Maksymowych Walter P, Carmona Raj, Weber Ulrich, Aydin Sibel Zehra, Yeung James, Reis Jodie, Masetto Ariel, Rohekar Sherry, Mosher Dianne, Zouzina Olga, Martin Liam, Keeling Stephanie O, Paschke Joel, Dadashova Rana, Carapellucci Amanda, Wichuk Stephanie, Lambert Robert G, Chan Jonathan
University of Alberta and CARE Arthritis, Edmonton, Alberta, Canada.
McMaster University, Hamilton, Ontario, Canada.
Arthritis Rheumatol. 2025 Jan;77(1):47-58. doi: 10.1002/art.42967. Epub 2024 Sep 3.
We aimed to assess the following: (1) the frequency of axial spondyloarthritis (axSpA) according to extra-articular presentation and HLA-B27 status, (2) clinical and imaging features that distinguish axSpA from non-axSpA, and (3) the impact of magnetic resonance imaging (MRI) on diagnosis and classification of axSpA.
The Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) study enrolled patients in two multicenter cohorts. Consecutive patients with undiagnosed chronic back pain attending dermatology, ophthalmology, and gastroenterology clinics with psoriasis (PsO), acute anterior uveitis (AAU), or inflammatory bowel disease (IBD) were referred to a local rheumatologist with special expertise in axSpA for a structured diagnostic evaluation. The primary outcome was the proportion of patients diagnosed with axSpA by the final global evaluation.
Frequency of axSpA was 46.7%, 61.6%, and 46.8% in patients in SASPIC-1 (n = 212) and 23.5%, 57.9%, and 23.3% in patients in SASPIC-2 (n = 151) with PsO, AAU, or IBD, respectively. Among those who were B27 positive, axSpA was diagnosed in 70%, 74.5%, and 66.7% of patients in SASPIC-1 and in 71.4%, 87.8%, and 55.6% of patients in SASPIC-2 with PsO, AAU, or IBD, respectively. All musculoskeletal clinical features were nondiscriminatory. MRI was indicative of axSpA in 60% to 80% of patients and MRI in all patients (SASPIC-2) versus on-demand (SASPIC-1) led to 25% fewer diagnoses of axSpA in patients who were HLA-B27 negative with PsO or IBD. Performance of the Assessment of SpondyloArthritis International Society classification criteria was greater with routine MRI (SASPIC-2), though sensitivity was lower than previously reported.
Optimal management of patients presenting with PsO, AAU, IBD, and undiagnosed chronic back pain should include referral to a rheumatologist. Conducting MRI in all patients enhances diagnostic accuracy.
我们旨在评估以下内容：（1）根据关节外表现和HLA - B27状态的轴向脊柱关节炎（axSpA）的发生率；（2）区分axSpA与非axSpA的临床和影像学特征；（3）磁共振成像（MRI）对axSpA诊断和分类的影响。
银屑病、虹膜炎和结肠炎轴向脊柱关节炎筛查（SASPIC）研究纳入了两个多中心队列中的患者。连续患有未确诊慢性背痛的患者，分别患有银屑病（PsO）、急性前葡萄膜炎（AAU）或炎症性肠病（IBD），他们就诊于皮肤科、眼科和胃肠病科诊所，随后被转诊至当地一位在axSpA方面有专业专长的风湿病专家处进行结构化诊断评估。主要结局是通过最终综合评估被诊断为axSpA的患者比例。
在SASPIC - 1队列（n = 212）中，患有PsO、AAU或IBD的患者中axSpA的发生率分别为46.7%、61.6%和46.8%；在SASPIC - 2队列（n = 151）中，相应的发生率分别为23.5%、57.9%和23.3%。在B27阳性的患者中，SASPIC - 1队列中患有PsO、AAU或IBD的患者中分别有70%、74.5%和66.7%被诊断为axSpA；在SASPIC - 2队列中，相应比例分别为71.4%、87.8%和55.6%。所有肌肉骨骼临床特征均无鉴别性。MRI在60%至80%的患者中提示为axSpA，并且在所有患者中进行MRI检查（SASPIC - 2）与按需进行MRI检查（SASPIC - 1）相比，在患有PsO或IBD且HLA - B27阴性的患者中，axSpA的诊断减少了25%。国际脊柱关节炎评估协会分类标准在常规MRI检查（SASPIC - 2）中的表现更好，尽管敏感性低于先前报道。
对于患有PsO、AAU、IBD以及未确诊慢性背痛的患者，最佳管理应包括转诊至风湿病专家处。对所有患者进行MRI检查可提高诊断准确性。
