Aksiyal Spondiloartrit Hastalarında Lateral Femoral Kutanöz Sinirin Elektrodiagnostik Değerlendirilmesi

Öz

Bu kesitsel çalışma, aksiyel spondiloartritli hastalarda bilateral lateral femoral kutanöz sinirin elektrofizyolojik özelliklerini sinir iletim çalışmaları ile değerlendirmeyi ve bu bulguların hastalık aktivitesi, fonksiyonel durum ve klinik parametrelerle ilişkisini araştırmayı amaçlamıştır. Çalışmaya 50 aksiyel spondiloartritli hasta ile yaş, cinsiyet ve vücut kitle indeksi açısından eşleştirilmiş 38 sağlıklı kontrol dahil edilmiştir. Tüm katılımcıların demografik ve klinik özellikleri (spinal mobilite ölçümleri dâhil) kaydedilmiştir. Aksiyel spondiloartrit grubunda hastalığa ilişkin değişkenler; semptom süresi, tanı süresi, hasta ve hekim global değerlendirmeleri, yorgunluk, Bath Ankilozan Spondilit Hastalık Aktivite İndeksi, Bath Ankilozan Spondilit Metroloji İndeksi ve Bath Ankilozan Spondilit Fonksiyonel İndeksi içermektedir. Tüm katılımcılarda bilateral lateral femoral kutanöz sinir iletim çalışmaları yapılmış ve analizlerde sağ ve sol taraf ölçümlerinin ortalama değerleri kullanılmıştır. Ayrıca aksiyel spondiloartritli hastalarda HLA-B27 durumuna göre alt grup analizleri yapılmıştır. Aksiyel spondiloartrit hastaları ile kontrol grubu arasında lateral femoral kutanöz sinir amplitüdü, latans ve ileti hızları açısından istatistiksel olarak anlamlı bir fark saptanmamıştır (tüm p > 0,05). HLA-B27 pozitif ve negatif aksiyel spondiloartrit hastaları arasında lateral femoral kutanöz sinir elektrodiagnostik parametreleri açısından anlamlı bir fark bulunmamıştır. Aksiyel spondiloartrit grubunda lateral femoral kutanöz sinirin elektrodiagnostik parametreleri ile hastalık aktivitesi, fonksiyonel durum veya klinik değişkenler arasında anlamlı bir ilişki saptanmamıştır. Bu çalışma, aksiyel spondiloartrit hastalarında lateral femoral kutanöz sinir iletiminin elektrofizyolojik olarak değerlendirildiği ilk çalışmalardan biridir ve sonuçlar, sağlıklı bireylerle karşılaştırıldığında, belirgin bir elektrofizyolojik anormallik ya da klinik hastalık parametreleriyle tutarlı bir ilişki göstermemiştir.

Anahtar Kelimeler

• Ankilozan spondilit
• aksiyel spondiloartrit
• lateral femoral kütanöz sinir
• sinir iletim çalışmaları
• periferik nöropati

Electrodiagnostic Evaluation of The Lateral Femoral Cutaneous Nerve in Patients with Axial Spondyloarthritis

Öz

This cross-sectional study aimed to evaluate bilateral lateral femoral cutaneous nerve conduction in patients with axial spondyloarthritis using nerve conduction studies and to investigate its relationship with disease activity, functional status, and clinical parameters. Fifty patients diagnosed with axial spondyloarthritis and thirty-eight healthy controls matched for age, sex, and body mass index were included. Demographic and clinical characteristics, including spinal mobility measures, were recorded. Disease-related variables included symptom duration, time since diagnosis, patient and physician global assessments, fatigue, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, and Bath Ankylosing Spondylitis Functional Index. Bilateral lateral femoral cutaneous nerve sensory nerve conduction studies were performed in all participants, and the mean values of the right and left measurements were used in the analyses. Subgroup analyses were also performed according to HLA-B27 status in patients with axial spondyloarthritis. No significant differences were found in lateral femoral cutaneous nerve amplitudes, latencies, or conduction velocities between axial spondyloarthritis patients and healthy controls (all p> 0.05). Similarly, no significant differences were observed between HLA-B27-positive and HLA-B27-negative patients with axial spondyloarthritis. Within the axial spondyloarthritis group, no significant associations were identified between lateral femoral cutaneous nerve electrodiagnostic parameters and disease activity, functional indices, or other clinical variables. This study represents one of the first electrodiagnostic evaluations of lateral femoral cutaneous nerve conduction in axial spondyloarthritis and demonstrates no significant electrophysiological abnormalities compared with healthy controls, and no consistent associations with clinical disease measures.

