Kerami Zohra, van de Sande Marleen, Fagerli Karen Minde, Ramonda Roberta, Weel Angelique E A M, van der Heijde Désirée, Landewé Robert, de Hooge Manouk
Department of Rheumatology and immunology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.
Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
RMD Open. 2025 May 28;11(2):e005555. doi: 10.1136/rmdopen-2025-005555.
To investigate the extent and performance of structural lesions in sacroiliac joints on MRI (MRI-SI) in patients with axial spondyloarthritis (axSpA), chronic back pain, postpartum back pain, runners and healthy subjects.
MRI-SIs in 172 subjects, including 47 patients with diagnosed axSpA fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria, 47 patients with chronic back pain, 7 women with postpartum back pain, 24 runners and 47 healthy individuals, were scored by two well-trained readers for erosions, fatty lesions, sclerosis and ankylosis, using an adjusted Spondyloarthritis Research Consortium of Canada scoring method. In addition, cut-off values proposed by the Imaging workgroups of Leiden and the ASAS were tested.
Of the axSpA patients, 37 (79%) had structural lesions. Most frequently reported structural lesions were erosions in 35 (75%) patients and fatty lesions in 19 (40%) patients. Erosions and fatty lesions were uncommon in chronic back pain, runners and healthy individuals. There was a statistically significant difference in the prevalence of erosions, fatty lesions and ankylosis between axSpA and chronic back pain. Ankylosis was rare in both groups. Comparing axSpA to non-axSpA, Leiden cut-off definitions were more specific than ASAS cut-offs.
Structural changes resembling axSpA may occur in individuals who do not have axSpA, but at a lower rate than inflammatory changes. Erosions and fatty lesions are most specific. Using cut-off definitions for these structural lesions results in good discrimination between axSpA and non-axSpA. In axSpA, structural lesions primarily occur in concordance with ongoing inflammation.
研究轴向性脊柱关节炎（axSpA）、慢性背痛、产后背痛患者、跑步者及健康受试者骶髂关节在磁共振成像（MRI-SI）上结构损伤的程度及表现。
对172名受试者的MRI-SI进行评分，其中包括47名符合国际脊柱关节炎评估协会（ASAS）标准的确诊axSpA患者、47名慢性背痛患者、7名产后背痛女性、24名跑步者和47名健康个体，由两名训练有素的阅片者采用调整后的加拿大脊柱关节炎研究联盟评分方法对侵蚀、脂肪病变、硬化和强直进行评分。此外，还测试了莱顿成像工作组和ASAS提出的截断值。
axSpA患者中，37例（79%）有结构损伤。最常报告的结构损伤是35例（75%）患者出现侵蚀，19例（40%）患者出现脂肪病变。侵蚀和脂肪病变在慢性背痛患者、跑步者和健康个体中不常见。axSpA与慢性背痛患者在侵蚀、脂肪病变和强直的患病率上存在统计学显著差异。两组中强直均少见。将axSpA与非axSpA进行比较，莱顿截断定义比ASAS截断定义更具特异性。
无axSpA的个体可能出现类似axSpA的结构改变，但发生率低于炎症改变。侵蚀和脂肪病变最具特异性。使用这些结构损伤的截断定义可很好地区分axSpA和非axSpA。在axSpA中，结构损伤主要与持续炎症一致。
