An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis
An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis
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DOI：
10.1378/chest.127.1.192
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发表时间：
2005-01-01
期刊：
影响因子：
9.6
通讯作者：
Kitas, GD
中科院分区：
文献类型：
--
作者：
Erb, N;Cushley, MJ;Kitas, GD
目的：结节病是一种慢性肉芽肿性多系统疾病，其中关节炎相对常见。骶髂关节关节炎（骶髂关节炎）已在结节病中被描述，但被认为是罕见的。本研究的目的是确定结节病二级护理人群中骶髂关节炎的患病率。方法：对结节病二级护理专科门诊的患者使用标准背痛问卷评估脊柱症状，检查脊柱活动度，并进行红细胞沉降率、C反应蛋白、血清血管紧张素转换酶和新蝶呤/肌酐比值的实验室测量。对人类白细胞抗原 (HLA)-B27 等位基因的存在进行组织分型。对每位患者拍摄骶髂关节的 X 光片，并由两名观察者独立检查；另一位观察员审查了有争议的射线照片。结果：61 名患者完成了评估（占受邀参加的所有患者的 80.3%）。 61 名患者中有 49 名 (80.3%) 报告在其一生中的某个时刻曾出现背痛。 61 名患者中，有 31 名 (50.8%) 的背痛问卷评分提示炎性脊柱疾病，但其中只有 3 名患者的放射线检查显示骶髂关节糜烂性损伤，提示骶髂关节炎。另一名患者在放射线检查中出现糜烂性损伤，总共有 4 名患者有骶髂关节炎的证据，患病率为 6.6%。 4 名患者（1 名骶髂关节炎患者）HLA-B27 呈阳性。背痛问卷对该人群中骶髂关节炎的敏感性为 75%，特异性为 51%。结论：正常人群中脊柱关节病的患病率估计为 1.9%。在研究的结节病人群中，患病率为 6.6%，表明这两种情况之间可能存在关联。用于识别炎症性脊柱疾病的标准背痛问卷在该人群中的敏感性和特异性较低。
Objectives: Sarcoidosis is a chronic granulomatous multisystem disease in which arthritis is relatively common. Arthritis of the sacroiliac joints (sacroiliitis) has been described in sarcoidosis but is thought to be rare. The objective of this study was to determine the prevalence of sacroiliitis in a secondary-care population of patients with sarcoidosis.Methods: Patients attending a specialist secondary-care sarcoidosis clinic underwent evaluation of spinal symptoms using a standard back pain questionnaire, examination of spinal mobility, and laboratory measurements of erythrocyte sedimentation rate, C-reactive protein, serum angiotensin-converting enzyme, and neopterin/creatinine ratio. Tissue typing for the presence of the human leukocyte antigen (HLA)-B27 allele was undertaken. Radiographs of the sacroiliac joints were obtained in each patient and reviewed independently by two observers; a further observer reviewed disputed radiographs.Results: Sixty-one patients completed the assessments (80.3% of all patients invited to participate). Forty-nine of 61 patients (80.3%) reported having back pain at some point in their lives. Thirty-one of 61 patients (50.8%) had a score on the back pain questionnaire suggestive of inflammatory spinal disease, but only 3 of these patients had erosive damage of the sacroiliac joints on radiography indicating sacroiliitis. One further patient had erosive damage on radiography, making a total of four individuals with evidence of sacroiliitis, a prevalence of 6.6%. Four patients (one patient with sacroiliitis) were positive for HLA-B27. The back pain questionnaire had a sensitivity of 75% and a specificity of 51% for sacroiliitis in this population.Conclusion: The prevalence of spondyloarthropathy in the normal population has been estimated to be 1.9%. In the sarcoid population studied the prevalence was 6.6% suggesting a possible association between these two conditions. The standard back pain questionnaire for the identification of inflammatory spinal disease had a low sensitivity and specificity in this population.