Value of HRCT of the chest in evaluation of ankylosing spondylitis: correlation between pleuro-parenchymal abnormalities and disease activity

Iman Mohamed Hamdy Ibrahim,Nehal El Ghobashy,Mohammed Raafat Abd El-Mageed,Ahlam Ahmed Hussein Alaqel,Adel Ibrahim Azzam

doi:10.1186/s43055-021-00603-0

Abstract

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disorder primarily involving the sacroiliac joints and spine. It is associated with both articular and extra-articular clinical manifestations. Pulmonary involvement is a well-recognized comorbidity of AS, even among patients with early disease. The availability of high-resolution computed tomography (HRCT) has enabled better visualization of the entire lung parenchyma and earlier identification of lung pathologies, ranging from mild to more severe involvement, which were previously missed on X-rays. The aim of the study is to establish the role of HRCT in the detection of pleuro-parenchymal manifestations of AS and to look for correlations between these findings and AS activity.ResultsLung CT scans were done for all our patients and 27 patients (90%) had positive HRCT thoracic findings, while the remaining 3 patients (10%) had a normal HRCT thoracic study. Lower lobe fibrotic changes were the most common finding seen in 20 patients (66.7%) followed by bronchial wall thickening in 13 patients (43.3%) and upper and lower fibrotic changes seen in 9 patients (30%). HRCT thoracic findings were more prominent in late AS (disease duration ≥ 10 years) (13 of 13 patients); while 14 of 17 patients with early AS (disease duration < 10 years) had mildly abnormal HRCT findings. The result of statistical analysis showed that there was negative correlation between thoracic findings and disease activity assessed by BASDAI and this correlation was insignificant (p value = 0.5).ConclusionHRCT offers an accurate and safe method of assessment of lung disease in patients with AS and without respiratory symptoms. Although there was no correlation between pulmonary findings and AS activity assessed by BASDAI, a positive correlation, albeit insignificant, between pulmonary involvement and disease duration had been found.

Highlights

Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily involving the sacroiliac joints and spine
The six questions comprising Bath ankylosing spondylitis disease activity index (BASDAI) are as follows: (1) How would you describe the degree of fatigue or tiredness you have had?; (2) How would you describe the overall level of neck, back and hip pain related to your illness?; (3) How would you describe the overall level of pain and edema in other joints, apart from neck, back and hip?; (4) How would you describe the overall level of discomfort you felt to the touch or compression in the painful regions of your body?; (5) How would you describe the intensity of morning stiffness you have had, from the time you wake up?; (6) How long does your morning stiffness take, from the time you wake up?(
When evaluating the disease activity in AS patients using the BASDAI score (BASDAI 4 inactive diseases and BASDAI ≥ 4 active diseases), mean score was 3.8 ± 1.4 Standard deviation (SD), with 10 patients (33.3%) had high disease activity and 20 patients (66.7%) low disease activity

Summary

Introduction

Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily involving the sacroiliac joints and spine It is associated with both articular and extra-articular clinical manifestations. The availability of high-resolution com‐ puted tomography (HRCT) has enabled better visualization of the entire lung parenchyma and earlier identification of lung pathologies, ranging from mild to more severe involvement, which were previously missed on X-rays. Ankylosing spondylitis is a chronic inflammatory disorder primarily involving the sacroiliac joints and spine. It is associated with both articular and extra-articular. Pulmonary involvement encompasses a wide range of well-defined abnormalities including interstitial lung disease (ILD), upper lobe fibrosis, mycetoma formation as a result of secondary infections, emphysema, bronchiectasis, ventilatory impairment as a result of chest wall restriction and sleep apnea. Non-specific pleuropulmonary changes including, septal thickening, parenchymal micronodules, pleural thickening, parenchymal bands, bronchial wall thickening, and blebs have been described [3, 4].

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