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UO’K: 616.711-002.72-007.274 -085
IMPORTANCE OF THE SPINE MAPPING SYSTEM IN ANKYLOSING
SPONDILITIS
h ps://doi.o g/10.5281/zenodo.17679473
Kh.Akhmedo
P o esso , DSc
✉
Tashken S a e Medical Uni e si y
S. Rakhimo
assis an p o esso
✉
Tashken S a e Medical Uni e si y
K.Sh. Say iddin Khoji
mas e
✉
Tashken S a e Medical Uni e si y
Аbs ac
Ankylosing spondyli is (AS) is an au oimmune au oin lamma o y disease wi h
in lamma o y p ocesses o he spine and sac oiliac join s. Radiog aphic
examina ions a e one o he main ools in diagnosing AS and assessing he
dynamics o disease de elopmen . Co ec and sys ema ic isualiza ion
examina ions allow o iden i y s uc u al changes in he sac oilii is and spine e en
in he ea ly s ages o he disease. This a icle e iews he use o adiog aphic
echniques, including compu ed omog aphy (CT) and magne ic esonance
imaging (MRI), in he diagnosis o AS. The a icle also analyzes he impo ance o
e alua ing he disease h ough he mapping sys em o sac oiliac join and spinal
inju ies. The mapping sys em allows o a comple e unde s anding o s uc u al
changes and hei s ep-by-s ep acking.
Pu pose: o s udy he impo ance o he mapping sys em in he de ec ion and
assessmen o adiog aphic changes in ankylosing spondyli is (AS) and axial
spondyloa h i is, o analyze he mechanisms o assessmen o s uc u al changes in
he sac oiliac join and spine h ough imaging me hods, including CT and MRI
examina ions. De e mining he s ages o he disease based on he mapping sys em,
e alua ing he e ec i eness o ea men and conside ing indi idual app oach
me hods.
Ma e ials and me hods: A o al o 170 pa ien s diagnosed wi h ankylosing
spondyli is (AS) and axial-spondyloa h i is (axial-SpA) we e s udied in his s udy.
Pa ien s we e di ided in o wo g oups: AS g oup (n=65), Axial-SpA g oup (n=105).
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MRT, CT, UTT and X- ay me hods we e used o adiog aphic examina ion. Du ing
he s udy, ASAS, ASR classi ica ion c i e ia we e used o diagnosis. Disease
ac i i y in pa ien s was assessed using he BASDAI index. mSASSS (modi ied S oke
Ankylosing Spondyli is Spinal Sco e) was used o e alua e s uc u al changes. A
map o adiog aphic changes equency, s ages, and de eloped s uc u al changes
was made in each g oup o pa ien s.
Resul s: In his s udy, di e en ypes o spinal co d damage in axial
spondyloa h i is (axial-SpA) and ankylosing spondyli is (AS) we e compa ed in
adiog aphic examina ions. In case o 19.5% o signs o os ei is in axil-SpA, his
indica o is 5 imes highe in AS (P<0.001). In case 2, en hesi is and pa a e eb al
in lamma ion we e up o 17.2% in axial-SpA and 7.4% in AS. In iew 3, luid
densi y and os eopo osis we e 28.7% lowe in axil-SpA and 3 imes lowe in AS
(P<0.001). In iew 4, 10-25% hinning and hickening o he e eb al column was
he same in bo h g oups (P>0.05). In iew 5, 25-50% inc ease in e eb al diame e
and “ iangula ” shape changes occu ed 4 imes mo e o en in AS compa ed o
o he s (P<0.001). In iew 6, 25-50% hinning o he e eb ae and 50-75% hickening
we e ound wice mo e in ACS (P<0.05). In iew 7, syndesmophy es we e 7.3% in
axil-SpA and 16.6% in AS.
Key wo ds
Ankylosing spondyli is, axial spondyloa h i is, sac oilii is, e osi e
ўzga ishla , en hesopa hy, os eophy e, enosyno i is, magne ic esonance imaging
(MRI), compu e omog aphy (CT), ASAS, BASDAI, mSA
Ankylosing spondyli is (AS) is a ch onic in lamma o y a h i is o he
se onega i e spondyloa h i is, p ima ily a ec ing he spine and sac oiliac join .
