Significant overlap of inflammatory and degenerative features on imaging among patients with degenerative disc disease, diffuse idiopathic skeletal hyperostosis and axial spondyloarthritis: a real-life cohort study

IF 4.9 2区医学 Q1 Medicine

Arthritis Research & Therapy Pub Date : 2024-08-03 DOI:10.1186/s13075-024-03359-w

Nelly Ziade, Melanie Udod, Nikolaos Kougkas, Styliani Tsiami, Xenofon Baraliakos

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引用次数: 0

Abstract

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. 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. 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%). 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.

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椎间盘退行性病变、弥漫性特发性骨骼增生症和轴性脊柱关节炎患者影像学检查中炎症和退行性病变特征的显著重叠：一项现实生活中的队列研究

区分椎间盘退行性病变（DDD）、弥漫性特发性骨骼增生症（DISH）和轴性脊柱关节炎（axSpA）是腰背痛（LBP）患者的诊断难题。我们的目的是评估转诊到一所大学三级风湿病中心的腰背痛患者中炎症和退行性影像特征的分布情况。我们对转诊的腰椎间盘突出症患者进行了回顾性横断面分析，收集了人口统计学、症状信息和可用的影像学资料。如果脊柱出现以下与SpA相关的典型病变之一，则考虑为SpA样病变：常规X光片（CR）上的侵蚀、硬化、鳞状突起和联合骨赘，以及核磁共振成像（MRI）上的骨髓水肿（BMO）、侵蚀、硬化和脂肪病变（FL）。根据纽约标准对 SIJ CR 进行分级；在 MRI 上，按象限对 SIJ 的 BMO、侵蚀、FL、硬化和强直进行评估，这与柏林 SIJ MRI 评分系统所使用的方法类似。风湿免疫科医生的最终诊断是金标准。数据按患者和象限进行描述，并在三个诊断组之间进行比较。在136名转诊患者中，71人患有DDD，38人患有DISH，27人患有axSpA；中位年龄为62岁[IQR55-73]，63%为男性。在 CR 上，腰椎 axSpA 的 SpA 样变明显较高（50%，DDD 23%，DISH 22%），胸椎 DISH 的 SpA 样变明显较高（28%，DDD 8%，axSpA 12%），颈椎 DDD 的 SpA 样变明显较高（67%，DISH 0%，axSpA 33%）。在核磁共振成像中，DISH 的胸椎 BMO 明显更高（37%，而 DDD 为 22%，axSpA 为 5%），腰椎的 BMO 分布相当（35-42%）。在胸椎的 DISH 和 axSpA（分别为 56% 和 52%）以及腰椎的 DDD 和 axSpA（分别为 65% 和 74%）中，发现 FL 的频率明显更高。退行性病变在三组中都很常见。49%的患者（axSpA 76%、DDD 48%、DISH 29%）患有骶髂关节炎（纽约标准）。DDD、DISH和axSpA的炎症和退行性影像学特征有明显重叠。特别是，在四分之一的 DISH 患者中发现了类似 SpA 的脊柱 CR 特征，在三分之一的患者中发现了 MRI BMO。

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来源期刊

Arthritis Research & Therapy RHEUMATOLOGY-

CiteScore

8.60

自引率

2.00%

发文量

261

审稿时长

14 weeks

期刊介绍： Established in 1999, Arthritis Research and Therapy is an international, open access, peer-reviewed journal, publishing original articles in the area of musculoskeletal research and therapy as well as, reviews, commentaries and reports. A major focus of the journal is on the immunologic processes leading to inflammation, damage and repair as they relate to autoimmune rheumatic and musculoskeletal conditions, and which inform the translation of this knowledge into advances in clinical care. Original basic, translational and clinical research is considered for publication along with results of early and late phase therapeutic trials, especially as they pertain to the underpinning science that informs clinical observations in interventional studies.