Arthritis Research & Therapy

ПРЕДПОСЫЛКИ:

Преды­ду­щие ис­сле­до­ва­ния по­ка­за­ли, что ан­ки­ло­зи­ру­ю­щий спон­ди­лит (АС), пред­ше­ству­ю­щий ак­си­аль­но­му спон­ди­ло­арт­ри­ту (Акс СпА), ха­рак­те­ри­зу­ет­ся про­грес­си­ро­ва­ни­ем са­кро­и­ле­и­та и спон­ди­ли­та. В по­след­нее вре­мя для ана­ли­за от­ло­же­ния кри­стал­лов мо­но­ура­та на­трия (МУН) ис­поль­зу­ет­ся двух­энер­ге­ти­че­ская ком­пью­тер­ная то­мо­гра­фия (ДЭКТ), ме­тод с вы­со­кой чув­стви­тель­но­стью и спе­ци­фич­но­стью. Од­на­ко оста­ет­ся неяс­ным, свя­за­но ли вы­яв­ля­е­мое на ДЭКТ от­ло­же­ние кри­стал­лов МУН в крест­цо­во-под­вздош­ном со­чле­не­нии у боль­ных АксСпА с су­ще­ству­ю­щи­ми струк­тур­ны­ми по­ра­же­ни­я­ми. Це­лью дан­но­го ис­сле­до­ва­ния бы­ло по­ка­зать, что вы­яв­ля­е­мые с по­мо­щью ДЭКТ от­ло­же­ния кри­стал­лов МУН у боль­ных АксСпА, не стра­да­ю­щих по­дагрой, и под­твер­дить вза­и­мо­связь меж­ду от­ло­же­ни­ем кри­стал­лов МУН и по­ра­же­ни­ем струк­тур крест­цо­во-под­вздош­но­го со­чле­не­ния.

МЕТОДЫ:

В ис­сле­до­ва­ние на­бра­ли 186 боль­ных АксСпА, не стра­да­ю­щих по­дагрой. Бы­ли по­лу­че­ны про­стые рент­ге­нов­ские сним­ки, ДЭКТ-изо­бра­же­ния крест­цо­во-под­вздош­но­го су­ста­ва и кли­ни­че­ские ха­рак­те­ри­сти­ки. Все ста­ти­сти­че­ские по­ка­за­те­ли, свя­зан­ные со сте­пе­нью по­ра­же­ния (0−4) ле­во­го или пра­во­го крест­цо­во-под­вздош­но­го со­чле­не­ния, рас­счи­ты­ва­ли неза­ви­си­мо друг от дру­га. Вза­и­мо­связь меж­ду кли­ни­че­ски­ми про­яв­ле­ни­я­ми и ре­зуль­та­та­ми лу­че­вой ди­а­гно­сти­ки по­ра­же­ния крест­цо­во-под­вздош­но­го со­чле­не­ния ана­ли­зи­ро­ва­ли с по­мо­щью би­ва­ри­ат­но­го ана­ли­за и ло­ги­сти­че­ской ре­грес­сии.

РЕЗУЛЬТАТЫ:

У боль­ных АксСпА бы­ли вы­яв­ле­ны круп­ные от­ло­же­ния кри­стал­лов МУН в ма­лом та­зе. Сред­ний объ­ем кри­стал­лов МУН в ле­вом крест­цо­во-под­вздош­ном су­ста­ве, пра­вом крест­цо­во-под­вздош­ном су­ста­ве и в ма­лом та­зе был ра­вен 0,902±1,345, 1,074±1,878 и 5,272±9,044 см³, и эти зна­че­ния кор­ре­ли­ро­ва­ли с уров­нем мо­че­вой кис­ло­ты в сы­во­рот­ке (r = 0,727, 0,740, 0,896; p<0,001). В би­ва­ри­ант­ном ана­ли­зе ос­нов­ные кли­ни­че­ские по­ка­за­те­ли бы­ли ас­со­ци­и­ро­ва­ны со сте­пе­нью по­вре­жде­ния крест­цо­во-под­вздош­ных су­ста­вов. Кро­ме то­го, дли­тель­ность АксСпА, балл по Бат­ско­му ин­дек­су функ­цио­наль­ных на­ру­ше­ний при ан­ки­ло­зи­ру­ю­щем спон­ди­ло­арт­ри­те (BASFI) и объ­ем кри­стал­лов МУН в крест­цо­во-под­вздош­ных су­ста­вах с обе­их сто­ро­ны бы­ли про­пор­цио­наль­ны сте­пе­ни по­ра­же­ния крест­цо­во-под­вздош­ных су­ста­вов по ре­зуль­та­там лу­че­вой ди­а­гно­сти­ки в ор­ди­наль­ных ло­ги­сти­че­ских мо­де­лях (скор­рек­ти­ро­ван­ное от­но­ше­ние шан­сов сле­ва = 1,180, 3,800, 1,920; сОШ спра­ва = 1,190, 3,034, 1,418; p<0,01).

ВЫВОДЫ:
ДЭКТ по­ка­за­ла боль­шие от­ло­же­ния кри­стал­лов МУН в ма­лом та­зе боль­ных АксСпА, не стра­да­ю­щих по­дагрой. У этих па­ци­ен­тов от­ло­же­ние кри­стал­лов МУН в крест­цо­во-под­вздош­ных су­ста­вах бы­ло свя­за­но не толь­ко с дли­тель­но­стью АксСпА и бал­лом по BASFI, но и со сте­пе­нью по­ра­же­ния су­ста­вов по ре­зуль­та­там лу­че­вой ди­а­гно­сти­ки.