Anahtar Kelimeler

• Ankylosing spondylitis
• axial spondyloarthritis
• lateral femoral cutaneous nerve
• nerve conduction studies
• peripheral neuropathy.

Kaynakça

1. Sieper J, Poddubnyy D. Axial spondyloarthritis. The Lancet. 2017;390(10089):73-84. doi:10.1016/S0140-6736(16)31591-4
2. Sieper J, Braun J, Dougados M. Axial spondyloarthritis. Nature reviews Disease primers. 2015;1(1):1-16. doi:10.1038/nrdp.2015.13.
3. Fernández‐Carballido C, Navarro‐Compán V, Castillo‐Gallego C, et al. Disease activity as a major determinant of quality of life and physical function in patients with early axial spondyloarthritis. Arthritis care & research. 2017;69(1):150-155. doi:10.1002/acr.22908.
4. Macfarlane GJ, Rotariu O, Jones GT. Determining factors related to poor quality of life in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS). Annals of the rheumatic diseases. 2020;79(2):202-208. doi:10.1136/annrheumdis-2019-216143.
5. Danve A, Deodhar A. Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities. Clinical rheumatology. 2019;38(3):625-634. doi:10.1007/s10067-018-4397-3.
6. Inman RD, Garrido-Cumbrera M, Chan J, et al. Work-related issues and physical and psychological burden in Canadian patients with axial Spondyloarthritis: results from the international map of axial Spondyloarthritis. The Journal of Rheumatology. 2023;50(5):625-633. doi:10.3899/jrheum.220596.
7. Rohde G, Berg KH, Prøven A. The relationship between demographic-and disease-related variables and health-related quality of life in patients with axial spondyloarthritis. BMC musculoskeletal disorders. 2017;18(1):328. doi:10.1186/s12891-017-1693-z.
8. Fattorini F, Gentileschi S, Cigolini C, et al. Axial spondyloarthritis: one year in review 2023. Clin Exp Rheumatol. 2023;41(11):2142-2150. doi:10.55563/clinexprheumatol/9fhz98.

9. Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Annals of the rheumatic diseases. 2023;82(1):19-34. doi:10.1136/ard-2022-223296.
10. Ward MM, Deodhar A, Gensler LS, et al. 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis & rheumatology. 2019;71(10):1599-1613. doi:10.1002/art.41042.
11. Garrido-Castro J, Concha-Aranda I, Gardiner P, et al. AB0867 Axial spondyloarthritis posture assessment using inertial sensors. Annals of the Rheumatic Diseases. 2018;77:1561. doi:10.1136/annrheumdis-2018-eular.3903
12. Pan T, Qian B-P, Qiu Y. Comparison of sagittal spinopelvic alignment in patients with ankylosing spondylitis and thoracolumbar fracture. Medicine. 2016;95(4):e2585. doi:10.1097/MD.0000000000002585.
13. Mangone M, Paoloni M, Procopio S, et al. Sagittal spinal alignment in patients with ankylosing spondylitis by rasterstereographic back shape analysis: An observational retrospective study. Eur J Phys Rehabil Med. 2020;56(2):191-196. doi:10.23736/S1973-9087.20.05993-6.
14. Sawacha Z, Carraro E, Del Din S, et al. Biomechanical assessment of balance and posture in subjects with ankylosing spondylitis. Journal of neuroengineering and rehabilitation. 2012;9(1):63. doi:10.1186/1743-0003-9-63.
15. Mac-Thiong JM, Wang Z, de Guise JA. Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine (Phila Pa 1976). 2008;33(21):2316-2325. doi:10.1097/BRS.0b013e318186b236.
16. Ahmed A. Meralgia paresthetica and femoral acetabular impingement: a possible association. J Clin Med Res. 2010;2(6):274-276. doi:10.4021/jocmr468w.
17. Kesikburun B, Ata AM, Mert A. The effect of posture misalignment and muscles surrounding the lateral femoral cutaneous nerve on meralgia paresthetica. Gait Posture. 2025;120:170-176. doi: 10.1016/j.gaitpost.2025.03.020
18. Paul Y, Swanepoel M, Ellapen TJ, et al. What Is the Association between an Anteriorly Tilted Pelvis and Trendelenburg Gait. Open Journal of Orthopedics. 2018;8:464-475. doi:10.4236/ojo.2018.812048
19. Larsen K, Chien GCC. Lumbosacral plexus entrapment syndrome. Part one: A common yet little-known cause of chronic pelvic and lower extremity pain. Anaesthesia, Pain & Intensive Care. 2019:124-137. doi:10.35975/apic.v23i2.1055
20. de la Caridad Gomez Y, Remotti E, Momah DU, et al. Meralgia paresthetica review: update on presentation, pathophysiology, and treatment. Health Psychology Research. 2023;11:71454. doi:10.52965/001c.71454
21. Donati D, Giorgi F, Farì G. The influence of pelvic tilt and femoral torsion on hip biomechanics: implications for clinical assessment and treatment. Applied Sciences. 2024;14(20):9564. doi:10.3390/app14209564
22. Khedr EM, Rashad SM, Hamed SA. Neurological complications of ankylosing spondylitis: neurophysiological assessment. Rheumatology International. 2009;29(9):1031-1040. doi:10.1007/s00296-009-0841-7.
23. Fox MW, Onofrio BM, Kilgore JE. Neurological complications of ankylosing spondylitis. Journal of Neurosurgery. 1993;78(6):871-878. doi:10.3171/jns.1993.78.6.0871.
24. Păsăran E-D, Diaconu AE, Oancea C. An actual insight into the pathogenic pathways of ankylosing spondylitis. Current Issues in Molecular Biology. 2024;46(11):12800-12812. doi:10.3390/cimb46110762.
25. Jefferson D, Eames RA. Subclinical entrapment of the lateral femoral cutaneous nerve: an autopsy study. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 1979;2(2):145-154. doi:10.1002/mus.880020209.
26. Dias Filho L, Valença M, Guimarães Filho F, et al. Lateral femoral cutaneous neuralgia: an anatomical insight. Clinical anatomy: the Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists. 2003;16(4):309-316. doi:10.1002/ca.10106.
27. Rudwaleit M, Van Der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Annals of the rheumatic diseases. 2009;68(6):777-783. doi:10.1136/ard.2009.108233.
28. Laroy V, Knoops P, Semoulin P. The lateral femoral cutaneous nerve: nerve conduction technique. Journal of Clinical Neurophysiology. 1999;16(2):161-163. doi:10.1097/00004691-199903000-00009.
29. Ozturk EC, Yagci I. The structural, functional and electrophysiological assessment of paraspinal musculature of patients with ankylosing spondylitis and non-radiographic axial spondyloarthropathy. Rheumatology International. 2021;41(3):595-603. doi:10.1007/s00296-020-04781-4.
30. Erdal A, Gündüz O, Duruöz T. AB0759 peripheral nervous system involvement and neuropathic pain in ankylosing spondylitis. Annals of the Rheumatic Diseases. 2015;74:1152-1153. doi:10.1136/annrheumdis-2015-eular.5853
31. Atik S, Sahin O, Atik I, Polat M. Neuropathic Pain Component in Patients with Ankylosing Spondylitis and the Relationship of Neuropathic Pain and Disease Activity Parameters: A Cross-Sectional Study. J Musculoskelet Neuronal Interact. 2024;24(3):284-290.
32. Gündüz OH, Kiralp MZ, Özçakar L, Çakar E, Yildirim P, Akyuz G. Nerve conduction studies in patients with ankylosing spondylitis. J Natl Med Assoc. 2010;102(3):243.
33. Finsterer J, Scorza FA. Small fiber neuropathy. Acta Neurologica Scandinavica. 2022;145(5):493-503. doi:10.1111/ane.13591.
34. Ghasemi M, Rajabally YA. Small fiber neuropathy in unexpected clinical settings: a review. Muscle & Nerve. 2020;62(2):167-75. doi:10.1002/mus.26808.
35. Shin YB, Park JH, Kwon DR. Variability in conduction of the lateral femoral cutaneous nerve. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2006;33(5):645-649. doi:10.1002/mus.20505.
36. Boon AJ, Bailey PW, Smith J. Utility of ultrasound‐guided surface electrode placement in lateral femoral cutaneous nerve conduction studies. Muscle & Nerve. 2011;44(4):525-530. doi:10.1002/mus.22102