Ex e nal en i onmen al ac o s, smoking, alcohol and gene ic ac o s signi ican ly
agg a a e he cou se o he disease. A he same ime, he in es inal mic o lo a also
a ec s he pa hophysiology o he disease. The associa ion o AS wi h he HLA-B27
gene, IL23R, ERAP1 genes, immunological cells and a numbe o cy okines a e
ac o s ha de e mine he clinical cou se and p ognosis o he disease. Be ween he
ages o 18-30, he onse o he disease is highe among men han among women. I
is known ha women ha e lowe incidences, diagnos ic delays and inc eased
disease ac i i y, as well as di e ences in he e ec i eness o d ugs, depending on
gende . S udies ha e examined mo e han 100 disease- ela ed genes, mos o which
a e s ongly associa ed wi h IL-23 and IL-17 cy okines and an igen p esen a ion.
Acco ding o he Wo ld Heal h O ganiza ion (WHO), he incidence o AS is
expec ed o inc ease by 50% in he nex 30 yea s. Despi e he ac ha his disease is
he mos s udied o all spondyloa h i is, i has no ound a comple e cu e.
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Pha macological d ugs and ehabili a ion measu es can con ol he symp oms o
he disease, educe i s p og ession (ankylosis and de o mi y o he spine and
sac oiliac join ) and main ain op imal unc ion. In mos cases, non-s e oidal an i-
in lamma o y d ugs a e e ec i e in educing in lamma ion, pain and join s i ness.
O he basic an i heuma ic d ugs, TNF-α inhibi o s om sul asalazine and β-
DMARDs, IL-17 |inhibi o s and JAK inhibi o s om s-DMARDs a e gaining
impo ance. In ankylosing spondyli is, s uc u al and s uc u al damage occu s as
a esul o he o ma ion o syndesmophy es and he de elopmen o i e e sible
ankylosis in he spine. In u n, e alua ing hese changes and he e ec i eness o
ea men equi es adiog aphic obse a ions. I is impo an o c ea e a mapping
sys em based on hese adiog aphic indings and he assessmen o s uc u al
changes in he spine. The c i e ia o Modi ied S oke Ankylosing Spondyli is Spinal
Sco e (mSASSS), Ba h Ankylosing Disease Ac i i y Index (BASDAI) and
Assessmen o SpondyloA h i is In e na ional Sco e (ASAS) a e impo an in
assessing adiog aphic p og ession, symp oms and signs o he disease,
de e io a ion o spinal mobili y and unc ions. Ankylosing spondyli is is a ype o
axial spondyloa h i is, in which an in lamma o y p ocess in he sac oiliac egion is
de ec ed on X- ay examina ion. In he ea ly s ages o axial spondyloa h i is,
adiog aphic examina ion does no show ankylosis in he spine. Fo his eason,
diagnos ic di icul ies o his disease s ill exis . I X- ay examina ion does no
con i m AS, an MRI examina ion is equi ed. Du ing he disease, os eodes uc i e
changes a ely occu . E osi e and scle o ic changes a e obse ed in he ea ly s age
o adiog aphic changes, leading o he de elopmen o syndesmophy es, e eb al
ankylosis and he o ma ion o "bamboo spine". Syndesmophy e and ankylosis a e
pa hognomonic s uc u al changes o he disease. A numbe o BASRI and mSASSS
assessmen indica o s a e used o e alua e disease p og ession, adiog aphic
moni o ing o s uc u al changes, and ea men e icacy. Acco ding o he
Assessmen o SpondyloA h i is In e na ional Sco e (ASAS), mSASS is he
p e e ed me hod o assessing adiog aphic p og ession in ankylosing spondyli is.
