강직성 척추염의 임상상과 진단
Clinical Manifestation and Diagnosis of Ankylosing Spondylitis
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강직성 척추염은 척추관절염 질환군 중 가장 근간이 되는질환으로, 주된 관절 증상은 염증성 요통이지만 기계적 요통과 때로는 구분이 어렵거나 같이 동반될 수 있다. 염증성 요통은 조조경직이 있고 운동을 하면 증상이 호전되며 새벽에악화되는 경향이 있다. 척추 외에도 어깨, 고관절 침범이 가능하며 말초관절염은 주로 하지 관절에 발생한다. 부착부염은 건, 인대, 근막 등이 뼈에 붙는 부위에 생기는 염증으로발뒤꿈치, 발바닥, 무릎, 가슴 등 통증을 호소할 때 의심해보아야 한다. 강직성 척추염을 진단하고 추적관찰하는 데 쓰이는 기본적인 영상검사는 단순 X-선 검사이다. 조기에 천장관절염을 진단하는 데 MRI 가 도움이 될 수 있으며 골스캔은 검사 해석에 주의를 요한다. 그 동안 강직성 척추염의분류기준으로 염증성 요통과 관절운동 장애, 단순 X-선 검사 소견으로 이루어진 modified New York criteria를 주로 사용해왔지만 이제는 조기 진단 및 치료의 필요성이 대두되면서 축성 ‘척추관절염’ 질환명을 중심으로 한 진단 툴이 정립될 것으로 보인다.
Abstract
Ankylosing spondylitis (AS) is the main disease entity within spondyloarthritides. AS patients can present with both articular and extra-articular manifestations. Especially, inflammatory back pain has been recognized as the main symptom of AS, however it should be noted that mechanical back pain could also ensue in advanced cases. Peripheral arthritis mostly involves in lower extremities in the form of asymmetric oligoarthritis. Enthesitis could develop in the heel, iliac crest, anterior tibial tuberosity, or anterior chest wall. As for imaging, plain radiographs are used to assess the presence or degree of sacroiliac joint and spinal involvement. Magnetic resonance imaging (MRI) is useful in detecting non-radiographic sacroiliitis, for its ability to delineate bone marrow edema. In this regard, MRI has recently been incorporated as a modality to help diagnose axial spondyloarthritis (2010 ASAS classification). Early diagnosis of AS should be based on the combination of clinical, laboratory, and imaging findings, not on solely structural changes.
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