OBJECTIVE:To investigate the association of spinal inflammation on MRI in patients with various clinical, functional and radiological outcomes in patients with axial spondyloarthritis (SpA). METHODS:Three hundred and ninety-seven participants with axial SpA and back pain were recruited from 10 rheumatology centres. Clinical, biochemical and radiological parameters were collected and participants underwent MRI of the spine. MRI features including inflammatory lesions of facet joints and costovertebral joints, corner inflammatory lesions, and spondylitis were assessed. BASFI, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Global Index, BASMI and modified Stoke Ankylosing Spondylitis Spinal Score were measured. Multivariate linear regression models were used to determine the associations between MRI parameters and various clinical, functional and radiological outcomes. RESULTS:BASMI and BASFI correlated well with inflammatory features in spinal MRI. Multivariate analysis showed that lumbar facet joint inflammation was independently associated with BASMI (regression coefficient (β) = 0.12, P < 0.001), lumbar spinal flexion (β = 0.13, P = 0.00), lateral spinal flexion (β = 0.09, P = 0.04), tragus-to-wall distance (β = 0.16, P < 0.001) and BASFI (β = 0.14, P = 0.01). Costovertebral joint inflammation was also associated with BASMI (β = 0.08, P = 0.05). CONCLUSION:Inflammatory lesions of facet and costovertebral joints in MRI are associated with restriction in spinal mobility and functional impairment. These important yet commonly overlooked lesions should be reviewed in clinical practice in patients with SpA.

译文

目的:探讨脊柱炎(SpA)患者在各种临床,功能和影像学检查结果中,脊髓炎症与MRI的相关性。
方法:从10个风湿病学中心招募了379名患有轴向SpA和背痛的参与者。收集临床,生化和放射学参数,并对参与者进行脊柱MRI检查。评估了MRI特征,包括小关节和肋骨关节的炎性病变,角部炎性病变和脊柱炎。测量了BASFI,巴斯强直性脊柱炎疾病活动指数,巴斯强直性脊柱炎整体指数,BASMI和改良的斯托克强直性脊柱炎脊柱评分。多元线性回归模型用于确定MRI参数与各种临床,功能和放射学结果之间的关联。
结果:BASMI和BASFI与脊髓MRI的炎症特征密切相关。多因素分析表明,腰椎小关节炎症与BASMI(回归系数(β)= 0.12,P <0.001),腰椎屈曲(β= 0.13,P = 0.00),脊柱外侧屈曲(β= 0.09,P = 0.04),耳屏距离(β== 0.16,P << 0.001)和BASFI(β== 0.14,P4 = 0.01)。肋椎关节炎也与BASMI有关(β= 0.08,P = 0.05)。
结论:MRI小平面和肋骨关节的炎性病变与脊柱活动受限和功能障碍有关。这些重要但通常被忽视的病变应在SpA患者的临床实践中进行回顾。

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