| Part 1: Study on the characteristics of bone and joint structural lesions in ankylosing spondylitis.Objectives: To investigate the characteristics of spinal and hip joint lesions in patients with ankylosing spondylitis(AS),non-radiographic axial spondyloarthritis(nr-ax Sp A)and patients without spondyloarthritis(non-Sp A).Methods: A study was conducted on patients who visited the Department of Rheumatology and Immunology of Changzheng Hospital due to chronic low back pain from January 29,2015 to September 3,2020 and completed whole-spine X-ray examination.The contents included the patient’s gender,age,disease duration,m SASSS and BASRI score.Results:(1)Radiographs of 1043 patients were included in the study,including 539 patients with AS,86 patients with nr-ax Sp A and 418 patients without Sp A.(2)The proportion of males in AS patients was 84.0%,which was higher than that in nr-ax Sp A patients(68.6%),and the difference was statistically significant(p<0.05);The median age of AS patients was 35(29-44)years,and the median age of nr-ax Sp A patients was 31.5(27.75-42)years,the difference was not statistically significant(p>0.05).(3)New bone formation(syndesmophytes or bone bridges)in the cervical spine of AS patients accounted for 22.7%-28.6% and 24.7-44.3% in the lumbar spine;new bone formation in the AS spine was most common between the 12 th thoracic and 4th lumbar vertebrae;The vertebral lesions of nr-ax Sp A patients were lighter than those of non-Sp A patients.(4)In addition to the sacroiliac joints in AS patients,the lumbar spine is most likely to be affected,and the cervical and hip joints are the least affected.The cervical or lumbar spine was slightly correlated with sacroiliac joint lesions(r=0.325 & 0.354),the lumbar spine was moderately correlated with cervical lesions(r = 0.620),only weak correlation or no significant correlation between other parts;no significant correlation between bone and joint lesions in different parts of nr-ax Sp A patients,low correlation between the cervical and lumbar spine lesions in non-Sp A patients(r =0.443).(5)Spinal lesions in AS patients were slightly correlated with age of onset and disease duration(0.3<r<0.5),hip joint lesions were only related to onset age(r=-0.332),nr-ax Sp A lumbar and hip lesions were correlated with age and age of onset,lumbar lesions were correlated with age and age of onset in non-Sp A patients.(6)The cervical and lumbar spine lesions of AS patients were significantly increased in patients with a disease course of more than 10 years,and the difference was statistically significant(p<0.05);patients over 30 years old were more likely to have lumbar spine involvement,and patients under 30 years old were more likely to develop hip joint involvement,the difference was statistically significant(p<0.05);early age of onset was an independent correlative factor for hip joint disease.(7)After grouping according to the rate of progression of spinal lesions,it was found that there was no significant difference in age of onset and course of disease between different groups(p>0.05).Conclusions: Spinal structural lesions in patients with AS are not sacral to cranial and most commonly occur in thoracic 12 to lumbar 2 vertebral bodies.The sacroiliac joint lesions are lowly correlated with lumbar and cervical lesions,while the cervical and lumbar lesions are moderately correlated.Patients with younger onset age are more likely to develop hip joint disease,and patients with older onset age or a more prolonged course are more likely to develop spinal disease.There was no significant difference in the age of onset and disease duration among patients with different progression rates of spinal lesions.Part II Analysis of the possible causes and prognostic effects of bone and joint structural lesions in ankylosing spondylitisObjective: To explore the possible causes and prognosis of cervical,lumbar and hip joint lesions in patients with ankylosing spondylitis.Methods: A total of 106 AS patients who were hospitalized in the Rheumatology and Immunology Department of Changzheng Hospital from October 2019 to February 2020 were collected.All patients met the 1984 New York standard.Hip joint disease,using electronic medical records combined with questionnaires to clarify the patient’s general condition,test and examination results,social background,disease activity,impact on work and income,daily activities and mental health status,medication compliance.Related factors and prognosis effects of joint structural lesions were analyzed.Results:(1)According to BASRI classification,34 patients had cervical vertebra lesions,55 patients had lumbar vertebra lesions,and 46 patients had hip joint lesions.(2)The cervical spine lesion group of AS patients was higher than the non-lesion group in terms of married ratio,extra-articular involvement ratio,age,age of onset,disease course,treatment time,and overall disease evaluation,and the difference was statistically significant(p<0.05);Among them,increasing age of onset was an independent factor for cervical spine involvement.(3)The proportion of smoking history,age,age of onset,and disease duration in the lumbar spine lesion group of AS patients were higher than those in the non-lesion group,and the difference was statistically significant(p<0.05).Among them,higher age at onset and longer disease duration were independent effects of lumbar spine lesions.(4)The proportion of marriage,age,weight,BMI,age of onset,CCQR score,and daily activities in the hip joint lesion group of AS patients were lower than those in the non-lesion group,while the proportion of hip discomfort,CRP,and ASDAS were higher than those in the non-lesion group,the difference was statistically significant(p < 0.05),among which,younger age of onset was an independent factor for hip joint disease.Conclusion: Higher age of onset is an independent influencing factor of cervical spine involvement,older age of onset and more prolonged disease course are independent influencing factors of lumbar vertebral lesions,and younger age of onset is an independent influencing factor of hip joint disease. |
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