僵直性脊椎炎的臨床及放射線學表現之性別差異

Gender differences in clinical and radiographic presentations of ankylosing spondylitis

目的：探討男女性患者之可能的發病危險因子、臨床表現、實驗室檢查、影像學變化和日常功能之差異。方法：受試者來自某醫學中心的風濕科門診，均為診斷確定的僵直性脊椎炎患者，我們收集患者的基本資料、臨床表徵、各種Bath僵直性脊椎炎指數、HLA-B27、發炎指數、影像學變化及治療過程，並將兩組患者的資料加以分析比較。結果：共有179位僵直性脊椎炎患者（148位男性及31位女性）被納入研究，男女性之年齡及疾病持續時間並無顯著差異，但女性發病年齡明顯較男性為高（女性26.3 ± 10.2歲，男性21.0 ± 8.2歲, p=0.009），而被延遲診斷的時間較男性長（女性5.7 ± 7.1歲，男性5.0 ± 7.8歲, p=0.011）。兩組患者初發病部位均以脊柱關節最多，在整個病程中，女性患者與男性患者的脊柱疼痛比例並無顯著差異，但有更高比例曾有香腸指（趾）、膝部的接骨點病變、手部及顳顎關節發炎，但髖關節炎卻較男性少的多。雖然受影響的關節似乎在女性較多，但女性患者的Bath僵直性脊椎炎功能指數（BASFI）、Bath僵直性脊椎炎度量指數（BASMI）並未較男性差，且女性的薦腸關節、脊柱及髖關節的變化均較男性為輕。結論：僵直性脊椎炎的表現具有不少性別差異，女性有某些週邊關節及接骨點較容易受到侵犯，但髖關節侵犯遠較男性少，而影像學變化也輕微的多，此不典型表現常造成診斷女性僵直性脊椎炎的困難，因此臨床上面對一個懷疑是僵直性脊椎炎的女性患者必須特別小心以避免延遲或錯誤診斷。

Objective: Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine, peripheral entheses and peripheral joints, and is more prevalent in males than females. This study compared the differences between male and female patients with AS in possible risk factors, clinical manifestations, laboratory markers, radiographic changes, functional outcomes, and treatment in AS. Methods: AS patients were enrolled from rheumatologic clinics of a tertiary medical center. Direct interview, clinical evaluation, and chart review were used to collect the personal demographics, clinical symptoms/signs, Bath AS indices, HLA-B27, infl ammatory markers, radiographic fi ndings and treatment history. Findings were stratifi ed by gender. Results: The study included 179 AS patients (148 males and 31 females). The age and duration of disease were not different between genders. However, females were older at disease onset (females 26.3 ± 10.2 years, males 21.0 ± 8.2 years, p=0.009), and had a longer time delay to diagnosis (females 5.7 ± 7.1 years, males 5.0 ± 7.8 years, p=0.011) as compared to males. In both groups, the axial joints were the most common of the fi rst manifestation of AS. During similar disease duration, females had equal axial joint involvement, and more sausage digits, knee enthesopathy, hand and temporomandibular joint arthritis, but less hip arthritis on any occasion. Females were similar or better than males with regards to functional outcomes evaluated with Bath AS Functional Index (BASFI) and Bath AS Metrology Index (BASMI). Besides, the radiographic changes of female patients versus males were less in sacroiliac joints, spine and hip joints. Conclusions: In this study, female and male AS patients had different clinical manifestations. Females had more involvement in some peripheral joints and entheses, but less severe involvement of hip joints, and less severe radiographic changes. The milder course of AS in females might be one cause for the longer delay to diagnosis of the disease compared to males. These fi ndings suggested that clinicians should be more aware of possible AS diagnosis in female patients presenting with mild or atypical AS disease symptoms.