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Semin Arthritis Rheum. 2019 Jun 13. pii: S0049-0172(19)30198-2. doi: 10.1016/j.semarthrit.2019.06.008. [Epub ahead of print]

Associations of lumbar scoliosis with presentation of suspected early axial spondyloarthritis.

Author information

1
Rheumatology Unit, CHU Brest, BP 824, F-29609 Brest Cedex, France.
2
Radiology Unit, CHU brest, Brest 29609, France.
3
Neurosurgery Unit, CHU Brest, Brest 29609, France.
4
Radiology B Department, Paris Descartes University, AP-HP, Cochin Hospital, Paris, France.
5
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
6
Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
7
Department of Rheumatology, CHU Nancy, France.
8
AP-HP, Groupe Hospitalier Henri-Mondor, Service de Rhumatologie, Créteil 94000, France; Université Paris Est Créteil, EA 7379 - EpidermE, Créteil 94000, France.
9
Rheumatology Unit, CHU Brest, BP 824, F-29609 Brest Cedex, France; INSERM 1227, Université de Bretagne Occidentale, LabEx IGO, Brest, France. Electronic address: alain.saraux@chu-brest.fr.

Abstract

OBJECTIVE:

Scoliosis may impact the mechanical loading and cause secondary changes of the sacroiliac joints and lumbar spine. Our goal was to look how lumbar scoliosis modify the clinical and imaging-study in patients with recent-onset inflammatory back pain (IBP) suggesting axial spondyloarthritis (axSpA).

METHODS:

Baseline weight-bearing lumbar-spine radiographs obtained in the DESIR cohort of patients aged 18-50 years and having IBP for at least 3 months but less than 3 years suggesting axSpA were studied. After training on scoliosis detection based on Cobb's angle>10° plus Nash-Moe grade≥1, readers blinded to patient data measured spine lumbar scoliosis, sacral horizontal angle, lumbosacral angle and lumbar lordosis on the radiograph of the lumbar and scored sacroiliitis on the radiograph of the pelvis. Baseline MRIs T1 and STIR of the lumbar spine and sacroiliac joints were evaluated for respectively degenerative changes and signs of axSpA.

RESULTS:

Of the 360 patients (50.8% females) 88.7% had lumbar pain and 69.3% met ASAS criteria for axSpA. Mean Cobb's angle was 3.2°±5.0° and 28 (7.7%) patients had lumbar scoliosis. No statistical differences were observed for radiographic sacroiliitis, MRI sacroiliitis, modified Stoke Ankylosing Spondylitis Spinal Score, Pfirmmann score, high-intensity zone, protrusion, extrusion, MODIC score between patients with and without scoliosis. In both groups, degenerative changes by MRI were rare and predominated at L4-L5 and L5-S1.

CONCLUSION:

In patients with early IBP suggesting axSpA, lumbar scoliosis was not associated with inflammatory or degenerative changes.

KEYWORDS:

Ankylosing spondylitis; Axial spondyloarthritis; Degenerative disease; Lumbar lordosis; Lumbar scoliosis; Sacral slope

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