DESIR队列研究: 早期SpA患者骶髂关节放射学结构损伤的不同定义对结构损伤变化的敏感性

EULAR2015; PresentID: THU0356

 

SENSITIVITY TO CHANGE OF DIFFERENT DEFINITIONS OF SACROILIAC RADIOLOGICAL STRUCTURAL CHANGES IN EARLY SPONDYLOARTHRITIS: DATA FROM THE DESIR COHORT.

M. Dougados^1,*, C. demattei², A. Molto³, R. van den Berg⁴, V. V. Hoang⁵, F. Thevenin⁶, M. Reijnierse⁴, D. Loeuille⁷, A. Feydy⁶, P. Claudepierre⁸, D. van der Heijde⁹

¹Rheumatology, René Descartes University, paris, ²biostatistics, montpellier, ³René Descartes University, paris, France, ⁴LUMC, Leiden, Netherlands, ⁵Radiology, Lyon, ⁶Radiology - Cochin, paris, ⁷Rhumatology, Nancy, ⁸Rhumatology, Créteil, ⁹LUMC, Leiden, France

 

Background: The natural history (with regard to the structural damage of the Sacroiliac Joints) (SIJ) of axial radiographic (r) and non-radiographic (nr) axial spondyloarthritis (SpA) is not well known.

Objectives: To evaluate the 2 years SIJ radiological structural changes in early axial r- versus nr-axial SpA according to different definitions.

Methods: Patients: inflammatory back pain of less than 3 years duration suggestive of axial SpA according to the treating rheumatologist (DESIR cohort). Outcome measures: Pelvic X-rays collected both at baseline and at the 2 year follow up visit were stored after anonymizing and blinding of the time collection. The radiographs were read centrally by two different readers of well calibrated central readers blinded for clinical, laboratory and other imaging  data. In case of disagreement regarding the presence/absence of either sacroiliitis according to the modified New York (mNY) criteria or change of at least one grade in one SIJ, images were adjudicated by an experienced radiologist or rheumatologist. A score from 0 (normal) to 4 (fusion) was given to each SIJ (left and right). Analysis: Several outcome measures were used: a) changes (from nr to r or from r to nr) in the SIJ status according to the mNY criteria (e.g. r in case of at least a unilateral garde 3 or bilateral grade 2), b) changes in the 0-8 total SIJ (left + right) score c) progression/improvement defined by a change of at least one grade (≥+1 / ≤-1)   in either the left or right SIJ, d) Progression defined by a change of at least one grade in either the left or right SIJ AND a 2 year value of at least 2 in this joint with a progression of at least one grade.

Results: The table summarizes the changes observed in the 449 evaluated patients (age: 34 ± 9 + years old, male: 47%, HLA B27 positive: 61%)  according to the baseline radiographic status.

Conclusions: These data suggest that in early SpA a) the structural progression does exist but is quite small and only observed in a small number of patients, b) there is a relatively high rate of improvement indicating that it is difficult to assess the true progression rate c) the total  SIJ score and/or the progression defined by a change of at least one grade are the most sensitive, d) such rate of progression is higher in the sub-group of patients fulfilling the mNY criteria at baseline.

 

背景：放射学（r）和非放射学（nr）中轴SpA自然发展史（就骶髂关节结构损伤而言）尚不十分清楚。

目标：评价早期r-SpA和nr-SpA患者在2年期间的骶髂关节放射学结构改变。

方法：患者：炎性背痛<3年，风湿科医生疑诊为中轴SpA的患者（DESIR队列）。结局检测：匿名收集患者基线和随访2年的盆骨X线片，中心阅片由2位阅片师盲态评估，他们之间的阅片一致性很好。若两位阅片者对是否存在骶髂关节炎（符合纽约修订标准）有分歧，或单个骶髂关节分期差距≥1级，则由另一位经验丰富的风湿科医生或放射科医生裁决。对每侧骶髂关节进行评分：范围0-4分，0分为正常，4分为融合。分析：测量以下指标：a) 骶髂关节结构改变（从nr到r，或从r到nr，采用纽约修订标准）；b) 双侧骶髂关节总评分改变（范围0-8分）；c) 单侧骶髂关节的放射学进展或改善，定义为至少有1级变化（≥+1 / ≤-1）；d) 进展: 定义为单侧骶髂关节结构破坏加重至少1级，而且随访满2年时该关节的放射学评分至少为2级且该关节在2年间放射学进展至少1级。

结果：下表总结了449例患者按基线放射学状态分组的治疗后变化情况。这些患者的年龄34±9岁，男性47%，HLA-B27阳性61%。

结论：以上数据提示，早期SpA的确存在结构破坏的进展，但进展幅度很小且仅在少量患者中观察到；相对较高的改善率提示评估真实进展率是很难的；骶髂关节总评分和/或放射学进展≥1级是最敏感的；基线符合mNY放射学标准的患者在2年间的进展率相对较高。

表. 449例早期SpA在随访2年期间骶髂关节放射学变化

结构改变	基线mNY放射学情况*
	阴性 N=326	阳性 N=123	所有 N=449
mNY 阴性→阳性	16（4.9%）	NA	NA**
mNY 阳性→阴性	NA	7(5.7%)	NA
SIJ 评分(0-8)	0.2±0.7	0.0±0.8	0.1±0.8
改变≥1级 — 恶化 — 改善	20（6.3%） 12（3.7%）	20（19.3%） 14（12.8%）	50（11.1%） 26（5.8%）
改变≥1级且 2年≥2级	21（6.4%）	18（17.1%）	39（8.7%）

*mNY阳性：符合放射学定义，即单侧至少3级或双侧至少2级改变

**NA：无可用