Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: In daily practice, the diagnostic work-up of patients with possible axial spondyloarthritis (axSpA) starts with clinical and laboratory data. In many patients MRI and/or X-rays of the sacroiliac joints (MRI-SIJ and X-SIJ) is performed to be able to diagnose patients with confidence. We investigated the contribution of imaging (MRI-SIJ and X-SIJ) in making a final diagnosis with confidence.
Methods: All patients with chronic back pain (≥3 months, but ≤2 years, onset ≤45 years) in the SPondyloArthritis Caught Early (SPACE)-cohort in our clinic underwent a diagnostic work-up according to a fixed protocol. First, medical history, physical examination and laboratory assessments, including HLA-B27 typing, were performed. Based on this information, an experienced rheumatologist diagnosed all patients as either SpA or no-SpA with a level of confidence (scale 0 (not confident at all) to 10 (very confident)). Second, imaging (MRI-SIJ and X-SIJ) was performed and a diagnosis was recorded by the same rheumatologist with a new level of confidence. For the analyses, cut-off values of ≤5 (not confident) and ≥6 (confident) were used.
Results: The results are presented in the table. In 52/157 of the patients (33%), the rheumatologist was confident about the diagnosis, either SpA (n=31) or no-SpA (n=21), based on clinical and laboratory data only. Imaging was positive in 32/157 patients (20.4%). In 3/157 patients (1.9%) the rheumatologist was confident about the diagnosis no-SpA, but revised the diagnosis into confident SpA after imaging. In 9/157 patients (5.7%) the rheumatologist reduced the level of confidence about the diagnosis SpA after imaging was performed, since imaging was negative. In 105/157 of the patients (67%), the rheumatologist was not confident about the diagnosis. After performing imaging, the rheumatologist was confident about the diagnosis in 73/105 patients: SpA in 21/105 (20%) patients and no-SpA in 52/105 (50%) patients. In the remaining 32/105 patients (30%) imaging did not change confidence, nor diagnosis.
Conclusion: Imaging (MRI-SIJ and/or X-SIJ) is useful for the rheumatologist in the large majority of patients with possible axSpA, except for the patients in which the rheumatologist is confident about the diagnosis of SpA before imaging.
|
Before imaging |
After imaging |
MRI pos, n |
X-ray pos, n |
MRI & X-ray pos, n |
|
|
Confident n=52 |
SpA n=31 |
Conf SpA n=22 |
5 |
0 |
1 |
|
Conf no-SpA n=0 |
– |
– |
– |
||
|
Not conf SpA n=9 |
0 |
0 |
0 |
||
|
Not conf no-SpA n=0 |
– |
– |
– |
||
|
No-SpA n=21 |
Conf SpA n=3 |
2 |
0 |
1 |
|
|
Conf no-SpA n=18 |
0 |
0 |
0 |
||
|
Not conf SpA n=0 |
– |
– |
– |
||
|
Not conf no-SpA n=0 |
– |
– |
– |
||
|
Not Confident n=105 |
SpA n=17 |
Conf SpA n=5 |
3 |
0 |
2 |
|
Conf no-SpA n=1 |
0 |
0 |
0 |
||
|
Not conf SpA n=11 |
0 |
0 |
0 |
||
|
Not conf no-SpA n=0 |
– |
– |
– |
||
|
No-SpA n=88 |
Conf SpA n=16 |
9 |
4 |
3 |
|
|
Conf no-SpA n=51 |
0 |
0 |
0 |
||
|
Not conf SpA n=2 |
1 |
0 |
0 |
||
|
Not conf no-SpA n=19 |
0 |
1 |
0 |
||
Disclosure:
R. van den Berg,
None;
M. de Hooge,
None;
V. Navarro-Compán,
None;
F. van Gaalen,
None;
M. Reijnierse,
None;
T. Huizinga,
None;
D. van der Heijde,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-useful-is-imaging-of-the-sacroiliac-joints-mri-andor-x-ray-in-patients-with-possible-spondyloarthritis-in-the-diagnostic-work-up/