B27阳性强直性脊柱炎患者的一级亲属存在脊柱关节炎的临床和影像学异常-上海强直医院

作者：Turina MC,et al.

翻译：北医三院翟佳羽<zhaijy_1987@163.com>

目的：探讨强直性脊柱炎患者的健康一级亲属是否存在脊柱关节炎的临床、实验室或影像学特征。

方法：年龄在18-40岁之间的HLA-B27阳性的强直性脊柱炎患者一级亲属纳入前瞻性队列研究—Pre-SpA，获得其临床、生物学和影像学资料。根据多套脊柱关节炎分类标准对一级亲属进行分类。

结果：我们报道纳入研究的51例一级亲属的基线特征。29例（57%）一级亲属有腰背痛，2例（4%）有银屑病，没有其他关节外表现。3例（6%）一级亲属有轻度骶髂关节炎，1例（2%）X线有颈椎骨赘形成。10例（20%）骶髂关节核磁共振存在骨髓水肿。17例（33%）一级亲属符合脊柱关节炎的分类标准：7例（14%）同时符合ASAS中轴型脊柱关节炎和ESSG分类标准，6例（12%）仅符合ASAS中轴型脊柱关节炎标准，4例（8%）仅符合ESSG标准。所有一级亲属均不符合其他脊柱关节炎分类标准。符合ASAS中轴型脊柱关节炎和/或ESSG分类标准的一级亲属腰背痛更频繁且疾病活动度更高。炎症指标、外周和关节外表现以及HLA-B27阳性情况两者之间无显著差异。4例（12%）不符合ASAS中轴型脊柱关节炎和/或ESSG分类标准的一级亲属有提示脊柱关节炎的影像学异常。

结论：部分看似健康的HLA-B27阳性强直性脊柱炎患者的一级亲属有提示脊柱关节炎的临床和/或影像学异常。33%一级亲属能够分类诊断为脊柱关节炎。进一步随访将显示哪些一级亲属能够发展为有临床表现的脊柱关节炎。

附原文：Objective: To investigate if seemingly healthy first-degree relatives (FDRs) of ankylosing spondylitis (AS) patients have clinical, laboratory or imaging features of spondyloarthritis (SpA). Methods: FDRs of HLA-B27 positive AS patients between 18-40 years were included in Pre-SpA, a prospective inception cohort study. Clinical, biological and imaging data were obtained. FDRs were classified according to several sets of SpA classification criteria. Results: We report baseline features of 51 FDRs included in this study. Twenty-nine (57%) FDRs had back pain; 2 (4%) had psoriasis, and none had other extra-articular manifestations. Three (6%) FDRs had low grade sacroiliitis, 1 (2%) had cervical syndesmophytes on X-ray, and 10 (20%) had bone marrow edema on MRI of the sacroiliiac joints. Seventeen of 51 (33%) FDRs fulfilled SpA classification criteria: 7 (14%) both the ASAS axSpA and ESSG criteria, 6 (12%) only the ASAS axSpA, and 4 (8%) only the ESSG criteria. None fulfilled other SpA classification criteria. FDRs fulfilling the ASAS axSpA and/or ESSG classification criteria had more frequently (inflammatory) back pain and had a higher level of disease activity. No difference in inflammatory parameters, peripheral and extra-articular disease and HLA-B27 presence was found. Four (12%) of the FDRs not fulfilling the ASAS axSpA and/or ESSG classification criteria had imaging abnormalities suggestive of SpA. Conclusion: A substantial proportion of seemingly healthy FDRs of HLA-B27 positive AS patients have clinical and/or imaging abnormalities suggestive of SpA. Thirty-three percent could be classified as SpA. Further follow-up will show which FDRs will develop clinically manifest SpA.

引自：Turina MC, de Winter JJ, Paramarta JE, et al. Clinical and imaging signs of spondyloarthritis in first-degree relatives of HLA-B27 positive ankylosing spondylitis patients: The pre-spondyloarthritis (Pre-SpA) cohort. Arthritis Rheumatol. 2016 May 23. doi: 10.1002/art.39766.

B27阳性强直性脊柱炎患者的一级亲属存在脊柱关节炎的临床和影像学异常

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