Junqing Zhu, Aiwu Li, Ertao Jia, Yi Zhou, Juan Xu, Shixian Chen, Yinger Huang, Xiang Xiao, Juan Li.
Arthritis Research & Therapy. 2017 May 2;19(1):83.
Ссылка на DOI

Спонсор выпуска новостей

eng

Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study

BACKGROUND:

Previous studies have revealed that ankylosing spondylitis (AS), as the progenitor of axial spondyloarthritis (AxSpA), has been characterized by the insidiously progressive nature of sacroiliitis and spondylitis. Dual-energy computed tomography (DECT) has recently been used to analyse the deposition of monosodium urate (MSU) crystals with higher sensitivity and specificity. However, it remains unclear whether the existence of the MSU crystal deposition detected by DECT at the sacroiliac joint in patients with AxSpA also is associated with the existing structural damage. Here, we performed this study to show the DECT MSU crystal deposits in AxSpA patients without coexisting gout and to ascertain the relationship between the MSU crystal deposition and the structural joint damage of sacroiliac joints.

METHODS:

One hundred and eighty-six AxSpA patients without coexisting gout were recruited. The plain radiographs of the sacroiliac joint were obtained, along with the DECT scans at the pelvis and the clinical variables. All statistics based on the left or right sacroiliac joint damage grading (0−4) were calculated independently. Bivariate analysis and ordinal logistic regression was performed between the clinical features and radiographic grades at the sacroiliac joint.

RESULTS:

At the pelvis, large quantities of MSU crystal deposition were found in patients with AxSpA. The average MSU crystal volume at the left sacroiliac joint, the right sacroiliac joint, and the pelvis were 0.902 ± 1.345, 1.074 ± 1.878, and 5.272 ± 9.044 cm3, values which were correlated with serum uric acid concentrations (r = 0.727, 0.740, 0.896; p < 0.001). In bivariate analysis, wide clinical variables were associated with the changes in sacroiliac joint damage. Further, the AxSpA duration, BASFI score, and the volume of MSU crystal at both sides of sacroiliac joint were associated with the progress of radiographic grade at the sacroiliac joints in the ordinal logistic models (left AOR = 1.180, 3.800, 1.920; right AOR = 1.190, 3.034, 1.418; p < 0.01).

CONCLUSIONS:
Large quantities of MSU crystal deposition detected by DECT were found at the pelvis in AxSpA patients without coexisting gout. In addition to AxSpA duration and BASFI score, the MSU crystal deposition at the sacroiliac joint is associated with the progress of radiographic grade at sacroiliac joints in those patients.

KEYWORDS:

Ankylosing spondylitis (AS); Axial Spondyloarthritis (AxSpA); Dual-energy computed tomography (DECT); Monosodium urate (MSU) crystal; Sacroiliac joint

Fig. 1 Bland-Altman plots for interobserver reproducibility analysis. a The dual-energy computed tomography (DECT) monosodium urate (MSU) crystal volume at the left sacroiliac joint. b The DECT MSU crystal volume at the right sacroiliac joint. c The DECT MSU crystal volume at the pelvis. Solid line shows bias and dashed lines show the 95% limits of agreement

Fig. 1 Bland-Altman plots for interobserver reproducibility analysis. a The dual-energy computed tomography (DECT) monosodium urate (MSU) crystal volume at the left sacroiliac joint. b The DECT MSU crystal volume at the right sacroiliac joint. c The DECT MSU crystal volume at the pelvis. Solid line shows bias and dashed lines show the 95% limits of agreement

Fig. 2 Four axial spondyloarthritis (AxSpA) patients with monosodium urate (MSU) crystal and radiographic structural damage at the sacroiliac joint. For each set of images, panel a shows the sacroiliac joint on plain radiographs, panel b shows the three-dimensional reconstruction dual-energy computed tomography (DECT) images, panel c shows the corresponding coronal (patient 2 and 4) or axial (patient 1 and 3) DECT images, and panel d shows the corresponding level of computed tomography (CT) images. A large quantity of MSU crystal deposition shown as green was found at the sacroiliac joint or the surrounding area in the DECT images. Four male patients (patient 1–4), aged 36, 44, 23, and 27 years old, had serum uric acid levels of 407 μmol/L, 370 μmol/L, 572 μmol/L, and 464 μmol/L, respectively. They were graded with a scale of 0, 0, II, III at the left sacroiliac joint and 0, I, II, III at the right sacroiliac joint, respectively, on plain radiographs

Fig. 2 Four axial spondyloarthritis (AxSpA) patients with monosodium urate (MSU) crystal and radiographic structural damage at the sacroiliac joint. For each set of images, panel a shows the sacroiliac joint on plain radiographs, panel b shows the three-dimensional reconstruction dual-energy computed tomography (DECT) images, panel c shows the corresponding coronal (patient 2 and 4) or axial (patient 1 and 3) DECT images, and panel d shows the corresponding level of computed tomography (CT) images. A large quantity of MSU crystal deposition shown as green was found at the sacroiliac joint or the surrounding area in the DECT images. Four male patients (patient 1−4), aged 36, 44, 23, and 27 years old, had serum uric acid levels of 407 μmol/L, 370 μmol/L, 572 μmol/L, and 464 μmol/L, respectively. They were graded with a scale of 0, 0, II, III at the left sacroiliac joint and 0, I, II, III at the right sacroiliac joint, respectively, on plain radiographs