Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
The early diagnosis of axial spondyloarthritis (axSpA) is difficult, however new classification criteria are available, the ASAS axSpA criteria. The SPondyloArthritis Caught Early (SPACE) cohort, back pain ≥ 3 months, ≤ 2 years, onset < 45 years, was set up to diagnose SpA early. In addition to SpA associated features on MRI and conventional radiographs, degenerative changes of the spine might be clinically important. Therefore we describe the prevalence of lumbar degenerative changes in axSpA patients (ASAS+) and no-axSpA patients (ASAS-).
Methods:
In 276 patients (pts) 1.5T T1 and STIR MRI and in 257 pts lateral radiography images of the lumbar spine and antero-posterior radiographs of the pelvis were available. Two readers scored for: disc degeneration (5 point scale of Pfirrmann), High intensity zone, bulging (extrusion and protrusion), herniation (central and lateral), Modic changes (3 point scale) and Schmorl’s nodes on MRI and loss of disc height, facet joint osteoarthrose (FJOA), osteophytes, sclerosis, Schmorl’s nodes, and sacralization on radiography. Kappa was calculated for inter rater agreement. Chi-square test was used to test for differences between pts groups.
Results:
Table 1 lists the number of patients from the whole cohort with none, one or multiple lesions.
|
|
0 |
Number of lesions 1 |
≥2 |
|
Pfirrmann* |
143 (51,8%) |
64 (23,2%) |
69 (25%) |
|
HIZ |
86 (31,2%) |
89 (32,2%) |
101 (36,6%) |
|
Extrusion |
218 (79,0%) |
46 (16,7%) |
12 (4,3%) |
|
Protrusion |
170 (61,6%) |
70 (25,4%) |
37 (13,4%) |
|
Stenosis central |
274 (99,3%) |
2 (0,7%) |
0 () |
|
Stenosis lateral |
262 (94,9%) |
14 (5,1%) |
0 () |
|
Modic |
237 (85,9%) |
35 (12,7%) |
4 (1,4%) |
|
Schmorl |
111 (40,2%) |
34 (12,3%) |
131 (47,5%) |
|
Loss of Disc Height |
200 (66,9%) |
53 (17,7%) |
46 (15,4%) |
|
FJOA |
277 (92,6%) |
21 (7,0%) |
1 (0,3%) |
|
Osteophytes |
227 (75,9%) |
49 (16,4%) |
15 (5,0%) |
|
Schmorl node |
275 (92,0%) |
13 (4,3%) |
9 (3,0%) |
|
Sclerosis |
257 (86,0%) |
34 (11,4%) |
6 (2,0%) |
|
LSTV |
213 (71,2%) |
86 (28,8%) |
NA |
On MRI, 133 pts (48%) had lower signal intensity of at least one (lumbar) intervertebral disc with or without loss of height (Pfirrmann class 3). No difference between ASAS+ (47/112, 42%) and ASAS- (86/163, 53%) pts was found (P=.078). Modic changes were seen in 39 pts (14%) and was statistically significant more present in ASAS- pts (29 vs 10, P=..038).
On X-ray, loss of disc height was found in 59 pts (23%), in 40 ASAS- pts and in 19 ASAS+ pts (P=.047). Osteophytes were present in 48 pts (19%, 13 ASAS+ and 35 ASAS-) and statistically significant more in ASAS- pts (P=.028).
Conclusion:
Pts have a high prevalence of degenerative changes. Nearly half of all pts have dehydrated intervertebral discs, a smaller proportion has loss of height on both MRI and conventional images. ASAS- pts have a higher prevalence of Modic changes, loss of disc height and osteophytes than ASAS+ pts. Prevalence of Modic changes was higher than reported in literature. The high prevalence of degenerative changes in ASAS- pts might be an explanation for the back pain, although clinical correlation is required.
Disclosure:
F. de Bruin,
None;
S. ter Horst,
None;
K. Fagerli,
None;
R. Landewe,
Pfizer, Janssen, Merck, Abbott,
2,
Pfizer, Janssen, Merck, Abbott, Amgen, Astra, BMS, Centocor, GSK, UCS, Vertex,
5;
M. van Oosterhout,
None;
J. L. Bloem,
None;
D. van der Heijde,
None;
M. Reijnierse,
None.
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/lumbar-degenerative-changes-in-the-spondyloartritis-caught-early-cohort/