More Than 10 Percent Patients with Recent Onset Chronic Mechanical Back Pain Fulfill the Modified NY Criteria for Sacroiliitis

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, ⁷Department of Rheumatology, CHRU de Tours; and Université François-Rabelais de Tours, 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: Monday, November 6, 2017

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

Session Type: ACR Poster Session B

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

Background/Purpose: only scarce data are available regarding the diagnostic value of pelvic Xrays abnormalities suggestive of axial spondyloarthritis (axSpA) in patients with recent onset back pain to distinguish mechanical chronic back pain (CBP) and axSpA.

Objective:To evaluate the prevalence of sacroiliac abnormalities suggestive of axSpA in a non-axSpA CBP population and to compare its prevalence to an recent onset axSpA cohort.

Methods:

Study design: Observational cross-sectional national multicentre study. Patients: a) Recent onset axSpA patients: first, a sample of 100 patients representative in terms of imaging abnormalities of the global DESIR ⁽¹⁾ 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. 21% of patients fulfilling the modified NY criteria (mNY)). b) 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: Pelvic Xrays were performed in both groups with an identical protocol. Central reading: an experienced reader (AM) centrally read X-ray films, blinded for clinical diagnosis.

Statistical analysis: prevalence of lesions suggestive of axSpA and the fulfilment of the mNY criteria for radiographic sacroiliitis were compared in both groups. Sensitivity, specificity and positive likelihood ratio of each lesion for the diagnosis of axSpA were calculated.

Results:

A total of 98 patients with CBP were included, and compared to 100 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).

Patients with axSpA had consistently more lesions suggestive of axSpA than CBP patients (Table), and presence of erosions showed the best positive likelihood ratio. The fulfilment of mNY criteria presented also a high positive likelihood ratio (LR+).

LESIONS	CBP n=98	axSpA n=100	p	Sensitivity	Specificity	LR+
Erosion	9/97 (9.3%)	35 (35.0 %)	<0.001	0.4 (0.3, 0.5)	0.9 (0.8, 0.9)	3.8 (1.9, 7.4)
Sclerosis	21/97 (21.6%)	50 (50.0%)	<0.001	0.5 (0.4, 0.6)	0.8 (0.7, 0.9)	2.3 (1.5, 3.5)
Joint widening	13/97 (13.4%)	25 (25.0%)	0.06	0.3 (0.2, 0.4)	0.9 (0.8, 0.9)	1.9 (1.0, 3.4)
Joint narrowing	11/97 (11.3%)	21 (21.0%)	NS	0.2 (0.1, 0.3)	0.9 (0.8, 0.9)	1.9 (0.9, 3.6)
Partial ankylosis	7/97 (7.2%)	11 (11.0%)	NS	0.1 (0.1, 0.2)	0.9 (0.9, 0.9)	1.5 (0.6, 3.8)
Total ankylosis	0	3 (3.0%)	NS	0.0 (0.0, 0.1)	1.0 (0.9, 1.0)	NA*
Modified NY criteria (Y/N)	11/95 (11.6%)	35 (35.0%)	<0.001	0.4 (0.3,0.5)	0.9 (0.8,0.9)	3.0 (1.6, 5.6)

* NA = not applicable, since one of the categories is 0, Specificity can not be calculated.

Conclusion:

Prevalence of sacroiliac lesions suggestive of axSpA in pelvic Xrays of patients with recent onset CBP is high, but significantly lower when compared to recent onset axSpA. Presence of erosions and fulfilment of mNY criteria were the best performing features for axSpA recognition even in an early disease stage.

Ref: (1) Dougados M, et al. cohort. Joint Bone Spine. 2015; (2)van den Berg R et al. Arthritis Rheumatol. 2014

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. More Than 10 Percent Patients with Recent Onset Chronic Mechanical Back Pain Fulfill the Modified NY Criteria for Sacroiliitis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/more-than-10-percent-patients-with-recent-onset-chronic-mechanical-back-pain-fulfill-the-modified-ny-criteria-for-sacroiliitis/. Accessed .

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