Inflammatory Lesions of the Sacroiliac Joints, but Not of the Spine, Are of High Utility for Recent Onset Axial Spondyloarthritis Recognition

Anna Molto¹, Laure Gossec², Violaine Foltz², Romain Beaufort³, Jean Denis Laredo⁴, Pascal Richette⁵, Philippe Dieude⁶, Philippe Goupille⁷, Antoine Feydy⁸ and Maxime Dougados⁹, ¹Hôpital Cochin, Department of Rheumatology, Paris Descartes University, Paris, France, ²UPMC University Paris 06, Pitié-Salpétrière Hospital, Paris, France, ³Private Practice,, Paris, France, ⁴Radiology Department, Lariboisière Hospital, Paris, France, ⁵Rheumatology Department, Université Paris Diderot, Paris, France, ⁶Université Paris-Diderot, Paris, France, ⁷Université François-Rabelais, Tours, France, ⁸Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de radiologie B, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France, Paris, France, ⁹Department of Rheumatology, Paris Descartes University, Hôpital Cochin, Paris, France

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: MRI, performance and spondylarthritis

Session Information

Date: Sunday, November 5, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: only scarce data are available regarding the prevalence of MRI inflammatory lesions of the sacroiliac joints (SIJ) or the spine suggestive of axial Spondyloarthritis (axSpA) in patients with recent onset mechanical chronic back pain (CBP).The aim of this study was to evaluate the prevalence of MRI (SIJ,Spine) inflammatory lesions suggestive of axSpA in a non-axSpA CBP population and to compare its prevalence to an recent onset axSpA cohort.

Methods:

Patients: a) Recent onset axSpA patients: first, a sample of 100 patients representative in terms of imaging abnormalities of the global DESIR ⁽¹⁾ recent onset axSpA cohort (> 3 months but <3 years), based on the results of the previously published central reading of baseline films of DESIR⁽²⁾ were selected (e.g. 35% of patients fulfilling the ASAS definition of MRI sacroiliitis). b) Recent onset CBP patients: consecutive in- and outpatients consulting for recent (>3months but <5years) mechanical CBP, initiating before the age of 45y and with a maximum age of 50y, in four tertiary care Hospitals were included in the study. Imaging: MRI scans (T2-STIR and T1 sequences) of the SIJ and full spine were performed in both groups with identical protocol. Central reading: an experienced reader (AM) centrally read all MRI scans, blinded for clinical diagnosis. Statistical analysis: prevalence of MRI inflammatory lesions suggestive of axSpA were compared in both groups. Sensitivity, specificity and positive likelihood ratio of each lesion were calculated.

Results:

A total of 98 patients with recent onset CBP were included, and compared to 100 recent onset axSpA patients. Age and gender were comparable (mean(SD) 36.2(9.9) vs. 32.2(8.7)y, and 41.8% and 45% males, in the CBP vs. axSpA groups, respectively). MRI inflammatory lesions of the SIJ were quite frequent in the CBP group (25% patients with at least one inflammatory lesion) but were significantly more frequently observed in the axSpA group (Table), with a mean SIJ – SPARCC score of 4.9 (8.8) vs. 0.6 (1.3), p<0.001. The ASAS definition of MRI sacroiliitis presented a high specificity and a good positive likelihood ratio. Conversely, prevalence of inflammatory lesions of the spine was very frequent in the CBP group and not significantly lower compared to the axSpA group (SPARCC spine 5.6 (13.5) vs. 3.3(5.8), in the axSpA vs. CBP groups, respectively). Regardless the definition of a positive MRI for the spine applied, performances were not good, with positive likelihoods ratios below 2.

		CBP N=98	SpA N=100	p	Sensitivity	Specificity	LR+
SIJ-MRI	At least one inflammatory lesion of the SIJ	24 (25.3%) n=95	40 (40.0%)	0.028	0.4 (0.3, 0.5)	0.8 (0.7, 0.8)	1.6 (1.0, 2.4)
SIJ-MRI	ASAS definition of positive MRI sacroiliitis	8 (8.4%) n=95	35 (35.0%)	<0.001	0.4 (0.3, 0.5)	0.9 (0.8, 0.9)	4.2 (2.0, 8.5)
Spine-MRI	At least one inflammatory lesions of the spine	44 (44.9%)	52 (52.5%) n=99	NS	0.5 (0.4, 0.6)	0.6 (0.5, 0.7)	1.2 (0.9, 1.6)
	ASAS definition of positive MRI spine ≥3 inflammatory lesions)	33 (33.7%)	44 (44.4%) n=99	NS	0.4 (0.3, 0.6)	0.7 (0.6, 0.8)	1.4 (0.9, 1.9)
	SPACE ⁽³⁾definition of positive MRI spine ≥5 inflammatory lesions)	25 (25.5%)	30 (30.3%) n=99	NS	0.3 (0.2, 0.4)	0.7 (0.7, 0.8)	1.2 (0.8, 1.9)

Conclusion:

ASAS definition of a positive MRI-sacroiliitis performed very well for axSpA recognition; however, definitions proposed for a positive MRI-spine suggestive of axSpA did not seem to perform adequately in this recent disease stage. This supports the idea of not including a positive MRI of the spine in the ASAS classification criteria.

Ref:1.- Dougados M, et al.Joint Bone Spine.2015. 2. van den Berg R et al.Ann Rheum Dis.2015.- de Hooge M et al.Ann Rheum Dis.2016

Disclosure: A. Molto, None; L. Gossec, None; V. Foltz, None; R. Beaufort, None; J. D. Laredo, None; P. Richette, None; P. Dieude, None; P. Goupille, None; A. Feydy, None; M. Dougados, Abbvie, Pfizer, Eli Lilly and Company, Novartis, UCB, Merck, Roche, BMS UCB, 2,Abbvie, Pfizer, Eli Lilly and Company, Novartis, UCB, Merck, Roche, BMS, UCB, 5.

To cite this abstract in AMA style:

Molto A, Gossec L, Foltz V, Beaufort R, Laredo JD, Richette P, Dieude P, Goupille P, Feydy A, Dougados M. Inflammatory Lesions of the Sacroiliac Joints, but Not of the Spine, Are of High Utility for Recent Onset Axial Spondyloarthritis Recognition [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/inflammatory-lesions-of-the-sacroiliac-joints-but-not-of-the-spine-are-of-high-utility-for-recent-onset-axial-spondyloarthritis-recognition/. Accessed .

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