调查看似健康的强直性脊柱炎（AS）患者一级亲属（FDR）是否具有脊柱关节炎（SpA）临床、实验室或影像学特征。
研究方法年龄为18～40岁的HLA-B27阳性AS患者FDR被纳入到一项名为Pre-SpA的前瞻性起始队列研究之中。获取临床、生物学和影像学数据。依据SpA分类标准数项设定对FDR进行分类。
研究结果我们在此项研究中报告了51例FDR的基线特征。29例（57%）FDR伴有背痛；2例（4%）伴有银屑病，无人伴有其他关节外表现。3例（6%）FDR伴有低度骶髂关节炎，1例（2%）伴有X线所示颈部韧带骨赘，10例（20%）伴有MRI所示骶髂关节骨髓水肿。51例FDR中有17例（33%）符合SpA分类标准：7例（14%）同时符合ASASaxSpA和ESSG标准，6例（12%）仅符合ASASaxSpA标准，4例（8%）仅符合ESSG标准。无人满足其他SpA分类标准。符合ASASaxSpA和/或ESSG标准的FDR背痛更为频繁（炎症性），并且疾病活动水平更高。在炎症参数、外周和关节外疾病以及HLA-B27存在方面未发现差异。4例（12%）不符合ASASaxSpA和/或ESSG标准的FDR伴有提示SpA的影像学异常。
研究结论相当一部分看似健康的HLA-B27阳性AS患者FDR伴有提示SpA的临床和/或影像学异常。33%可被分类为SpA。进一步随访将显示那些FDR将形成临床显性SpA。
原文摘要Clinicalandimagingsignsofspondyloarthritisinfirst-degreerelativesofHLA-B27positiveankylosingspondylitispatients:Thepre-spondyloarthritis(Pre-SpA)cohort
OBJECTIVE:Toinvestigateifseeminglyhealthyfirst-degreerelatives(FDRs)ofankylosingspondylitis(AS)patientshaveclinical,laboratoryorimagingfeaturesofspondyloarthritis(SpA).
METHODS:FDRsofHLA-B27positiveASpatientsbetween18-40yearswereincludedinPre-SpA,aprospectiveinceptioncohortstudy.Clinical,biologicalandimagingdatawereobtained.FDRswereclassifiedaccordingtoseveralsetsofSpAclassificationcriteria.
RESULTS:Wereportbaselinefeaturesof51FDRsincludedinthisstudy.Twenty-nine(57%)FDRshadbackpain;2(4%)hadpsoriasis,andnonehadotherextra-articularmanifestations.Three(6%)FDRshadlowgradesacroiliitis,1(2%)hadcervicalsyndesmophytesonX-ray,and10(20%)hadbonemarrowedemaonMRIofthesacroiliiacjoints.Seventeenof51(33%)FDRsfulfilledSpAclassificationcriteria:7(14%)boththeASASaxSpAandESSGcriteria,6(12%)onlytheASASaxSpA,and4(8%)onlytheESSGcriteria.NonefulfilledotherSpAclassificationcriteria.FDRsfulfillingtheASASaxSpAand/orESSGclassificationcriteriahadmorefrequently(inflammatory)backpainandhadahigherlevelofdiseaseactivity.Nodifferenceininflammatoryparameters,peripheralandextra-articulardiseaseandHLA-B27presencewasfound.Four(12%)oftheFDRsnotfulfillingtheASASaxSpAand/orESSGclassificationcriteriahadimagingabnormalitiessuggestiveofSpA.
CONCLUSION:AsubstantialproportionofseeminglyhealthyFDRsofHLA-B27positiveASpatientshaveclinicaland/orimagingabnormalitiessuggestiveofSpA.Thirty-threepercentcouldbeclassifiedasSpA.Furtherfollow-upwillshowwhichFDRswilldevelopclinicallymanifestSpA.Thisarticleisprotectedbycopyright.Allrightsreserved.
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