Journals / İzmir Tepecik Eğitim Hastanesi Dergisi / 2011 / Cilt: 21 - Sayı: 1
THE IMPACT OF MAGNETIC RESONANS IMAGING ON THE DIAGNOSIS OF ANKYLOSING SPONDYLITIS AND IT’S RELATION WITH CLINICAL AND LABARATORY FINDINGS AND HLA B27 IN TO THE PATIENTS WITH INFLAMATORY BACK PAIN
- Pages
- 33–37
- DOI
- —
Abstract
Aim: Until recently, the treatment of ankylosing Spondylitis(AS) was restricted to non steroid anti-inflammatory drugs (NSAID) and physical therapy. Since the anti-tumor necrosis factor α (TNF α) blocking agents (infliximab, etanercept or adalimumab) are effective treatments and improve most of the clinical parameters and functional capacity. Today, early diagnosis and treatment of AS is more important. As conventional radiography only shows late changes, magnetic resonance imaging (MRI) suggested showing both early clue of inflammation on soft tissue, cartilage and response to treatment. As MRI is expensive, not readily available and time consuming method, we aimed to find out some physical finding and laboratory data to increase sensitivity and accuracy of the MRI for clinicians in AS diagnosis. Methods: Forty six patients with inflammatory back pain (18 males) with normal conventional radiographs of sacroiliac joints were included in the study. Rheumatologic evaluation with ability of chest expansion, sacroiliac MRI and routine laboratory tests, including HLA B27(Human Leukocyte Antigen Subgrup B 27), CRP and ESR (Erytrocyt Sedimantation Rate) were measured. Results: Out of 46 patients with inflammatory back pain and normal conventional radiography of sacroiliac joint and thoracic-lumbar vertebra, 8 had sacroiliitis on MRI with average 7 years of disease duration. Decreased chest expansion, HLA B27 positivity, high CRP value, longer disease duration were significantly common in patients with positive MRI finding for axial spondylitis (p<0,05). On logistic regration analysis, high CRP values and longer disease duration correlated more strongly with positive MRI findings (r =0,8). Conclusion: Patients with inflammatory back pain with normal conventional radiographs, longer disease duration with high CRP, (+) HLAB27 and decreased chest expansion may increase probability of finding axial spondylitis with MRI
Özet
Amaç: Ankilozan spondilit tedavisi son zamanlara kadar non steroid anti-inflamatuar ilaçlar (NSAİİ) ve fizik tedaviden ibaretti. Tümör nekroz faktörü (TNF ?) engelleyici ajanların (infliximab, etanercept, adalimumab) kullanılmaya başlanmasıyla birlikte AS'te klinik parametrelerde ve fonksiyonel kapasite de önemli düzelmeler sağlanmıştır. Bu nedenle erken tanı önem kazanmıştır. Konvansiyonel grafiler geç bulguları gösterir, ancak MRG(manyetik resonans görüntüleme) ile erken hastalık döneminde yumuşak doku, kıkırdak ve kemik yapılardaki değişiklikler gösterilebilir. MRI, pahalı ve zaman alıcı bir yöntem olduğundan, MRG kullanımından en fazla yararı sağlamak için yardımcı olabilecek klinik bulgu ve laboratuar testlerini gündeme getirmeyi amaçladık. Sonuç: İnflamatuar bel ağrılı ancak konvansiyonel grafileri normal olan hastalarda, azalmış göğüs ekspansiyonu, HLA B27 pozitifliği, yüksek CRP ve uzun hastalık süresi MRG ile aksiyel spondilit saptamakta yardımcı olabilir