期刊
MEDICINE
卷 101, 期 29, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MD.0000000000029523
关键词
apparent diffusion coefficient; disease activity; late-onset; MRI; spondyloarthritis
资金
- Hong Kong Society of Rheumatology
- Li Ka Shing faculty of medicine start up grant
- University of Hong Kong-Shenzhen Hospital [HKUSZH201902013]
- Novartis Research
This study investigated the clinical, diagnostic, and imaging features of patients with late onset axial spondyloarthritis (SpA) and found that late onset axial SpA is associated with higher disease activity, more intense spinal MRI inflammation, less radiographic damage, and more tender joint count. The presence of less inflammatory back pain could make the diagnosis more difficult.
We aimed to investigate the clinical, diagnostic, and imaging features of patients with late onset axial spondyloarthritis (SpA) with initial symptom manifestation aged over 45 years. Participants with axial SpA were consecutively recruited. Clinical, demographic, blood, and imaging parameters were compared between the groups with early (<= 45 years) and late onset (>45 years) at a cross-sectional level. Logistic regressions were used to determine the independent associations with axial SpA with late onset. A total of 455 participants were recruited. Among them, 70 (15.4%) had late onset disease. Multivariate analyses showed that axial SpA with late onset was associated with higher C-reactive protein based ankylosing spondylitis disease activity index (ASDAS-CRP) (B = 0.10; P = .04), higher intensity of spinal inflammation as measured by maximum apparent diffusion coefficient (spinal ADC max) (B = 0.27; P = .03) and mean ADC (spinal ADC mean) (B = 0.30; P = .004), lower modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) (B = -0.12; P = .02), more tender joint count (B = 0.12; P = .02), and fewer inflammatory back pain (IBP) (OR = 0.26; P < .001). Axial SpA with late onset had higher clinical disease activity, higher intensity of spinal MRI inflammation, less radiographic damage, and more tender joint count. There was also less inflammatory back pain, which could make the diagnosis more difficult.
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