编者：贾俊峰，西京医院临床免疫科

不同研究显示银屑病关节炎（PsA）合并中轴关节受累的比例在25~70%，差别范围很大。有中轴关节受累的PsA不管是否使用NSAIDs均推荐TNF拮抗剂。而临床上判断银屑病关节炎（PsA）是否有中轴关节受累存在一定困难，研究显示相当一部分银屑病关节炎患者虽然没有“典型腰背痛”，但依然存在骶髂关节的破坏。故不能照搬强直性脊柱炎关于炎性腰背痛（IBP）标准判断PsA是否有中轴关节受累。对于PsA患者来说，无论是否有明显的腰背痛，均建议进一步影像学检查以明确是否有骶髂关节受累。

目   的：

确定风湿病学家判断的患者炎性腰背痛（IBP）和标准定义的IBP在预测银屑病关节炎（PsA）患者中的一致性，以及IBP在确定PsA的中轴受累的预测价值。

方   法：

收集前瞻性数据，采用Kappa系数，研究风湿病学家判断的患者IBP和标准定义的IBP（CALIN、Rudwaleit和ASAS的评估）之间的一致性。我们还测定其对（AxPsA）诊断的易感性、特异性和似然比。最后，比较了AxPsA患者有无背痛之间的临床和遗传标记差别。

结   果:

共检出171例患者(男性52%,平均年龄46.6岁)。96例（56.13%）报告慢性腰痛。65例（38.01%）有IBP。54例（32%）患者有脊柱放射学改变的证据。风湿病学家对IBP的判断与IBP标准的一致性以Calin标准最高(0.70)。放射轴位受累的阳性似然比以Rudwaleit标准最高（2.17）。有或无背痛的AxPsA患者之间没有发现差别，除了在背痛患者中较高的Bath强直性脊柱炎活动指数和较低的HLA-B*38的阳性率。

结  论：

风湿病学家判断的IBP或为强直性脊柱炎制定的IBP标准在确定PsA中轴受累时可能表现不佳。

参考文献：

OBJECTIVE: We aimed to determine the agreementbetween rheumatologist-judged inflammatory back pain (IBP) and criteriadefining IBP in patients with psoriatic arthritis (PsA) and predictive value ofIBP in identifying axial involvement in PsA.

METHODS: Using prospectively collected data, weinvestigated the agreement between rheumatologist judgement of IBP and IBPcriteria (Calin, Rudwaleit and Assessment of Spondyloarthritis InternationalSociety) using the kappa coefficient. We also determined the sensitivity,specificity and likelihood ratios of the presence of back pain,rheumatologist-judged IBP and the three IBP criteria for detecting axial PsA(AxPsA). Finally, we compared the clinical and genetic markers in patients withPsA with axial radiological changes with and without back pain.

RESULTS:171 patients (52% male, mean age 46.6years) were identified. Ninety-six (56.13%) patients reported chronic backpain. Sixty-five (38.01%) had IBP. 54 (32%) patients had evidence ofradiological change in the spine. The agreement between rheumatologistjudgement of IBP and IBP criteria was highest for the Calin criteria (0.70).Positive likelihood ratio for the presence of radiological axial involvementwas highest for Rudwaleit criteria (2.17). No differences between patients withAxPsA with or without back pain were found, except for higher Bath AnkylosingSpondylitis Disease Activity Index and lower prevalence of human leucocyte antigen-B*38in those with back pain.

CONCLUSION:Rheumatologist-judged IBP or thecriteria for IBP developed for ankylosing spondylitis may not perform well whenascertaining axial involvement in PsA.[1]

References

[1]       Yap KS, Ye JY, Li S, Gladman DD, Chandran V. Back pain inpsoriatic arthritis: defining prevalence, characteristics and performance ofinflammatory back pain criteria in psoriatic arthritis. Ann Rheum Dis. 2018.77(11): 1573-1577.