強直性脊椎炎

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease linked to systemic vascular complications. Evidence regarding the association between AS and peripheral artery disease (PAD) remains limited. We investigated whether patients with AS have an increased risk of PAD using a nationwide cohort in South Korea. METHOD: Using the Korean National Health Insurance Service database (2012-2023), we conducted a nationwide matched cohort study. Patients with AS were identified by at least two diagnoses of International Classification of Diseases, 10th Revision (ICD-10) code M45 within 1 year. Incident PAD was defined as at least one outpatient visit with ICD-10 code I73.9 after the index date. After a 3 year washout period, 2846 patients with AS and 28 460 matched controls were analysed. Risk was assessed using incidence rate ratios (IRRs) and Cox proportional hazards models. RESULTS: During a mean follow-up of 4.1 years, PAD incidence was higher in patients with AS than in controls (23.6 vs 16.9 per 1000 person-years; IRR 1.40, 95% confidence interval 1.23-1.59). Females aged <60 years had the highest excess risk (IRR 1.77), followed by males aged ≥60 years (IRR 1.64). Kaplan-Meier curves showed lower PAD-free survival in patients with AS (log-rank p < 0.0001). CONCLUSION: AS was associated with an increased risk of PAD, particularly among younger females, highlighting the need for early vascular screening and tailored prevention strategies.

Background/Objective: International recommendations exist for MRI evaluation of sacroiliac joints (SIJs) in adult spondylarthritis (SpA) and other joints in juvenile (J)SpA. However, consensus recommendations for MRI acquisition protocols for SIJs in JSpA are lacking. Our survey gathered information on current imaging practices on SIJ MRI and expert opinions about imaging protocols. Methods: A survey was sent to an international group of pediatric radiologists and rheumatologists. Participants were asked about practices regarding sequences/planes, use of contrast, and preferred sequences/planes for evaluating individual lesions. Results: There were 38 unique survey respondents (North America, n = 19; South America, n = 1; Europe, n = 12; Asia, n = 2; Australia, n = 2; unknown = 2) from 32 institutions with a median of 15 (range 3-32) years of experience. Most (93%) institutions use the 2nd sacral vertebral body posterior cortex to plan coronal oblique sequences; most perform these as non-fat-suppressed T1W and fluid-sensitive sequences for evaluation of damage and inflammation, respectively. Among the 84% of institutions performing small field-of-view imaging, all include a coronal oblique plane, and 78% also do an axial oblique plane. Of all institutions, 22% utilize gradient echo (GRE) sequences. Most respondents (79%) did not consider contrast necessary for evaluating SIJs. Conclusions: Areas of agreement for a consensus MRI protocol for SIJ evaluation in JSpA include using a non-contrast-enhanced protocol and the S2 vertebral body posterior cortex to plan coronal oblique sequences. Further international consensus is required concerning the optimal scan plane to prescribe for axial sequences and the incorporation of an erosion-specific sequence into standard protocols.

Background/Objectives: Andersson lesions are uncommon discovertebral complications of ankylosing spondylitis and may be overlooked when a new mechanical pain pattern is attributed to chronic inflammatory disease. This report describes the diagnostic reasoning, operative decision-making, and short-term outcome of a severe lumbar lesion with three-column instability. Methods: A 38-year-old woman with a 15-year history of ankylosing spondylitis presented with progressive low-back pain, left L5 radiculopathy, and marked functional decline without major trauma. Radiographs, computed tomography, and magnetic resonance imaging were used to characterize the lesion and assess spinal instability and neural compression. A Cawley type E Andersson lesion at L4/5 with severe three-column instability was diagnosed. The patient underwent single-stage posterior-anterior circumferential reconstruction consisting of L4/5 decompression, long-segment L2-S2 fixation, anterior debridement, and tricortical iliac crest grafting. Results: A postoperative gastrocnemius intramuscular venous thrombosis was detected and treated with anticoagulation. At 3 months, the activity-related visual analog scale score improved from 8 to 1, the Oswestry Disability Index improved from 68% to 18%, independent ambulation was restored, and imaging showed stable instrumentation with progressive osseous bridging. At the latest 9-month telephone follow-up, the patient reported maintained pain relief, mobility, and daily function; no new imaging was available. Conclusions: A change from inflammatory to mechanical pain or the development of neurologic findings in ankylosing spondylitis should prompt targeted imaging for an Andersson lesion. In carefully selected patients with severe three-column instability and substantial anterior column deficiency, circumferential reconstruction may provide effective short-term stabilization and functional recovery. Because radiographic follow-up was limited to 3 months, definitive fusion and long-term construct durability cannot be established.

Aortopathies in autoimmune rheumatic diseases (ARD) include a spectrum of aortic pathologies-including aortitis, aneurysms, dissections, and insufficiency-primarily caused by systemic inflammation. This comprehensive review investigates the clinical manifestations, pathophysiology, diagnostic modalities, and management strategies across various rheumatic diseases associated with aortopathies such as large vessel vasculitis (e.g., Takayasu arteritis, giant cell arteritis), connective tissue diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, systemic sclerosis) and less common conditions (e.g., relapsing polychondritis, Cogan's syndrome, Behçet's disease, IgG4-related disease). Disease-specific pathophysiologic mechanisms of aortic wall inflammation and remodeling, including granulomatous and lymphoplasmacytic patterns and mixed inflammatory infiltrates, are described. Diagnostic imaging modalities-such as CTA, MRI, and PET/CT-are evaluated for their roles in detecting active inflammation, assessing structural complications, and guiding clinical decision-making. Histopathological findings provide insight into disease-specific vascular changes. Management strategies focus on the use of glucocorticoids, disease-modifying antirheumatic drugs (DMARDs), and biologics, including IL-6 and TNF-α inhibitors, with an emphasis on patient-centered approaches, multidisciplinary care, and timely surgical intervention for complications. Evidence gaps include optimal screening intervals and the role of novel biomarkers in risk stratification and in monitoring disease progression, highlighting the need for early recognition, frequent monitoring, and aggressive management of aortic involvement in rheumatic diseases to prevent life-threatening complications.

Background: Ankylosing spondylitis (AS) associated with Crohn's disease (CD) is a nosological form of spondyloarthropathies with a low population prevalence. The pathogenesis of this disease is not fully understood, and there are no precise differential diagnostic methods to distinguish AS associated with CD from AS and CD separately in the early stages of the disease. The main objective for this study is to define lymphocyte-mediated immunity in patients with AS associated with CD. Methods: For the pilot study, we recruited four groups: CD (n = 16), AS+CD (n = 13), AS (n = 13) and healthy controls (HC, n = 26). Immune phenotyping of peripheral blood lymphocytes was carried out via flow cytometry. Results: In the AS+CD group, circulating regulatory T-cell (Treg) levels were increased compared to the other groups. The frequency of CD73+ Tregs within the effector memory (EM) compartment was also elevated in the AS+CD group relative to the AS and CD groups alone. At the same time, the EM Tcyt and EM Th populations were lower in the AS+CD group compared to the CD group. Tfh17 levels were lower in the AS+CD group than in the AS group and showed a positive correlation with Bm5 and 'switched' memory B cells. Additionally, Tfh17 and 'switched' memory B cells correlated negatively with acute-phase markers, whereas Tfh2 correlated positively with the BASDAI activity index. Conclusions: In patients with AS associated with CD, exhaustion of the regulatory compartment of adaptive immunity is seen, whereas the humoral component appears oriented towards resolving the inflammatory responses.