challenge in patients with low back pain (LBP). We aimed to evaluate the distribution of inflammatory and degenerative imaging features in a real-life cohort of LBP patients referred to a tertiary university rheumatology center.
In a retrospective cross-sectional analysis of patients referred for LBP, demographics, symptom information, and available imaging were collected. SpA-like changes were considered in the spine in the presence of one of the following lesions typically related to SpA: erosions, sclerosis, squaring, and syndesmophytes on conventional radiographs (CR) and bone marrow oedema (BMO), erosions, sclerosis, and fat lesions (FL) on MRI. SIJ CR were graded per New York criteria; on MRIs, SIJs were evaluated by quadrant for BMO, erosions, FL, sclerosis and ankylosis, similar to the approach used by the Berlin SIJ MRI scoring system. The final diagnosis made by the rheumatologist was the gold standard. Data were presented descriptively, by patient and by quadrant, and compared among the three diagnosis groups.
Among 136 referred patients, 71 had DDD, 38 DISH, and 27 axSpA; median age 62 years [IQR55-73], 63% males. On CR, SpA-like changes were significantly higher in axSpA in the lumbar (50%, vs. DDD 23%, DISH 22%), in DISH in the thoracic (28%, vs. DDD 8%, axSpA 12%), and in DDD in the cervical spine (67% vs. DISH 0%, axSpA 33%). On MRI, BMO was significantly higher in DISH in the thoracic (37%, vs. DDD 22%, axSpA 5%) and equally distributed in the lumbar spine (35-42%). FL were significantly more frequently identified in DISH and axSpA in the thoracic (56% and 52%) and DDD and axSpA in the lumbar spine (65% and 74%, respectively). Degenerative changes were frequent in the three groups. Sacroiliitis (NY criteria) was identified in 49% (axSpA 76%, DDD 48%, DISH 29%).
A significant overlap was found among DDD, DISH, and axSpA for inflammatory and degenerative imaging features. Particularly, SpA-like spine CR features were found in one-fourth of patients with DISH, and MRI BMO was found in one-third of those patients.
在患有下腰痛（LBP）的患者中，区分退行性椎间盘疾病（DDD）、弥漫性特发性骨肥厚（DISH）和轴性脊柱关节炎（axSpA）是一项具有挑战性的诊断任务。我们旨在评估在转诊至三级大学风湿病中心的 LBP 患者的真实队列中，炎症和退行性影像学特征的分布情况。
对因 LBP 而就诊的患者进行回顾性横断面分析，收集人口统计学、症状信息和可获得的影像学资料。在脊柱中存在与 SpA 相关的以下病变之一时，会考虑 SpA 样改变：常规放射照相（CR）上的侵蚀、硬化、方形化和韧带骨赘，以及骨髓水肿（BMO）；磁共振成像（MRI）上的侵蚀、硬化和脂肪病变（FL）。纽约标准规定了骶髂关节炎（SIJ）CR 的分级；在 MRI 上，通过象限评估 SIJ 的 BMO、侵蚀、FL、硬化和强直，类似于柏林 SIJ MRI 评分系统的方法。风湿病医生的最终诊断是金标准。数据以患者和象限为单位进行描述性呈现，并在三组诊断中进行比较。
在 136 名转诊患者中，71 名患有 DDD，38 名患有 DISH，27 名患有 axSpA；中位年龄 62 岁[IQR55-73]，63%为男性。在 CR 上，axSpA 在腰椎（50%，而 DDD 为 23%，DISH 为 22%）、DISH 在胸椎（28%，而 DDD 为 8%，axSpA 为 12%）和 DDD 在颈椎（67%，而 DISH 为 0%，axSpA 为 33%）中的 SpA 样改变明显更高。在 MRI 上，DISH 在胸椎（37%，而 DDD 为 22%，axSpA 为 5%）中的 BMO 明显更高，在腰椎（35-42%）中的分布相当。FL 在 DISH 和 axSpA 中更频繁地在胸椎（56%和 52%）和 DDD 和 axSpA 中在腰椎（65%和 74%）中被识别。三组均有明显的退行性改变。骶髂关节炎（NY 标准）在 49%（axSpA 为 76%，DDD 为 48%，DISH 为 29%）中被发现。
DDD、DISH 和 axSpA 之间存在炎症和退行性影像学特征的显著重叠。特别是，在四分之一的 DISH 患者中发现了 SpA 样脊柱 CR 特征，而在三分之一的 DISH 患者中发现了 MRI BMO。
