Early Predictors of Juvenile Sacroiliitis in Enthesitis-related Arthritis
Early Predictors of Juvenile Sacroiliitis in Enthesitis-related Arthritis
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DOI：
10.3899/jrheum.100090
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发表时间：
2010-11-01
影响因子：
3.9
通讯作者：
Simonini, Gabriele
中科院分区：
文献类型：
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作者：
Pagnini, Ilaria;Savelli, Sara;Simonini, Gabriele
Objective.在一组附着点炎相关性关节炎（ERA）患者中确定骶髂关节（SI）受累的早期预测因素。在7年随访期间，所有符合ERA ILAR分类标准的连续患者均入组。收集的数据包括疾病发作时、炎性背痛发作时和末次随访时的人口统计学、临床和实验室变量。所有发生炎性背痛的患者同时进行骨盆X线片和骶髂关节动态磁共振成像（MRI）扫描。研究了59例ERA儿童; 40例男性，19例女性;发病时的中位年龄为9岁4个月（范围6岁6个月-13岁3个月）。在发病后1年3个月的中位时间间隔，21名儿童报告了炎性背痛的症状。在所有病例中，骶髂关节X线片均为阴性，而动态MRI显示17例急性骶髂关节炎。多因素分析显示，SI的早期预测因素为发病时活动关节数（p < 0.03）和活动附着点数（p < 0.001）。在我们的队列中，大约30%的ERA/幼年特发性关节炎儿童出现骶髂关节炎的临床和MRI证据，最早在疾病发作后1年可通过动态MRI检测到。需要更多病例系列的数据来评估该技术在疾病早期的特异性和敏感性，并确认该队列中报告的SI累及率。（2010年9月1日首次发布; J Rheumol 2010;37：2395-401; doi：10.3899/jrheum.100090）
Objective. To identify early predictors of sacroiliac (SI) involvement in a cohort of patients with enthesitis-related arthritis (ERA).Methods. During a 7-year followup period, all consecutive patients fulfilling the ILAR classification criteria for ERA were enrolled. Data collected included demographic, clinical and laboratory variables at disease onset, at the onset of inflammatory back pain, and at the last available followup visit. Pelvis radiographs and dynamic magnetic resonance imaging (MRI) scans for SI joints were obtained simultaneously in all patients who developed inflammatory back pain.Results. Fifty-nine children with ERA were studied; 40 male, 19 female; median age at disease onset 9 years 4 months (range 6 yrs 6 mo - 13 yrs 3 mo). At a median interval after disease onset of 1 year 3 months, 21 children reported symptoms of inflammatory back pain. In all cases, radiographs of SI joints were negative, while dynamic MRI revealed acute sacroiliitis in 17 cases. Multivariate analysis showed that the early predictors of SI were the number of active joints (p < 0.03) and the number of active entheses (p < 0.001) at onset.Conclusion. In our cohort, roughly 30% of children with ERA/juvenile idiopathic arthritis develop clinical and MRI evidence of sacroiliitis, detectable with dynamic MRI as early as I year after disease onset. Additional data from larger case series are needed to assess the specificity and sensitivity of this technique in the early phase of the disease and to confirm the rate of SI involvement reported in this cohort. (First Release September 1 2010; J Rheumatol 2010;37:2395-401; doi:10.3899/jrheum.100090)