Ce ical (S2-S7) and lumba (L1-L5) e eb ae a e e alua ed. The o al sco e is om
0 o 72 poin s, Sco e 0: no mal appea ance (no changes), Sco e 1: e osion and
scle o ic changes a e p esen , Sco e 2: p esence o syndesmophy es, Sco e 3:
p esence o ankylosis. Th ough he mapping sys em, i is possible o s udy
syndesmophy es o new bone g ow hs, he de elopmen o ankyloses and he
e ec i eness o he he apy being ca ied ou depending on he p og ession o he
disease. In addi ion, i is possible o de e mine he s age o he disease and he le el
o damage, and selec biological ea men and o he he apies h ough an
indi idual app oach. Ankylosing Spondyli is spine Magne ic Resonance Imaging-
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ac i i y sco e, Be lin modi ica ion o he Ankylosing Spondyli is spine Magne ic
Resonance Imaging-ac i i y, Spondyloa h i is Resea ch Conso ium o Canada
sco e, Canada-Denma k sco ing sys em The e a e also a numbe o sco ing sys ems
based on s uc u al changes in MRI examina ions, bu clinical e o s ela ed o he
de elopmen o he disease occu due o he ac ha he images aken in p ac ice
a e no always p ope ly analyzed and he e is a lack o specialis s. I is p ecisely in
AS ha c ea ing a pe ec map o he spine based on adiog aphic examina ions has
a posi i e e ec on he diagnosis and managemen o he disease. CT and MRI
scans o he spine and sac oiliac join s in pa ien s wi h AS e ealed some
di e ences be ween AS (n=65) and axial-SpA (n=105). In pa icula , he o med
e osi e changes we e signi ican ly di e en in AS pa ien s compa ed o axial-SpA
pa ien s ( <0.05) and hese changes occu ed in 45.3% o AS cases, while his
indica o was obse ed in 30.8% o axial-SpA cases. Also, endo agini is was 34.5%
in AS e sus 24.7% in pa ien s wi h axial-SpA, and changes in en hesopa hy
showed 54.9% e sus 39.9%. In e es ingly, he combina ion o o med os ei is oci
wi h e osi e changes was obse ed wice as o en in AS cases in 73.6% o cases
( <0.05) compa ed o 36.3% o axial-SpA pa ien s. Epiphyseal os eopo osis was
eco ded in 40.8% o pa ien s wi h AS, and axial-SpA in 52.6%. Subchond al
scle osis was obse ed in 42.2% o AS pa ien s, 52.6% in axial-SpA, os eophy osis in
36.8% o AS and 53.8% in axial-SpA. Meniscal b anch abno mali ies we e no
signi ican ly di e en be ween he wo g oups o pa ien s, 11.8% e sus 7.6%, and
chond oma and Go co puscle o ma ion we e mo e common in AS pa ien s. These
da a show he ole o isualiza ion me hods in dis inguishing he s uc u al
changes o diseases belonging o he g oup o spondyloa h i is.
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G aph 1. Occu ence a e o MRI and sonog aphic signs in pa ien s wi h axial-
SpA and AS.
I is known ha spondyloa h i is is mainly accompanied by in lamma ion o
he ileo-cecal join , ha is, sac oilii is.
45,3
34,5
54,9
73,6
38,4
40,8
42,2
36,8
22,6
11,8
5,4
9,1
8,2
30,8
24,7
39,9
36,3
48,8
52,6
53,8
46,7
26,9
7,6
3,8
2,9
3,7
010 20 30 40 50 60 70 80
E osi e in lamma ion
Tendo agini is
En hesopa hy
Os ei is
Ligamen osis
Epiphyseal os eopo osis
Subchond al scle osis
Os eophy osis
Os eocys osis
Diso de in he b anches o he meniscus
Bake 's cys
Chond omous bodies
Go co puscles
%
Ankylosing spondyli is (АС), % Axial spondyloa h i is (axial-SpA)
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Table 1. Incidence o sac oilii is in pa ien s wi h SpAs acco ding o
adiog aphic s ages (Kellg en J.H., Je ey M.R.)
The s ages
G oups
Encoun e
a e
Bila e al
abs
%
abs
%
S age 0
G oup I, n=65
(Ankylosing spondyli is (AS))
0
0
0
0
G oup II, n=105
(Axial spondyloa h i is (axial-
SpA))
6
5,7
0
0
To al, n=170
6
3,53
0
0
S age 1
G oup I, n=65
(Ankylosing spondyli is (AS))
12
18,46
8
13,3
G oup II, n=105
(Axial spondyloa h i is (axial-
SpA))
27
25,7
5
4,7
To al, n=170
39
22,9
13
7,65
S age 2
G oup I, n=65
(Ankylosing spondyli is (AS))
18
27,69
11
16,9
G oup II, n=105
(Axial spondyloa h i is (axial-
SpA))
31
29,52
4
3,8
To al, n=170
49
28,8
15
8,8
S age 3
G oup I, n=65
(Ankylosing spondyli is (AS))
7
10,7
13
20
G oup II, n=105
(Axial spondyloa h i is (axial-
SpA))
24
22,83
7
6,67
To al, n=170
31
18,2
20
11,7
S age 4
G oup I, n=65
(Ankylosing spondyli is (AS))
3
4,6
7
10,7
G oup II, n=105
(Axial spondyloa h i is (axial-
SpA))
17
16,2
5
4,76
To al, n=170
20
19
12
7
To al
60
35,15
No e: * - p<0.05 is he le el o eliabili y o he di e ence be ween g oups.
