Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: CBP is often the starting point for a suspicion of axSpA. In the ASAS-criteria for axial SpA either MRI of the SI-joints or HLA-B27-testing are dominant. But, CBP is an extremely common presenting symptom and not all patients can be followed up by MRI and/or HLAB27 testing. This analysis was undertaken to investigate which characteristics of back-pain forecast a positive MRI of the SI-joints.
Objectives: To evaluate which inflammatory characteristics of CBP are associated with the presence of sacroiliitis on MRI in patients with a suspicion of axSpA.
Methods: Baseline dataset from the EsPeranza cohort (<45 years old, symptoms duration 3-24 months and with inflammatory back pain -IBP- or asymmetrical arthritis or spinal/joint pain plus ≥1 SpA features) was used. For this study, only data from all patients with axial symptoms who underwent sacroiliac joint (SIJ) MRI were analysed. Univariable and multivariable logistic regression analyses were employed to estimate odds ratio for the association between IBP characteristics (morning stiffness, improve with exercise and not with rest, alternating buttock pain, insidious onset, awakening at 2nd half of night and good response to NSAID) and their different combinations with a positive SIJ MRI (ASAS definition). Furthermore, diagnostic utility measures were also calculated.
Results: Data from 326 patients (53.7% male, 45% HLA-B27 positive, mean (SD) age 32.8 (7) years and mean (SD) symptoms duration 12.6 (6.4) months) were included in this analysis. A total of 130 (40%) patients had sacroiliitis on MRI. Table shows the association between each separate characteristic (1A) and each possible IBP definition (1B) with a positive MRI. Alternating buttock pain (OR=3.43;p<0.001), insidious onset (OR=2.15;p<0.05) and awakening at 2nd half of the night (OR=1.71;p<0.05) were significantly and positively associated with a positive MRI. The combination of these three characteristics (92%) and the addition to the ASAS-definition of IBP of alternating buttock pain (94%) or NSAID response (86%) had highest specificity, but insufficient sensitivity.
Conclusion: Alternating buttock pain is a distinguishing IBP characteristic strongly associated with a positive SIJ MRI in patients with suspected axSpA. The addition of this criterion in the decision to perform MRI of the SIJ may improve diagnostic efficiency in patients with suspected axSpA.
Acknowledgements: The EsPeranza Program has been supported by an unrestricted grant from Pfizer
Disclosure of Interest: None declared
Table: Association between each of the CBP characteristics and each of the possible IBP definitions with a positive MRI.
|
|
Sacroiliitis positive (N=130) |
Sacroiliitis negative (N=196) |
Univariable analysis |
Multivariable analysis |
Diagnostic utility measures |
||||||
|
N (%) |
N (%) |
OR |
OR |
Sen |
Spe |
PPV |
NPV |
LR+ |
LR- |
||
|
Table 1A: Individual Characteristic of IBP |
|||||||||||
|
Morn. Stiff > 30 min |
89 (68.5) |
106 (54.1) |
1.84* |
1.30 |
68.5 |
45.9 |
45.6 |
68.7 |
1.27 |
0.69 |
|
|
Imp. exercise, not rest |
41 (31.5) |
56 (28.6) |
1.15 |
|
31.5 |
71.4 |
42.3 |
61.1 |
1.10 |
0.04 |
|
|
Alter. buttock pain |
62 (47.7) |
36 (18.4) |
4.05** |
3.43** |
47.7 |
81.6 |
63.3 |
70.2 |
2.59
|
0.64 |
|
|
Insidious onset |
114 (87.7) |
142 (72.4) |
2.71** |
2.15* |
87.7 |
27.6 |
44.5 |
77.1 |
1.21
|
0.44 |
|
|
Awake 2nd half night |
84 (64.6) |
85 (43.4) |
2.39** |
1.71* |
64.6 |
56.6 |
49.7 |
70.7 |
1.49
|
0.63 |
|
|
Response to NSAIDs |
90 (69.2) |
110 (56.1) |
1.76* |
1.32 |
69.2 |
43.9 |
45.0 |
68.3 |
1.23 |
0.70 |
|
|
Table 1B: IBP Definition |
|||||||||||
|
Calin criteria |
67 (51.5) |
57 (29.1) |
2.59** |
– |
51.5 |
70.9 |
54.0 |
68.8 |
1.77 |
0.68 |
|
|
Berlin criteria |
94 (72.3) |
97 (49.5) |
2.67** |
– |
72.3 |
50.5 |
49.2 |
73.3 |
1.46 |
0.55 |
|
|
ASAS criteria |
62 (47.7) |
45 (23.0) |
3.06** |
– |
47.7 |
77.0 |
57.9 |
68.9 |
1.45 |
0.67 |
|
|
Night + Insidious + Buttock (2/3)
|
93 (71.5) |
80 (40.8) |
3.65** |
|
71.5 |
59.2 |
53.8 |
75.8 |
1.75 |
0.48 |
|
|
Night + Insidious + Buttock (3/3) |
89 (33.8) |
15 (7.7) |
6.17** |
– |
33.8 |
92.3 |
74.6 |
67.8 |
4.39
|
0.72 |
|
|
Calin + Night (5/6) |
52 (40.0) |
41 (20.9) |
2.52** |
– |
40.0 |
79.1 |
55.9 |
66.5 |
1.91 |
0.76 |
|
|
Berlin + Insidious (3/5) |
89 (68.5) |
81 (41.3) |
3.08** |
– |
68.5 |
58.7 |
52.4 |
73.7 |
1.66 |
0.54 |
|
|
ASAS + Buttock (5/6) |
40 (30.8) |
11 (5.6) |
7.48** |
– |
30.8 |
94.4 |
78.4 |
67.3 |
5.50
|
0.73 |
|
|
ASAS + NSAIDs (5/6)
|
48 (36.9) |
27 (13.8) |
3.66** |
– |
36.9 |
86.2 |
64.0 |
67.3 |
2.67 |
0.73 |
|
|
ASAS + Buttock + NSAIDs (6/7)
|
28 (21.5) |
7 (3.6) |
7.41** |
– |
21.5 |
96.4 |
80.0 |
64.9 |
5.97
|
0.81 |
|
p<0.05;**p<0.001
Disclosure:
V. Navarro-Compán,
None;
R. Almodóvar González,
None;
A. Hernández,
None;
E. Beltrán,
None;
E. De Miguel,
None;
R. B. M. Landewé,
None;
D. van der Heijde,
None;
P. Zarco,
None.
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