Background Axial spondyloarthritis (AxSpA) can be triggered by infection and environmental factors, and some cases involve trauma. Whiplash injury in a traffic accident may lead to exacerbation of symptoms of AxSpA.
Objectives The aims of this study are to survey the prevalence of trauma before or after onset of AxSpA and to examine the prevalences of neck trauma and other trauma in patients with a history of AxSpA.
Methods The patients completed a questionnaire, and clinical presentation, inflammatory markers (ESR, CRP), radiographs, MRI of sacroiliac joints, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrology index (BASMI) were assessed. Onset of symptoms was evaluated using European criteria for spondyloarthritis and patients were asked about mechanical stress (spinal trauma, extremity trauma, and internal organ injury). Patients with rheumatoid arthritis (RA) were included as controls and underwent the same evaluation. Patients with neck trauma were divided into four groups based on a short (<3 years) (group A) or long (≥3 years) (group B) period between disappearance of trauma symptoms and onset of inflammatory back pain (IBP); continuous IBP after trauma (group C); and a gradual change from minor symptoms to severe IBP after trauma (group D).
Results The subjects were 124 patients with AxSpA and 102 with RA. Trauma occurred at a significantly higher rate in patients with AxSpA than in those with RA (66 (53.2%) vs. 12 (11.8%), p<0.0001). Neck trauma was also significantly more frequent in patients with AxSpA (63 (53.2%) vs. 9 (8.8%), P<0.0001) (Table 1). There were no significant differences in clinical background between patients with AxSpA with and without trauma (Table 2). Regarding the period from neck trauma to onset of IBP in patients with AxSpA, there were 4 (6.3%), 22 (34.9%), 14 (22.2%), and 23 (36.5%) cases in groups A, B, C and D, respectively.
Conclusions The remarkable finding in this study is that half of patients with AxSpA had a history of whiplash injury. These results suggest that trauma may influence the course of AxSpA through the immunological system or hypothalamic-pituitary-adrenal axis.
Disclosure of Interest None declared