A. O. Vasilieva, D. E. Filipenko, E. V. Kapustina, N. V. Popov, P. Shesternya
{"title":"轴性银屑病关节炎临床症状与磁共振成像数据的分离","authors":"A. O. Vasilieva, D. E. Filipenko, E. V. Kapustina, N. V. Popov, P. Shesternya","doi":"10.14412/1996-7012-2023-6-44-51","DOIUrl":null,"url":null,"abstract":"Currently, there is no generally accepted definition of axial lesions in psoriatic arthritis (axPsA), and the diagnostic criteria are extrapolated from the recommendations for ankylosing spondylitis and axial spondyloarthritis.Objective: To evaluate data of magnetic resonance imaging (MRI) of spine and sacroiliac joints (SIJ) in patients with psoriasis complaining of chronic back pain of any cause.Material and methods. 143 patients were enrolled to the study, including 57 (39.9%) men and 86 (60.1%) women, median age – 47 [36; 57] years, mean duration of psoriasis was 17.4±13.4 years. In all patients, the agreement of the existing symptoms with the inflammatory back pain (IBP) criteria of A. Calin et al., M. Rudwaleit et al. and ASAS was checked. All patients underwent MRI of the spine and SIJ, determination of ESR, CRP levels, HLA-B27 and consultations with a dermatologist and a rheumatologist.Results and discussion. An association of bone marrow edema (BME) in the spine and SIJ with nail involvement (odds ratio, OR 2.32; 95% confidence interval, CI 1.12–4.81; p=0.035), palmoplantar psoriasis (OR 3.85; 95% CI 1.43–10.41; p=0.054) and a weak correlation with PASI (r=0.329, p=0.034) was found. There were no statistically significant differences in PASI between patients with BME and without BME. In patients with IBP who fulfilled the criteria of A. Calin et al., osteitis in the SIJ was present in 19 (34.5%; OR 2.79; 95% CI 1.26–6.19; p=0.01); Berlin criteria of 4 signs – 25 (28.7%; OR 2.42; 95% CI 1.00–5.84; p=0.045); Berlin criteria of 3 signs – in 18 (24.0%; OR 1.12; 95% CI 0.51–2.44; p=0.783); ASAS criteria – in 17 (34.0%; OR 2.48; 95% CI 1.12–5.49; p=0.023). In almost half of the patients with BME in the spine or SIJ, the symptoms did not fulfil the criteria for IBP. Signs such as the presence and duration of morning stiffness had a high prognostic value. Isolated spondylitis (presence of BME in vertebrae and absence of BME in SIJ) was rarely found in patients with IBP fulfilling various criteria (in 4.0–8.1% of cases).Conclusion. Considering the existing discrepancy between symptoms and MRI results, it is necessary to develop independent tools for screening and early diagnosis of axPsA.","PeriodicalId":18651,"journal":{"name":"Modern Rheumatology Journal","volume":"46 ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dissociation of clinical symptoms and magnetic resonance imaging data in axial psoriatic arthritis\",\"authors\":\"A. O. Vasilieva, D. E. Filipenko, E. V. Kapustina, N. V. Popov, P. Shesternya\",\"doi\":\"10.14412/1996-7012-2023-6-44-51\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Currently, there is no generally accepted definition of axial lesions in psoriatic arthritis (axPsA), and the diagnostic criteria are extrapolated from the recommendations for ankylosing spondylitis and axial spondyloarthritis.Objective: To evaluate data of magnetic resonance imaging (MRI) of spine and sacroiliac joints (SIJ) in patients with psoriasis complaining of chronic back pain of any cause.Material and methods. 143 patients were enrolled to the study, including 57 (39.9%) men and 86 (60.1%) women, median age – 47 [36; 57] years, mean duration of psoriasis was 17.4±13.4 years. In all patients, the agreement of the existing symptoms with the inflammatory back pain (IBP) criteria of A. Calin et al., M. Rudwaleit et al. and ASAS was checked. All patients underwent MRI of the spine and SIJ, determination of ESR, CRP levels, HLA-B27 and consultations with a dermatologist and a rheumatologist.Results and discussion. An association of bone marrow edema (BME) in the spine and SIJ with nail involvement (odds ratio, OR 2.32; 95% confidence interval, CI 1.12–4.81; p=0.035), palmoplantar psoriasis (OR 3.85; 95% CI 1.43–10.41; p=0.054) and a weak correlation with PASI (r=0.329, p=0.034) was found. There were no statistically significant differences in PASI between patients with BME and without BME. In patients with IBP who fulfilled the criteria of A. Calin et al., osteitis in the SIJ was present in 19 (34.5%; OR 2.79; 95% CI 1.26–6.19; p=0.01); Berlin criteria of 4 signs – 25 (28.7%; OR 2.42; 95% CI 1.00–5.84; p=0.045); Berlin