Lee Kyung-Ann, Oh Eunsun, Kim Seunghyun, Kim Hyun-Sook
Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, South Korea.
Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, South Korea.
Clin Rheumatol. 2025 Jul;44(7):2809-2818. doi: 10.1007/s10067-025-07535-4. Epub 2025 Jun 14.
This single‑center, retrospective study aimed to investigate the prevalence and progression of entheseal lesions at the hip and pelvis via computed tomography (CT) and determine the associated factors in patients with axial spondyloarthritis (axSpA).
AxSpA patients who underwent CT including the pelvis and hip and age-sex-matched controls who underwent CT for genitourinary indications were analyzed. Eight bilateral entheseal sites were evaluated and scored as follows: 0 (no damage), 1 (irregularities and/or erosions), and 2 (enthesophytes). Agreement between readers for CT scoring was excellent (intraclass correlation coefficient, 0.673-1.000). To evaluate the longitudinal changes of radiographic enthesitis, additional CT for any reason after the baseline CT were also scored.
Ninety-one patients (mean age 36.6 ± 13.1 years) and 91 controls were analyzed. Enthesopathy was more frequently observed in the axSpA group (39.6%) compared to that in controls (21.9%) (P = 0.01), with the symphysis pubis (22.0%) most commonly affected. Entheseal scores of the symphysis pubis and greater trochanter were significantly higher in the axSpA group than those in controls. Smoking (OR, 3.653), modified Stoke Ankylosing Spondylitis Spinal Score (OR, 1.186), and use of TNF-alpha blockers (OR, 4.645) were independent factors associated with enthesopathy in axSpA patients. Radiographic progression of entheseal lesions over approximately 2 years was very rare.
Radiographic enthesopathy of the pelvis and hip was prominent in axSpA patients and linked to spinal damage, smoking, and use of TNF-alpha blockers. Key points • Pelvic enthesopathy was more frequent in axSpA patients than in controls (39.6% vs. 21.9%). • The symphysis pubis was the most commonly affected entheseal site in axSpA patients. • Smoking, spinal damage, and TNF-alpha blockers were independent risk factors for enthesopathy • Radiographic progression of pelvic enthesopathy over two years was rare in axSpA patient.
本单中心回顾性研究旨在通过计算机断层扫描（CT）调查髋部和骨盆附着点病变的患病率及进展情况，并确定轴性脊柱关节炎（axSpA）患者的相关因素。
分析接受包括骨盆和髋部CT检查的axSpA患者以及因泌尿生殖系统指征接受CT检查的年龄和性别匹配的对照组。评估8个双侧附着点部位并进行如下评分：0（无损伤）、1（不规则和/或侵蚀）和2（骨赘）。阅片者之间CT评分的一致性极佳（组内相关系数，0.673 - 1.000）。为评估影像学附着点炎的纵向变化，对基线CT检查后因任何原因进行的额外CT检查也进行了评分。
分析了91例患者（平均年龄36.6±13.1岁）和91例对照。与对照组（21.9%）相比，axSpA组附着点病的发生率更高（39.6%）（P = 0.01），耻骨联合（22.0%）是最常受累部位。axSpA组耻骨联合和大转子的附着点评分显著高于对照组。吸烟（比值比，3.653）、改良斯托克强直性脊柱炎脊柱评分（比值比，1.186）和使用肿瘤坏死因子-α阻滞剂（比值比，4.645）是axSpA患者附着点病的独立相关因素。附着点病变在约2年的影像学进展非常罕见。
axSpA患者骨盆和髋部的影像学附着点病较为突出，且与脊柱损伤、吸烟和使用肿瘤坏死因子-α阻滞剂有关。要点 • axSpA患者骨盆附着点病比对照组更常见（39.6%对21.9%）。 • 耻骨联合是axSpA患者最常受累的附着点部位。 • 吸烟、脊柱损伤和肿瘤坏死因子-α阻滞剂是附着点病的独立危险因素 • axSpA患者骨盆附着点病在两年内的影像学进展罕见。
