Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis?

doi:10.1136/ard.57.3.135

Annals of the Rheumatic Diseases 1998;57:135-140; doi:10.1136/ard.57.3.135

Ann Rheum Dis 1998;57:135-140 ( March )

Extended reports

Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis? P S Helliwell,^a P Hickling,^b V Wright^*^a

^a Rheumatology and Rehabilitation Research Unit, University of Leeds, ^b Mount Gould Hospital, Plymouth

Correspondence to: Dr P S Helliwell, Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ.

Accepted for publication 20 January 1998

OBJECTIVE $---$ In 1971 McEwen and colleagues suggested that the radiological changes of classic ankylosing spondylitis (AS), and the changesof the spondylitis associated with inflammatory bowel diseasediffer in several respects from the radiological features of psoriaticand reactive spondylitis. The findings of this study have neverbeen confirmed. The aim of this study was to replicate the McEwenstudy comparing films blinded to diagnosticgroup.
METHODS $---$ The study population comprised 91 patients with classic AS, 15 patients with regional enteritis, 16 patients with ulcerativecolitis, five patients with sexually acquired reactive arthritis,two with post-dysenteric arthritis, and 34 with psoriatic arthritis.Blinded reading of spinal radiographs was undertaken, scoringfor severity, symmetry, paravertebral ossification, size of syndesmophytes,ligamentous calcification, squaring, discitis, pseudo-fractures,zygoapophyseal joint involvement, and completeankylosis.
RESULTS $---$ Comparison of the four groups $---$ classic, enteropathic, psoriatic, and reactive AS $---$ showed differences with respect to symmetryof sacroiliitis, symmetry of lumbar spinal involvement, and frequencyand size of syndesmophytes. Zygoapophyseal joint involvement wasmore frequent in the lumbar spine in classic and enteropathicspondylitis but no between group differences were found with respectto symphisitis, squaring, apophyseal joint involvement and ligamentouscalcification in the lumbar spine, and otherareas.
CONCLUSIONS $---$ Some of the radiological differences described by McEwen et al, notably the asymmetry, the less severe changes, and the distinctivesyndesmophytes in psoriasis, have been confirmed. A number ofhypotheses are proposed to explain these differences includingbiomechanical, biochemical, and geneticfactors.

Keywords: psoriatic arthritis; ankylosing spondylitis; reactive arthritis; inflammatory bowel disease

^* Professor Wright died on 31 January1998.

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