Background/Purpose:  Recurrent acute anterior uveitis (rAAU) is associated with spondyloarthritis (SpA). However, it is not known if patients with rAAU, but no back symptoms could have positive findings on sacroiliac joint (SIJ) MRI. Aim: To assess the prevalence of definite SpA by combined T1W/STIR MRI (global MRI), to quantify acute and chronic lesions in SIJ using MRI in patients with rAAU with and without back symptoms, and to assess which MRI lesion-based criteria optimally reflect the global MRI designation of definite SpA.

Methods:  A total of 50 consecutive patients with rAAU without prior rheumatologic diagnosis were included in this cross-sectional study and were compared to 21 healthy volunteers. MRI scans were read by two rheumatologists according to the SPARCC/MORPHO protocol. 

Results:  rAAU patients were classified as axial SpA (Group 1, n=20), according to ASAS criteria (2009); non-specific back pain (Group 2, n=6) and asymptomatic (Group 3, n=24). The groups were similar regarding age, sex, ethnicity, age at onset of uveitis, current uveitis activity and duration of eye disease. HLA-B27 was positive in 48% of those with rAAU. Considering only group 3, nine (37.5%) patients had SIJ MRI and/or X-ray positive for axial SpA (5 MRI and x-ray, 1 MRI, 3 x-ray). MRI scans compatible with SpA in groups 1(n=12) and 3 (n=6) were similar regarding acute and chronic lesions analysed according to MORPHO. The best sensitivity/specificity criterion to define a positive global MRI assessment was bone marrow edema (BME) ≥ 3 (92%/94%).

Conclusion:  This is the first study evaluating SIJ MRI in patients with rAUU without back symptoms showing positive findings for sacroiliitis, confirming a uvea-axial spine link, and BME ≥ 3 as optimal for a positive MRI.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/positive-sacroiliac-joint-mri-in-asymptomatic-patients-with-recurrent-acute-anterior-uveitis-a-proof-of-concept/