Advanced clinical and radiological features of ankylosing spondylitis: relation to gender, onset of first symptoms and disease duration [Uznapredovala klinička i radiološka obilježja ankilozantnog spondilitisa: povezanost sa spolom, dobi pojave prvih simptoma i trajanjem bolesti]

Grubišić, Frane and Jajić, Zrinka and Alegić-Karin, Anita and Borić, Igor and Jajić, Ivo (2015) Advanced clinical and radiological features of ankylosing spondylitis: relation to gender, onset of first symptoms and disease duration [Uznapredovala klinička i radiološka obilježja ankilozantnog spondilitisa: povezanost sa spolom, dobi pojave prvih simptoma i trajanjem bolesti]. Collegium Antropologicum, 39 (4). pp. 927-934. ISSN 0350-6134

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Abstract

To determine the frequency of advanced clinical and radiological features of AS with reference to gender, onset of symptoms and disease duration. Fifty-seven patients diagnosed with AS were included in this study. Functional evaluation of the musculoskeletal system detected advanced clinical features: rubber-ball phenomenon, flattening of the chest anterior wall, diastasis of rectus abdominis muscle, steel back phenomenon, umbilical extrusion, skiing posture. Conventional radiographs of sacroiliac joints, pelvis and axial skeleton were obtained in order to analyze signs of sacroiliitis, syndesmophytes, vertebral squaring and ligamentous ossification. Statistical significance is found in the distribution of particular advanced clinical and radiological features of AS between men and women: rubber-ball phenomenon (p = 0.002), flat chest (p = 0.002), diastasis of rectus abdominis muscle (p = 0.002), skiing position (p = 0.000), syndesmophytes (p = 0.009) and ligamentous ossification (p = 0.030) in thoracic and lumbar spine. Onset of first disease symptoms (> 20 years of age) is significantly associated with radiological changes in thoracic spine (ligamentous ossification, p = 0.015) and cervical spine (vertebral squaring, p = 0.032). Longer disease duration (> 10 years) is significantly associated with the appearance of particular clinical features: rubber-ball phenomenon, p < 0.01; rectus abdominis diastasis, p=0.042) and radiological changes of sacroiliac joints (grade IV sacroileitis, p = 0.012), thoracic and lumbar spine (syndesmophytes, p = 0.015; ligamentous ossification, p = 0.027). Our study shows that the occurrence of clinical and some radiological features of AS appears to be gender dependent. Furthermore, onset of first disease symptoms (> 20 years of age) and longer disease duration (> 10 years) are associated with the higher risk of developing particular clinical signs and radiological features in sacroiliac joints and axial skeleton.

Abstract in Croatian

Cilj je odrediti učestalost uznapredovalih kliničkih i radioloških manifestacija ankilozantog spondilitisa obzirom na spol ispitanika, dužinu trajanja bolesti i dob pojave prvih kliničkih smetnji. U istraživanje je uključeno 57 bolesnika sa dijagnozom ankilozantnog spondilitisa. Uznapredovala klinička obilježja ankilozantnog spondilitisa otkrivena su kliničkim pregledom: fenomen gumene lopte, ravna prsa, dijastaza mišića rectus abdominisa, ekstruzija umbilikusa, fenomen očeličenih leđa, fenomen ravnih prsa, stav skijaša. Radiološke promjene u vidu sakroileitisa, sindezmofita, skveringa kralješka i osifikacije ligamenata analizirane su na standardnim rentgenogramima sakroilijakalnih zglobova, zdjelice i kralješnice. Ststiatički značajna razlika nađena je u raspodjeli određenih uznapredovalih kliničkih i radioloških obilježja bolesti između muškaraca i žena: fenomen gumene lopte (p=0,002), fenomen ravnih prsiju (p=0,002), dijastaza mišića rektus abdominisa (p=0,002), stav skijaša (p<0,001), sindezmofiti (p=0,009) i osifikacija ligamenaza (p=0,003) u području torakalne i slabinske kralješnice. Pojava prvih simptoma bolestu (>20. godine života) značajno je povezana sa radiološkim promjena na torakalnoj kralješnici (osifikacija ligamenata, p=0,015) i vratnoj kralješnici (četvrtasti oblik kralješka, p=0,032). Duži tijek bolesti (>10 godina) značajno je povezan sa pojavom određenih kliničkih obilježja-fenoment gumene lopte (p<0,01), dijastaza mišića rektus abdominsa (p=0,042) i radioloških promjena na sakroilijakalnim zglobovima (IV. stadij sakroileitisa, p=0,012), torakalnoj i slabinskoj kralješnici (sindezmofiti, p=0,015, osifikacija ligamenata, p=0,027). Istraživanje pokazuje da pojava uznapredovalih kliničkih i pojedinih radioloških oblilježja bolesti ovisi o spolu. Nadalje, pojava prvnih simptoma bolesti (>20 godina života) i duži tijek bolesti (>10 godina) povezani sa povećanim rizikom razvoja određenih kliničkih obilježja i radioloških obilježja na sakroilijakalnim zglobovima i aksijalnom skeletu.

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