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The structural, functional and electrophysiological assessment of paraspinal musculature of patients with ankylosing spondylitis and non-radiographic axial spondyloarthropathy

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Abstract

Paravertebral muscles are affected in spondyloarthritis. Decreased mobility of spine may lead to atrophy and fatty degeneration of these muscles. The objective of this study was to compare the sonographic, electrophysiological and magnetic resonance imaging (MRI) features of paraspinal muscles between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). The patients who were diagnosed as AS with modified New York criteria and those as nr-axSpA with ASAS 2009 criteria were enrolled. Clinical evaluation, electrophysiological examination including nerve conduction studies and needle electromyography (EMG) for lower extremities and paraspinal mapping (PSM) were performed by the first examiner. The second examiner measured lumbar multifidus areas, graded the fatty degeneration of the muscle at different levels in T2 weighted axial MRI and also performed the ultrasonographic evaluation. A total of 19 patients with AS and 14 patients with nr-axSpA were evaluated. MRI of 2 patients with AS could not be obtained. Right lumbar multifidus area/vertebra area (MV ratio) was smaller in AS patients at L3 level (p 0,029); there were no significant differences in other levels. Fatty degeneration was also higher in AS patients in left multifidus at L5–S1 disc level (p 0,015). PSM scores that demonstrate the extent of denervation in paraspinal muscles were significantly higher in AS patients than in nr-axSpA patients (p < 0,001). Patients with AS have more fatty degeneration and denervation in paraspinal muscles. These processes may also contribute the severity of pain and disability. The relationship between paraspinal muscle denervation and progression of fatty degeneration should further be revealed.

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Acknowledgements

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There is no additional funding except social health insurance expenditures of participants.

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Contributions

The authors ECO and IY conceived the study and design, carried out the assessments of participants. ECO performed the statistical analyses and wrote the draft of this paper. IY reviewed and revised the content prior to submission. They both approved the final manuscript.

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Correspondence to Ekim Can Ozturk.

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All procedures were performed in accordance with ethical standards of the institutional/national committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was provided from institutional ethics committee. Protocol Number: 09.2016.012.

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Written and verbal consent was obtained from all participants before the initiation of survey, and all data were kept confidential.

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Ozturk, E.C., Yagci, I. The structural, functional and electrophysiological assessment of paraspinal musculature of patients with ankylosing spondylitis and non-radiographic axial spondyloarthropathy. Rheumatol Int 41, 595–603 (2021). https://doi.org/10.1007/s00296-020-04781-4

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