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FRI0504
VERTEBRAL CORNER INFLAMMATION IN
ANKYLOSING SPONDYLITIS AND SYNDESMOPHYTE FORMATION
F. Joyce 1, 2,*, L.
McHattie 2, R. D. Sturrock 3, G. T. Jones
1
1Epidemiology Group, University of
Aberdeen, 2School of Pharmacy and Life Sciences, Robert
Gordon University, Aberdeen, 3Centre for Rheumatic
Diseases , Glasgow Royal Infirmary, Glasgow, United
Kingdom
Background: It is hypothesized that vertebral
corner (VC) inflammation precedes the formation of
syndesmophytes. Several studies have tested this;
however they have varied in sample size and methodology, and none
have expressed the relationship in terms of risk.
Objectives: To review and summarise the existing
evidence to determine whether the risk of syndesmophyte formation
is greater at sites of VC inflammation.
Methods: A systematic review of the literature
was conducted in MEDLINE, CINAHL and EMBASE from 2005 to
present. Abstracts from EULAR and ACR conferences
from 2008 to 2010 were searched and several experts in the field
were consulted for grey literature. The relationship between VC
inflammation (visualised on MRI) and syndesmophyte formation
(x-ray) was examined using risk ratios. Data was
pooled to compute a summary estimate based on raw data in the
papers and, thus, larger studies have more weight.
Results: Six studies were identified from four
papers. There was a large variation in sample
size (range 18-182 patients), patient groups (observational cohorts
and clinical trials) and follow up time (12-104 weeks). All studies
revealed a increase in the risk of syndesmophyte formation
associated with VC inflammation, five of which were
significant. The pooled risk ratio, across all
six studies, was 2.2 (95%CI: 1.7-2.9), see Figure 1.
Conclusions: We have shown that,in patients with
AS, the risk of syndesmophyte formation over an 2yr period, is more
than doubled at VC that exhibit inflammation.
This pooled estimate, across six studies, is lower than many of the
previous estimates and, for the first time, describes the
relationship in terms of risk. These findings
strongly support the hypothesis that inflammatory vertebral lesions
lead to ankylosis. Five of the six studies included had failed to
take into account within-patient variation and, thus, it was not
possible to incorporate this into this review.
Future research should further refine the estimate of this
association accordingly, and should also aim to determine the
mechanism underpinning this relationship. Also this relationship
should be examined in the longer term, and the influence of
anti-inflammatory therapies should be determined.
References: Paper 1 – Maksymowych et
al. Arthritis Rheum 2009; 60: 93-102;
Paper 2 – Van der Heijde et al. Ann Rheum
Dis 2008; 67 (Supplement II):130; Paper 3 – Baraliakos et
al. Athriitis Res Ther 2008; 10: R104;
Paper 4 – Maksymowych et al. Arthritis Rheum 2010; 62: 10
(Supplement):S819. Abstract #1957.
图片/曲线:
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荟萃分析6项研究表明炎症与骨赘形成有关联
F. Joyce, EULAR 2011. Present No:
FRI0504
背景:
有学者提出假设，椎角(VC)的炎症出现在骨赘形成之前。多项研究已经对此进行检测，但样本数和方法学各不相同，且没有一个能证实这一风险的相关性。
目标：回顾并总结已有的证据以明确骨赘形成的风险是否在VC部位更高。
方法：对2005年至今的MEDLINE、CINAHL和EMBASE文献进行系统复习。对2008年至2010年的EULAR和ACR会议摘要进行检索，对灰色文献咨询该领域的专家。应用风险比检测VC炎症（见于MRI）和骨赘形成（X-线）的相关性。汇总文献中的原始数据，计算出一个总结评估值,因此,规模较大的研究所占的比重也更大。
结果：4篇文献中6项研究符合本研究。其样本大小（18-182例患者不等），患者组（观察人群和临床试验），随访期（12-104周）差异较大。所有研究均提示骨赘形成的风险与VC炎症相关，其中5项研究中的风险有显著意义。6项研究的汇总比数比为2.2（95%CI:
1.7-2.9），见图1。
结论：我们证实，AS患者中2年观察期内骨赘形成的风险，在VC炎症部位高出两倍以上。6项研究的汇总预测值，比以往的许多估计值要低，并首次描述了这一风险的相关性。这些发现充分支持椎体炎症部位导致强直的假设。6项研究中有5项未能考虑到患者间变异度的影响，因此不能合并入这篇综述。进一步的研究应该更好地精确这一关联的估计值,同时致力于探索该关连的潜在机制。同时，这种相关性还应该在长期随访中进行验证，并确定抗炎治疗的影响。
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