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Rheumatology (Oxford). 2019 Jun 24. pii: kez240. doi: 10.1093/rheumatology/kez240. [Epub ahead of print]

Spinal-pelvic orientation: potential effect on the diagnosis of spondyloarthritis.

Author information

1
Rheumatology Unit.
2
Radiology Unit, CHU, Brest.
3
Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM.
4
Rheumatology Department, Pitie-Salpétrière Hôpital, AP-HP, Paris.
5
Neurosurgery Unit, CHU, Brest.
6
Radiology Department, Cochin Hospital, AP-HP, Paris, France.
7
Department of Radiology.
8
Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
9
Department of Rheumatology, CHU, Nancy, France.
10
AP-HP, Groupe Hospitalier Henri-Mondor, Service de Rhumatologie.
11
Université Paris Est Créteil, EA 7379 - EpidermE, Créteil.
12
INSERM 1227, Université de Bretagne Occidentale, LabEx IGO, Brest, France.

Abstract

OBJECTIVE:

To assess associations of spinal-pelvic orientation with clinical and imaging-study findings suggesting axial SpA (axSpA) in patients with recent-onset inflammatory back pain.

METHODS:

Spinal-pelvic orientation was assessed in DESIR cohort patients with recent-onset inflammatory back pain and suspected axSpA, by using lateral lumbar-spine radiographs to categorize sacral horizontal angle (<40° vs ⩾40°), lumbosacral angle (<15° vs ⩾15°) and lumbar lordosis (LL, <50° vs ⩾50°). Associations between these angle groups and variables collected at baseline and 2 years later were assessed using the χ2 test (or Fisher's exact) and the Mann-Whitney test. With Bonferroni's correction, P < 0.001 indicated significant differences.

RESULTS:

Of 362 patients, 358, 356 and 357 had available sacral horizontal angle, lumbosacral angle and LL values, respectively; means were 39.3°, 14.6° and 53.0°, respectively. The prevalence of sacroiliitis on both radiographs and MRI was higher in the LL < 50° group than in the LL ⩾50° group, but the difference was not statistically significant. Clinical presentation and confidence in a diagnosis of axSpA did not differ across angle groups. No significant differences were identified for degenerative changes according to sacral horizontal angle, lumbosacral angle or LL.

CONCLUSION:

Spinal-pelvic balance was not statistically associated with the clinical or imaging-study findings suggesting axSpA in patients with recent-onset inflammatory back pain.

KEYWORDS:

ankylosing spondylitis; axial spondyloarthritis; lumbar lordosis; sacral slope; sacroiliitis

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