Arthritis Care Res：早期强直性脊柱炎患者功能障碍更易受放射学损害影响

在强直性脊柱炎（AS）的病程中，放射学损害和功能障碍是不断加重的。来自美国马里兰州贝塞斯达市国立卫生研究院关节肌肉及皮肤病系的MICHAEL M. WARD等人进行了一项研究，该研究的目的是观察在晚期AS患者，放射学损害对功能障碍影响是否更大；放射学损害和功能障碍的关联程度是否随受累的解剖区域而变化。研究结果在在线发布在2013年2月的《关节炎治疗与研究》（Arthritis Care Res）上。作者发现，尽管在AS病程中，放射学损害和功能障碍不断进展；但晚期AS放射学损害对功能障碍的影响相对早期AS低。
该项横断面研究共纳入801位AS患者。研究者对腰椎及颈椎修订版斯托克AS脊柱评分（mSASSS）、腰椎后路融合术、颈椎后路融合术、髋关节与强直性脊柱炎功能指数（BASFI）及脊柱关节炎健康评估调查问卷(HAQ-S)的关系进行研究。
研究结果如下：腰椎及颈椎mSASSS评分越高，功能障碍越严重；但是mSASSS评分和AS病程有一定的相关性。例如，AS病程越长，腰椎及颈椎mSASSS评分与功能障碍相关性越弱。颈椎后路融合术独立于mSASSS评分与严重功能障碍相关。髋关节炎独立于脊髓损伤的评价与功能障碍显著相关。对于AS病程大于40年的患者，功能变化的主要原因是多种合并症，与BASFI和HAQ-S评分结果相似。
研究发现，尽管在AS病程中放射学损害和功能障碍不断进展；但晚期AS放射学损害对功能障碍的影响相对早期AS低。这一发现提示，随病程延长，患者能部分适应功能障碍。但是，不同解剖部位受累对功能的影响在AS的病程中持续存在。晚期AS伴发的合并症也可以造成功能障碍。
与强直性脊柱炎相关的拓展阅读：

• 早期强直性脊柱炎患者功能障碍更易受放射学损害影响
• ACR：早期强直性脊柱炎患者功能障碍与放射学损害相关性更强
• Nat Genet：强直性脊柱炎新易感基因位点被发现
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Regional radiographic damage and functional limitations in patients with ankylosing spondylitis: Differences in early and late disease.
OBJECTIVE
Both radiographic damage and functional limitations increase with the duration of ankylosing spondylitis (AS). We examined whether radiographic damage contributed more to functional limitations in late AS than in early AS, and if the strength of association varied with the anatomic region of damage.
METHODS
In this cross-sectional study of 801 patients with AS, we examined associations of the lumbar modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), the cervical mSASSS, lumbar posterior fusion, cervical posterior fusion, and hip arthritis with the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Health Assessment Questionnaire modified for the spondyloarthritides (HAQ-S).
RESULTS
Higher lumbar and cervical mSASSS scores were associated with more functional limitations, but there was an interaction between mSASSS scores and the duration of AS, such that the strength of their association with functional limitations decreased with increasing duration of AS. Cervical posterior fusion was associated with worse functioning independent of mSASSS scores. Hip arthritis was significantly associated with functional limitations independent of spinal damage measures. Among patients with AS duration ≥40 years, the number of comorbid conditions accounted for most of the variation in functioning. Results were similar for both the BASFI and the HAQ-S.
CONCLUSION
Although both radiographic damage and functional limitations increase over time in AS, the relative contribution of radiographic damage to functional limitations is lower among patients with longstanding AS than with early AS, suggesting patients may accommodate to limited flexibility. Damage in different skeletal regions impacts functioning over the duration of AS. Functional limitations due to comorbidity supervene in late AS.