Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: To address the question whether active inflammation starts at specific sites of the sacroiliac joints (SI-joints) and/ or the spine.
Methods:
Wb-MRIs of 75 patients with early axial spondyloarhtritis (SpA) with a disease duration of < 5 years [1] were scored for active inflammatory lesions on STIR sequences and T1 weighted images in the 23 vertebral units (VUs) of the spine and in the 8 sacroiliac (SI)-joint quadrants. Scoring was performed by two blinded radiologists.
Results:
In the total group of patients, 52% (39/75) showed active inflammation only at the SI-joints (active sacroiliitis), 41.3% (31/75) in the SI-joints and the spine and 5.3 (4/75) only in the spine (isolated spinal inflammation).
Mean scores for active inflammatory changes were 6.7 (SD 5.8) out of possible 24 points for the SI-joints and 1.9 (SD 3.3) out of possible 69 for the spine.
Active inflammation in the SI-joint quadrants were found as the following (in decreasing order): quadrant I (sacral bone, upper quadrant; 66% of patients, n= 50); quadrant II (sacral bone, lower quadrant; 60%, n= 45), quadrant IV (iliac bone, upper quadrant, 53%, n= 40), quadrant III (iliac bone, lower quadrant, 69%, n=52).
The most frequently affected sites of active inflammation in the spine were the lower thoracic spine and the lumbar spine: in decreasing order the most frequently affected VUs were T6/T7 (n= 11), T10/T11 (n= 11), T7/T8 (n= 10), L1/L2 (n= 10) and L4/L5 (n= 9) and L5/S1 (n= 9). The cervical spine was less often affected.
Table: Distribution of active inflammation in the Sacroiliac Joint Quadrants and the Spinal vertebral units
|
Anatomie site |
Percentage of affected patients |
|
SI-joint quadrant I (sacral bone, upper quadrant) |
66% |
|
SI-joint quadrant II (sacral bone, lower quadrant) |
60% |
|
SI-joint quadrant IV (iliac bone, upper quadrant) |
53% |
|
SI-joint quadrant III (iliac bone, lower quadrant |
69% |
|
C2/C3 |
3% |
|
C3/C4 |
1% |
|
C4/C5 |
1% |
|
C5/C6 |
4% |
|
C6/C7 |
7% |
|
C7/T1 |
3% |
|
T1/T2 |
4% |
|
T2/T3 |
7% |
|
T3/T4 |
7% |
|
T4/T5 |
9% |
|
T5/T6 |
8% |
|
T6/T7 |
15% |
|
T7/T8 |
13% |
|
T8/T9 |
11% |
|
T9/T10 |
8% |
|
T10/T11 |
15% |
|
T11/T12 |
5% |
|
T12/L1 |
8% |
|
L1/L2 |
13% |
|
L2/L3 |
9% |
|
L3/L4 |
11% |
|
L4/L5 |
12% |
|
L5/S1 |
12% |
[1] Song I.-H. et al. 2011. Ann Rheum Dis. 2011 Apr;70(4):590-6.
Conclusion:
In this cohort of early axial SpA patients there was no significant predilection of SI-joint quadrants affected by active inflammtion. In the spine the thoracic and lumbar parts were mostly affected.
Disclosure:
I. H. Song,
Pfizer Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals,
5;
C. Althoff,
None;
H. Haibel,
Pfizer Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals.,
5;
J. Listing,
None;
A. Weiß,
None;
B. Freundlich,
former employee from Pfizer,
3;
M. Rudwaleit,
Abbott, BMS, MSD, Pfizer, Roche, and UCB,
5;
J. Sieper,
Abbott, Merck, Pfizer, and UCB,
2,
Abbott, Merck, Pfizer, and UCB,
5,
Abbott, Merck, Pfizer, and UCB,
8.
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