criteria of 3 signs – in 18 (24.0%; OR 1.12; 95% CI 0.51–2.44; p=0.783); ASAS criteria – in 17 (34.0%; OR 2.48; 95% CI 1.12–5.49; p=0.023). In almost half of the patients with BME in the spine or SIJ, the symptoms did not fulfil the criteria for IBP. Signs such as the presence and duration of morning stiffness had a high prognostic value. Isolated spondylitis (presence of BME in vertebrae and absence of BME in SIJ) was rarely found in patients with IBP fulfilling various criteria (in 4.0–8.1% of cases).Conclusion. Considering the existing discrepancy between symptoms and MRI results, it is necessary to develop independent tools for screening and early diagnosis of axPsA.\",\"PeriodicalId\":18651,\"journal\":{\"name\":\"Modern Rheumatology Journal\",\"volume\":\"46 \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-12-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Modern Rheumatology Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14412/1996-7012-2023-6-44-51\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Modern Rheumatology Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14412/1996-7012-2023-6-44-51","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目前,银屑病关节炎(axPsA)的轴性病变还没有公认的定义,诊断标准是从强直性脊柱炎和轴性脊柱关节炎的建议中推断出来的:评估主诉任何原因引起的慢性背痛的银屑病患者的脊柱和骶髂关节(SIJ)磁共振成像(MRI)数据。研究共纳入 143 例患者,其中男性 57 例(39.9%),女性 86 例(60.1%),年龄中位数为 47 [36; 57] 岁,平均银屑病病程为(17.4±13.4)年。对所有患者的现有症状与 A. Calin 等人的炎症性背痛(IBP)标准、M. Rudwaleit 等人的炎症性背痛(IBP)标准和 ASAS 标准进行了核对。所有患者均接受了脊柱和SIJ核磁共振成像检查、血沉、CRP水平和HLA-B27测定,并接受了皮肤科医生和风湿免疫科医生的会诊。脊柱和SIJ骨髓水肿(BME)与指甲受累(几率比,OR 2.32;95%置信区间,CI 1.12-4.81;P=0.035)、掌跖银屑病(OR 3.85;95%置信区间,CI 1.43-10.41;P=0.054)有关,与PASI(r=0.329,P=0.034)呈弱相关。有 BME 和无 BME 患者的 PASI 没有明显的统计学差异。在符合 A. Calin 等人标准的 IBP 患者中,SIJ 骨炎的发生率为 0.5%、19例(34.5%;OR 2.79;95% CI 1.26-6.19;P=0.01)出现 SIJ 骨炎;柏林标准 4 种体征 - 25 例(28.7%;OR 2.42;95% CI 1.00-5.84;P=0.045);柏林 3 种体征标准--18 例(24.0%;OR 1.12;95% CI 0.51-2.44;P=0.783);ASAS 标准--17 例(34.0%;OR 2.48;95% CI 1.12-5.49;P=0.023)。几乎一半的脊柱或 SIJ BME 患者的症状不符合 IBP 的标准。晨僵的存在和持续时间等体征具有很高的预后价值。在符合各种标准的 IBP 患者中,很少发现孤立性脊柱炎(椎骨存在 BME,SIJ 没有 BME)(占病例的 4.0%-8.1%)。考虑到目前症状与核磁共振成像结果之间的差异,有必要开发独立的工具来筛查和早期诊断axPsA。
Dissociation of clinical symptoms and magnetic resonance imaging data in axial psoriatic arthritis
Currently, there is no generally accepted definition of axial lesions in psoriatic arthritis (axPsA), and the diagnostic criteria are extrapolated from the recommendations for ankylosing spondylitis and axial spondyloarthritis.Objective: To evaluate data of magnetic resonance imaging (MRI) of spine and sacroiliac joints (SIJ) in patients with psoriasis complaining of chronic back pain of any cause.Material and methods. 143 patients were enrolled to the study, including 57 (39.9%) men and 86 (60.1%) women, median age – 47 [36; 57] years, mean duration of psoriasis was 17.4±13.4 years. In all patients, the agreement of the existing symptoms with the inflammatory back pain (IBP) criteria of A. Calin et al., M. Rudwaleit et al. and ASAS was checked. All patients underwent MRI of the spine and SIJ, determination of ESR, CRP levels, HLA-B27 and consultations with a dermatologist and a rheumatologist.Results and discussion. An association of bone marrow edema (BME) in the spine and SIJ with nail involvement (odds ratio, OR 2.32; 95% confidence interval, CI 1.12–4.81; p=0.035), palmoplantar psoriasis (OR 3.85; 95% CI 1.43–10.41; p=0.054) and a weak correlation with PASI (r=0.329, p=0.034) was found. There were no statistically significant differences in PASI between patients with BME and without BME. In patients with IBP who fulfilled the criteria of A. Calin et al., osteitis in the SIJ was present in 19 (34.5%; OR 2.79; 95% CI 1.26–6.19; p=0.01); Berlin criteria of 4 signs – 25 (28.7%; OR 2.42; 95% CI 1.00–5.84; p=0.045); Berlin criteria of 3 signs – in 18 (24.0%; OR 1.12; 95% CI 0.51–2.44; p=0.783); ASAS criteria – in 17 (34.0%; OR 2.48; 95% CI 1.12–5.49; p=0.023). In almost half of the patients with BME in the spine or SIJ, the symptoms did not fulfil the criteria for IBP. Signs such as the presence and duration of morning stiffness had a high prognostic value. Isolated spondylitis (presence of BME in vertebrae and absence of BME in SIJ) was rarely found in patients with IBP fulfilling various criteria (in 4.0–8.1% of cases).Conclusion. Considering the existing discrepancy between symptoms and MRI results, it is necessary to develop independent tools for screening and early diagnosis of axPsA.