Acco ding o he ob ained esul s, he AS o m o SpA di e ed om axial-SpA
by lowe s ages o sac oilii is and, mo eo e , by symme y indica o s. In pa icula ,
as can be seen om able 2, in pa ien s wi h axial SpA, he X- ay s age 1 o
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sac oilii is was 2 imes highe han in he o m o AS. On he con a y, he 3 d and
4 h s ages o he disease we e 3.5 imes mo e common in pa ien s wi h he AS o m
han in he o he o m. Allba a AS n=65 pa ien s and axial-SpA we e ob ained
compa ed o n=105 pa ien s.
G aph 2. Compa a i e iew o he deg ee o occu ence o sac oilii is
acco ding o he o m o SpA.
As shown in Table 3, he incidence a e o axial-SpA inc eased as ileo-cecal
join damage inc eased in pa ien s wi h AS. Axial-SpA, on he o he hand,
dec eased. In addi ion, when compa ing he symme y o he sac oilii is be ween
he g oups, i s symme ic, i.e., bila e al damage was 33.3% in ankylosing
spondyli is, while i was ound in only 12% o pa ien s wi h axial SpA. As can be
seen om able 2, sac oilii is became bila e al mainly in he 3 d and 4 h s ages.
I is well known ha he e a e di icul ies wi h MRI analysis o p ac icing
doc o s. The e o e, he assessmen o s uc u al changes in he spine mapping
sys em is o scien i ic and p ac ical impo ance.
Table 2. Abno mali ies iden i ied by a spinal s uc u e mapping sys em in a
pa ien wi h AS
Cha ac e is ics o mapping
s uc u al changes
Elemen s o spinal s uc u e mapping
“Appea ance 1”
3,6
19,5
32,7
27,2
17
1,8
47,6
28,4
14,1
13,1
0
5
10
15
20
25
30
35
40
45
50
0 s age 1s s age 2nd s age 3 d s age 4 h s age
% AS axial-SpA
"Symp oms o os ei is (in lamma ion)"
de ec ed in he uppe and lowe pa s o he
spine”
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( o appea ance 1 +)
“appea ance 2”
( o appea ance 2 +)
“appea ance 3”
( o appea ance 3 +)
“appea ance 4”
( o appea ance 4 +)
“appea ance 5”
Spine spacing na owing o 25-50%
“T iangula ” ocal changes a he co ne s
o he e eb al body
Thinning o he in e e eb al disc o 10-
25%
Spine spacing na owing o 10-25%
A p onounced dec ease in bone densi y, he
o ma ion o os eopo osis
Fo med en hesi is
Thickening o pa a e eb al issue
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( o appea ance 5 +)
“appea ance 6”
( o appea ance 6 +)
“appea ance 7”
Using a “mapping sys em” o diso de s in he s uc u es o he spine, i is
possible o iden i y speci ic mani es a ions and ea ly changes o he disease in
pa ien s wi h AS. The e o e, he changes in he spine in he pa ien s included in he
s udy we e ans o med in o he “mapping iews” p esen ed in Table 2, acco ding
o he analysis o digi al echnology. Based on he iden i ied s uc u al changes, i
was di ided in o 7 di e en “ iews”.
G aph 3. Compa a i e analysis o he le el o "mapping ea u es" o damage o
he spine acco ding o he o ms o spondyloa h i is.
3,6
7,4
11,7
21,3 23 25,7
7,3
19,5 17,2
28,7
15,6
4,8
11,2
3
0
5
10
15
20
25
30
35
Appea ance 1 Appea ance 2 Appea ance 3 Appea ance 4 Appea ance 5 Appea ance 6 Appea ance 7
% Ankylosing spondyli is Axial spondyloa h i is
Thinning o he in e e eb al disc o 50-
75%
Spine spacing na owing o 75-100%
Syndesmo i o ma ion
Thinning o he in e e eb al disc o 25-
50%
Spine spacing na owing o 50-75%
