Wink F R, Diemel T, Arends S, Spoorenberg A
Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Rheumatology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.
Clin Rheumatol. 2025 Mar;44(3):1141-1150. doi: 10.1007/s10067-025-07345-8. Epub 2025 Jan 30.
In axial spondyloarthritis (axSpA), entheseal involvement is common, which contributes significantly to disease burden and may also lead to structural damage. Although radiographs of the pelvis are widely available in axSpA, information on entheseal damage and associated characteristics are lacking. Therefore, we assessed the prevalence of radiographic entheseal lesions at the pelvic region in radiographic (r-) axSpA compared with controls and explored associations with patient and disease characteristics.
Pelvic radiographs of 167 consecutive r-axSpA patients were randomized with 100 pelvic radiographs from age- and sex-matched controls. Radiographs were blinded for patient information and sacroiliac joints and bilaterally evaluated for erosions/cortical irregularities, enthesophytes, and calcifications by two trained readers at the greater and lesser trochanter, os ischium, and iliac crest.
Entheseal lesions were observed in 127 (76%) of r-axSpA patients and 58 (58%) controls. R-axSpA patients showed significantly more (bilateral) entheseal lesions than controls at all entheseal sites. Most lesions were found at the os ischium, erosions/cortical irregularities were most prevalent, and calcification was the most specific lesion in r-axSpA. Patients with lesions were significantly older, had longer symptom duration, and more severe spinal radiographic damage than patients without lesions. Enthesophytes were found significantly more often in patients with body mass index (BMI) ≥ 25.
Structural entheseal lesions observed at pelvic radiographs are not specific but occur often in r-axSpA patients. Treating physicians should keep in mind that these entheseal lesions are associated with more severe axial disease and high BMI which may be relevant for treatment decisions. Key Points • Pelvic radiographic entheseal lesions are significantly more prevalent in r-axSpA patients than in controls. • Radiographic entheseal lesions are associated with longer symptom duration and more spinal radiographic damage. • Pelvic enthesophytes are found significantly more often in r-axSpA patients with BMI ≥ 25.
在轴向性脊柱关节炎（axSpA）中，附着点受累很常见，这对疾病负担有显著影响，还可能导致结构损伤。尽管骨盆X线片在axSpA中广泛可得，但关于附着点损伤及相关特征的信息却很缺乏。因此，我们评估了与对照组相比，放射学（r-）axSpA患者骨盆区域放射学附着点病变的患病率，并探讨了其与患者及疾病特征的关联。
连续纳入167例r-axSpA患者的骨盆X线片，并与100例年龄和性别匹配的对照者的骨盆X线片进行随机分组。阅片者对患者信息及骶髂关节情况不知情，由两名经过培训的阅片者对大转子、小转子、坐骨和髂嵴双侧的侵蚀/皮质不规则、骨赘和钙化情况进行评估。
127例（76%）r-axSpA患者和58例（58%）对照者出现附着点病变。在所有附着点部位，r-axSpA患者的（双侧）附着点病变均显著多于对照者。大多数病变见于坐骨，侵蚀/皮质不规则最为常见，钙化是r-axSpA中最具特异性的病变。有病变的患者比无病变的患者年龄显著更大、症状持续时间更长、脊柱放射学损伤更严重。体重指数（BMI）≥25的患者骨赘出现频率显著更高。
骨盆X线片上观察到的结构性附着点病变并非axSpA所特有，但在r-axSpA患者中经常出现。治疗医师应牢记，这些附着点病变与更严重的轴向疾病及高BMI相关，这可能对治疗决策有重要意义。要点 • r-axSpA患者骨盆放射学附着点病变的患病率显著高于对照者。 • 放射学附着点病变与更长的症状持续时间及更严重的脊柱放射学损伤相关。 • 在BMI≥25的r-axSpA患者中，骨盆骨赘出现频率显著更高。
