一项横断面人群研究中比较放射学阴性的中轴脊柱关节炎患者与强制性脊柱炎患者之间的差别...

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Patients with Non-Radiographic Axial Spondyloarthritis Differ From Patients with Ankylosing Spondylitis in Several aspects– Results of a Cross-Sectional Cohort Study

 

Uta Kiltz ¹, Xenofon Baraliakos², Pantelis Karakostas², Manfred Igelmann³, Ludwig H. Kalthoff⁴, Claudia Klink⁵, Dietmar MJ Krause⁶, Elmar Schmitz-Bortz⁷, Martina Floerecke², Matthias Bollow⁸ and Juergen Braun², ¹Rheumazentrum Ruhrgebiet, Herne, Germany, ²Ruhr-University Bochum, Herne, Germany, ³Private Rheumatology office, Bochum, Germany, ⁴Private rheumatology office, Herne, Germany, ⁵Private rheumatology office, Gladbeck, Germany, ⁶Gladbeck, Germany, ⁷Private rheumatology office, Hattingen, Germany, ⁸Augusta Krankenanstalten, Bochum, Germany

 

Presentation Number: 506

 

Background/Purpose: Patients with axial spondyloarthritis (SpA) may already have established radiographic changes in the sacroiliac joints and the spine or not - the former are classified as having ankylosing spondylitis (AS), the latter as pre- or non-radiographic axial SpA (nraxSpA) according to the ASAS criteria. The nature and the relationship of these subentities are incompletely understood. The objective of this stufy was to study the patients’ clinical data and their view of the current disease status in relation to laboratory markers and spinal inflammation (MRI) in patients with AS and nraxSpA.

Method: A total of 100 consecutive patients with a diagnosis of axial SpA who had never been treated with TNF antagonists were studied and the results compared to those of laboratory parameters, spinal x-rays and MRIs which were scored by the mSASSS and the Berlin score, respectively. Standardized clinical assessment tools were used (NRS pain, BASDAI, ASDAS, BASFI, ASQoL, SF-36).

Result:  AS was diagnosed in 56 and nraxSpA in 44 patients. Patients with established nraxSpA and AS did not differ much in many clinical variables (BASDAI, BASFI, ASQoL) but the proportion of males (32% vs 72%) and the extent of inflammation were clearly lower in nraxSpA vs AS patients: CRP (5.7±6.6 vs 11.6±12.6), ASDAS (2.2±0.8 vs 2.9±0.9), Berlin score (0.8±1.2 vs 3.1±3.2) and mSASSS: 2.4±3.5 vs 13.2±20.7 (all p<0.01). The frequency of typical comorbidities (uveitis, psoriasis, CED or enthesitis), nor in the actual medication regarding NSAIDs or sulfasalazine differed between the groups. These results were confirmed by multivariate analyses adjusted for gender, CRP and mSASSS at baseline.

Conclusion: These data largely confirm earlier data showing that the disease burden in nraxSpA and established AS is similar. Interestingly, these subgroups did not differ much in clinical variables but in CRP levels and the extension of inflammation detected by MRI – both were higher in patients with AS. Expectedly, male patients were more prone to develop structural changes. Although this study was ‘only’ cross-sectional the data shows that a large group of patients with axSpA has not developed structural changes after almost 10 years of symptom duration. We propose that patients with nraxSpA should not be regarded as pre-radiographic AS but rather as non-radiographic axial SpA – a subgroup that is less prone to develop new bone formatio It will be interesting to see whether and how many of these patients will develop AS in the further disease course.

 

一项横断面人群研究中比较放射学阴性的中轴脊柱关节炎患者与强制性脊柱炎患者之间的差别

Uta Kiltz , et al. ACR 2011. Present No: 506

 

背景/目的:中轴脊柱关节炎患者(SpA)可以有或没有明确的骶髂关节和脊柱的影像学变化—— 根据ASAS标准，前者是区别患有无强直性脊柱炎(AS),后者用于鉴别前-或无放射学表现的中轴SpA(nraxSpA)。这些疾病亚群的本质和相关性尚未能完全理解。本研究目的是探讨AS和nraxSpA患者临床资料和他们对目前病情的判断与实验室标记和脊柱炎症(MRI)的相关性。

方法:共有100例诊断为中轴SpA并从未接受TNF拮抗剂治疗的患者连续纳入本研究，并比较AS和nraxSpA患者的实验室参数,脊柱x线和MRIs（由mSASSS和Berlin积分评价）。采用标准化的临床评估工具(NRS疼痛,BASDAI,ASDAS,BASFI,ASQoL,SF-36)。

结果: AS患者56例，nraxSpA患者44例。两组患者在许多临床变量上并没有多大差别 (如BASDAI,BASFI,ASQoL),但男性的比例在两组内分别为32%和72%, 炎症的程度在nraxSpA组明显低于AS 患者:CRP(5.7±6.6 vs.11.6 ±12.6), ASDAS(2.2±0.8 vs.2.9±0.9),Berlin积分(0.8±1.2 vs.3.1±3.2),mSASSS:2.4±3.5 vs. 13.2±20.7 (p 值均< 0.01)。两组中常见并发症的发生频率(葡萄膜炎、牛皮癣、CED或肌腱炎)也有所不同,而实际药物如非甾体类抗炎药或硫氮磺氨吡啶的应用没有差别。对性别、基线水平CRP和mSASSS校正后的多因素分析也证实这些结果。

结论:这些数据很大程度上肯定了早期的数据,即nraxSpA和确诊的AS 是相似的。有趣的是,这些亚组间在许多临床变量上没有差异, 但AS患者中CRP水平和MRI检测到的炎症程度较高。和预料一致，男性患者更容易发生结构性变化。虽然这项研究只是一个横截面数据，显示较大样本的axSpA患者在症状出现后近10年仍没有出现结构性变化。我们建议nraxSpA患者不应被视为AS的放射学改变前阶段， 而是放射学阴性的中轴 SpA-较不容易新骨形成的一种亚群。这些患者在将来的疾病过程中是否或有多少比例会发展成AS将会是非常值得探讨的问题。

Table 1: Comparison between the two analyzed subgroups for all measured parameters.

	nraSp	AS	p
Age y	39.1± .8	41.2±10.9	0.455
Symptom duration (y)	9.4±9.5	12.8± 0.7	0.085
NRS pain	4.0±2.1	4.7±2.7	0.244
Physician´s global assessment	2.7±1.7	3.5±1.9	0.064
Patient´s global assessment	4.0±2.7	4.6±2.7	0.265
BASDAI	3.6±1.7	4.2±2.2	0.194
BASFI	2.4±2.1	3.2±2.4	0.054
SF-36 MCS	45.0±12.3	47.5±11.5	0.382
SF-36 PCS	39.0±9.0	36.5±10.2	0.192
ASQoL	5.6±4.8	6.0±4.8	0.712