The prevalence, clinical features and association of HLA-B27 in sacroiliitis associated with established Crohn's disease
The prevalence, clinical features and association of HLA-B27 in sacroiliitis associated with established Crohn's disease
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DOI：
10.1111/j.1365-2036.2008.03868.x
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发表时间：
2009-01-15
影响因子：
7.6
通讯作者：
Wordsworth, B. P.
中科院分区：
文献类型：
--
作者：
Orchard, T. R.;Holt, H.;Wordsworth, B. P.
骶髂关节炎是克罗恩病的一种常见并发症，与进行性强直性脊柱炎（AS）不同，本研究旨在前瞻性地评估克罗恩病患者骶髂关节炎的患病率、临床特征及其与HLA-B27的相关性。患者接受临床评估，包括症状问卷调查，血液流变学检查和进行HLA基因分型。然后患者接受骶髂关节磁共振成像（MRI）。临床和放射学因素与HLA-B27状态相关。56例患者进行了初步评估，44例进行了MRI扫描。44例患者中有17例（39%）有骶髂关节炎的MRI证据，其中5例符合AS标准。大多数患者出现腰痛症状- 11/17（65%），而扫描正常的27例患者中有3例（11%）（P = 0.003）。除AS患者外，功能指标无差异。HLA-B27存在于7名患者中，所有7名患者都有骶髂关节炎的MRI证据，5名患者患有AS。骶髂关节炎在克罗恩病患者中很常见，在大多数情况下，如果仔细询问，患者会出现炎症性腰痛的症状。HLA-B27与孤立性骶髂关节炎无关，但与AS相关。然而，拥有HLA-B27似乎传达了非常高的风险，发展轴性炎症克罗恩病。
Sacroiliitis is a recognized complication of Crohn's disease and may occur distinct from progressive ankylosing spondylitis (AS).To estimate prospectively the prevalence of sacroiliitis in patients with established Crohn's disease, to characterize the clinical features and to correlate these with the presence of HLA-B27.All Crohn's disease patients under active follow-up of between 5 and 12 years duration were invited to participate. Patients underwent a clinical evaluation including symptom questionnaire, rheumatological examination and underwent HLA genotyping. Patients then underwent magnetic resonance imaging (MRI) of the sacroiliac joints. The clinical and radiological factors were correlated with HLA-B27 status.56 patients underwent initial assessment and 44 had MRI scans. Seventeen of 44 (39%) patients had MRI evidence of sacroiliitis, of whom 5 fulfilled the criteria for AS. Symptoms of low back pain were elicited in a majority of these patients - 11/17 (65%) compared to 3 of 27 (11%) patients with normal scans (P = 0.003). There were no differences in functional indices with the exception of patients with AS. HLA-B27 was present in seven patients, and all seven had MRI evidence of sacroiliitis, five had AS.Sacroiliitis is common in patients with established Crohn's disease and in the majority of cases, patients have symptoms of inflammatory low back pain if questioned carefully. HLA-B27 is not associated with isolated sacroiliitis, but is associated with AS. However, possession of HLA-B27 appears to convey a very high risk of developing axial inflammation in Crohn's disease.