背景:鉴别椎间盘退行性疾病(DDD),弥漫性特发性骨骼肥大(DISH),和轴向脊柱关节炎(axSpA)代表了下腰痛(LBP)患者的诊断挑战。我们旨在评估转诊到三级大学风湿病中心的LBP患者的真实队列中炎症和退行性成像特征的分布。
方法:在对因LBP转诊的患者进行的回顾性横断面分析中,人口统计,症状信息,和可用的成像收集。在存在以下通常与SpA相关的病变之一的情况下,脊柱中考虑了SpA样变化:糜烂,硬化症,平方,和常规X光片(CR)和骨髓水肿(BMO)上的合成植物,侵蚀,硬化症,和MRI上的脂肪病变(FL)。SIJCR根据纽约标准进行评级;在核磁共振成像上,SIJ通过象限评估BMO,侵蚀,FL,硬化症和强直,类似于柏林SIJMRI评分系统使用的方法。风湿病学家的最终诊断是金标准。数据以描述性方式呈现,按病人和象限,并在三个诊断组之间进行比较。
结果:在136名转诊患者中,71有DDD,38盘,和27axSpA;中位年龄62岁[IQR55-73],63%的男性。在CR上,腰椎中的axSpA样变化明显更高(50%,vs.DDD23%,DISH22%),在胸廓的盘中(28%,vs.DDD8%,axSpA12%),和DDD在颈椎(67%vs.DISH0%,axSpA33%)。核磁共振成像,胸部DISH的BMO明显更高(37%,vs.DDD22%,axSpA5%),并均匀分布在腰椎中(35-42%)。在胸椎的DISH和axSpA(56%和52%)以及腰椎的DDD和axSpA(65%和74%,分别)。在三组中,退行性变化很常见。在49%(axSpA76%,DDD48%,DISH29%)。
结论:在DDD之间发现了显着的重叠,DISH,和axSpA用于炎性和退行性成像特征。特别是,在DISH患者的四分之一中发现了SpA样脊柱CR特征,在三分之一的患者中发现了MRIBMO。
BACKGROUND: Differentiating between degenerative disc disease (DDD), diffuse idiopathic skeletal hyperostosis (DISH), and axial spondyloarthritis (axSpA) represents a diagnostic challenge in patients with low back pain (LBP). We aimed to evaluate the distribution of inflammatory and degenerative imaging features in a real-life cohort of LBP patients referred to a tertiary university rheumatology center.
METHODS: In a retrospective cross-sectional analysis of patients referred for LBP, demographics, symptom information, and available imaging were collected. SpA-like changes were considered in the spine in the presence of one of the following lesions typically related to SpA: erosions, sclerosis, squaring, and syndesmophytes on conventional radiographs (CR) and bone marrow oedema (BMO), erosions, sclerosis, and fat lesions (FL) on MRI. SIJ CR were graded per New York criteria; on MRIs, SIJs were evaluated by quadrant for BMO, erosions, FL, sclerosis and ankylosis, similar to the approach used by the Berlin SIJ MRI scoring system. The final diagnosis made by the rheumatologist was the gold standard. Data were presented descriptively, by patient and by quadrant, and compared among the three diagnosis groups.
RESULTS: Among 136 referred patients, 71 had DDD, 38 DISH, and 27 axSpA; median age 62 years [IQR55-73], 63% males. On CR, SpA-like changes were significantly higher in axSpA in the lumbar (50%, vs. DDD 23%, DISH 22%), in DISH in the thoracic (28%, vs. DDD 8%, axSpA 12%), and in DDD in the cervical spine (67% vs. DISH 0%, axSpA 33%). On MRI, BMO was significantly higher in DISH in the thoracic (37%, vs. DDD 22%, axSpA 5%) and equally distributed in the lumbar spine (35-42%). FL were significantly more frequently identified in DISH and axSpA in the thoracic (56% and 52%) and DDD and axSpA in the lumbar spine (65% and 74%, respectively). Degenerative changes were frequent in the three groups. Sacroiliitis (NY criteria) was identified in 49% (axSpA 76%, DDD 48%, DISH 29%).
CONCLUSIONS: A significant overlap was found among DDD, DISH, and axSpA for inflammatory and degenerative imaging features. Particularly, SpA-like spine CR features were found in one-fourth of patients with DISH, and MRI BMO was found in one-third of those patients.