目的:在MRI上评估后要素(PE)和小关节(FJ)炎症与随后的新FJ强直(FJA)的关系,放射学轴性脊柱关节炎(r-axSpA)患者。
方法:强直性脊柱炎队列中来自敏感成像的患者,纳入标准r-axSpA和≥1个放射学脊柱复合体,被研究过。在基线时进行完整脊柱的MRI,1年和2年。由三名读者评估每个椎体单位(VU)水平的PE/FJ炎性病变和FJA。使用多级时滞自回归广义估计方程,研究了PE/FJ炎症与FJA后续发展之间的关系,考虑到读者和VU水平。
结果:在58名至少有2个读者评分的患者中,平均年龄49(标准差10)岁,84%的男性59%有基线PE炎症,24%有FJ炎症,26%有FJA。PE炎症多见于下胸椎,FJ炎症多见于上胸椎。具有PE或FJ炎症的VU在两个和一个VU水平上显示出随后的新FJA,分别。与先前的FJ炎症相比,发生FJA的概率加倍。在多层次分析中,FJ炎症与随后的FJA相关(OR=3.8,95%CI:1.5至9.8),而PE炎症与新FJA之间未发现关联(OR=1.2(0.6-2.4))。
结论:FJ炎症在严重的r-axSpA中很少见,但是当存在时,与无炎症的FJ相比,随后发生FJA的可能性高出3倍以上.这一发现有助于理解axSpA患者在同一解剖位置的炎症和强直之间的关系。
OBJECTIVE: To assess the association of posterior element (PE) and facet joint (FJ) inflammation with subsequent new FJ ankylosis (FJA) on MRI, in patients with radiographic axial spondyloarthritis (r-axSpA).
METHODS: Patients from the Sensitive Imaging in Ankylosing Spondylitis cohort, inclusion criteria r-axSpA and ≥1 radiographic spinal syndesmophyte, were studied. MRI of the full spinal was performed at baseline, 1 and 2 years. PE/FJ inflammatory lesions and FJA were assessed per vertebral unit (VU) level by three readers. With multilevel time-lagged autoregressive generalised estimated equations, the association between PE/FJ inflammation and the subsequent development of FJA was investigated, taking the reader and VU levels into account.
RESULTS: Out of the 58 patients with at least 2 reader scores available, mean age 49 (SD 10) years, 84% men, 59% had baseline PE inflammation, 24% had FJ inflammation and 26% had FJA. PE inflammation was more prevalent in the lower thoracic spine and FJ inflammation in the upper thoracic spine. VU with PE or FJ inflammation showed subsequent new FJA in two and one VU levels, respectively. The probability of developing FJA doubled with prior FJ inflammation. In multilevel analysis, FJ inflammation was associated with subsequent FJA (OR=3.8, 95% CI: 1.5 to 9.8), while no association was found between PE inflammation and new FJA (OR=1.2 (0.6-2.4)).
CONCLUSIONS: FJ inflammation is rare in severe r-axSpA, but when present, the likelihood of developing subsequent FJA is over three times higher compared with FJ without inflammation. This finding contributes to the understanding of the relationship between inflammation and ankylosis at the same anatomical location in patients with axSpA.