Association Between Bone Marrow Edema and Structural Progression in the Same Quadrant in Axial Spondyloarthritis – 5-year Data from the DESIR Cohort

Santiago Rodrigues-Manica¹, Alexandre Sepriano ², Sofia Ramiro ³, Robert B.M. Landewé ⁴, Pascal Claudepierre ⁵, Anna Molto ⁶, Maxime Dougados ⁷, Miranda van Lunteren ² and Désirée van der Heijde ², ¹CEDOC, NOVA-Medical School | Hospital Egas Moniz, CHLO, Lisbon, Lisbon, Portugal, ²Leiden University Medical Center, Leiden, Netherlands, ³Leiden University Medical Center and Zuyderland Medical Centre, Leiden, Netherlands, ⁴Amsterdam University Medical Center, Amsterdam, Netherlands, ⁵Rheumatology, CHU Henri Mondor Créteil, Paris, France, ⁶Paris Descartes University, Medicine Faculty; APHP, Rheumatology, Hôpital Cochin, Hôpitaux de Paris, Paris, Paris, France, ⁷Cochin Hospital, Paris, France

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: axial spondyloarthritis, bone marrow lesions, Magnetic resonance imaging (MRI), spondylarthritis and ankylosing spondylitis (AS)

Session Information

Date: Sunday, November 10, 2019

Title: 3S083: Spondyloarthritis Including Psoriatic Arthritis – Clinical I: Imaging in Axial Spondyloarthritis & Psoriatic Arthritis (851–856)

Session Type: ACR Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: The overall presence of inflammation in the MRI-SIJ is associated with overall 5-year radiographic damage in patients with axSpA. But we do not know if a bone marrow edema (BME) lesion leads to a structural lesion at the same place (i.e. in the same quadrant). This study aims to investigate the association between BME and structural progression in the same quadrant of the SIJ, over time.

Methods: Patients from the DESIR cohort (early axSpA according to the rheumatologist) with ≥2 consecutive MRI-SIJ (out of baseline, 2 and 5 years), were included. Each image was independently scored by 3 trained central readers blinded to chronological order. BME was considered present in a time point if detected in ≥1/6 slices in each of the 8 quadrants. The prevalence of BME (yes/no) and structural lesions (sclerosis, erosions, fatty lesions and ankylosis; all yes/no) defined, per quadrant, by the agreement of ≥2 out of 3 readers, was described at BL and at 5 years. The longitudinal association between BME and each of the structural lesions in the same quadrant was tested in time-lagged multilevel Generalized Estimating Equation (GEE) models with autoregression (i.e. adjusted for the structural lesion in the previous time point) and adjusting for clinical variables selected a priori on clinical grounds (age, gender, disease activity and treatment).

Results: In total, 197 patients were included (age 34 (SD 9) years, 48% male and 61% HLA-B27 positive). While BME and fatty lesions were evenly distributed across quadrants, erosions and sclerosis occurred preferably in the iliac side (i.e. Q1 and Q4) (Table 1). The prevalence of BME decreased over time (baseline range: 11%-16%; 5-year range: 7%-14%), while erosions (baseline: 2%-23%; 5-year: 3%-28%) and especially fatty lesions (baseline: 4%-14%; 5-year: 9%-21%) increased. Ankylosis and sclerosis were rare in this early axSpA cohort. In the multivariable models, BME was longitudinally associated with sclerosis (OR:1.7 (95% CI: 1.0;3.2)), erosions (2.0 (1.5;2.5)) and fatty lesions (1.7 (1.1;2.5)) (Table 2). The possible association with ankylosis could not be tested due to too low number of lesions.

Conclusion: In patients with early axSpA, inflammation in one SIJ quadrant leads to structural damage in the same quadrant. This finding reinforces the pathophysiological implications of inflammation in axSpA.

Disclosure: S. Rodrigues-Manica, None; A. Sepriano, None; S. Ramiro, AbbVie, 5, 8, Eli Lilly, 5, 8, Lilly, 5, 8, MSD, 2, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Sanofi, 5, 8; R. Landewé, Abbott, 2, 5, 8, Abbott, Amgen, Bristol-Myers Squibb, Centocor, Merck, Pfizer, Roche, Schering-Plough, UCB, Wyeth, 8, Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB, Wyeth, 2, AbbVie, 5, Abbvie, 5, 8, AbbVie, Ablynx, Amgen, Astra-Zeneca, Bristol-Myers Squibb, Centocor, GSK, Novartis, Merck, Pfizer, Roche, Schering- Plough, UCB, Wyeth, 5, Ablynx, 5, Amgen, 2, 5, 8, AstraZeneca, 5, BMS, 5, 8, Bristol Myers Squibb, 5, 8, Bristol-Myers Squibb, 5, Celgene, 5, 8, Centocor, 2, 5, 8, Director of Rheumatology Consultancy BV, which is a registered company under Dutch law, 6, Eli Lilly, 5, 8, Eli Lilly and Company, 5, Eli-Lilly, 5, 8, Galapagos, 5, 8, Gilead, 5, 8, GlaxoSmithKline, 5, Glaxo-Smith-Kline, 5, 8, Janssen, 5, 8, Merck, 5, 8, MSD, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Rheumatology bv, 4, Rheumatology Consultancy BV, 9, Roche, 2, 5, 8, Schering-Plough, 2, 5, 8, UCB, 5, 8, UCB Pharma, 2, 5, 8, Wyeth, 2, 5, 8; P. Claudepierre, Janssen, 8; A. Molto, None; M. Dougados, AbbVie, 2, 5, 8, Amgen, 5, Biogen, 5, BMS, 2, 5, 8, Eli Lilly, 2, 5, 8, Gilead, 2, 5, Janssen, 2, 5, Merck, 2, 5, Merck Inc, 2, 5, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Pfizer Inc, 2, 5, Roche, 2, 5, 8, UCB, 2, 5, 8; M. van Lunteren, None; D. van der Heijde, AbbVie, 5, AbbVie, Amgen, Astellas, AstraZeneca, BMS, 5, Amgen, 5, Astellas, 5, 9, Astellas Pharma, 5, AstraZeneca, 5, BMS, 5, Boehringer Ingelheim, 5, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB, 5, Boehringer-Ingelheim, 5, Bristol-Myers Squibb, 5, Celgene, 5, Daiichi, 5, 9, Daiichi Sankyo, 5, Director of Imaging Rheumatology, 6, Director of Imaging Rheumatology bv, 9, Eli Lilly, 5, Eli Lilly and Company, 5, Eli-Lilly, 5, Galapagos, 5, Gilead, 5, Gilead Sciences, Inc., 5, GlaxoSmithKline, 5, Glaxo-Smith-Kline, 5, GSK, 5, 8, Imaging Rheumatology bv, 9, Imaging Rheumatology BV, 9, Imaging Rheumatology bv., 9, Janssen, 5, 8, Janssen Pharmaceutica, 5, Merck, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Pfizer Inc, 5, Regeneron, 5, 8, Rheumatology bv, 4, 9, Roche, 5, 8, Sanofi, 5, 8, Takeda, 5, 8, Takeda Pharmaceutical Company, 5, UCB, 5, 8, UCB Pharma, 5.

To cite this abstract in AMA style:

Rodrigues-Manica S, Sepriano A, Ramiro S, Landewé R, Claudepierre P, Molto A, Dougados M, van Lunteren M, van der Heijde D. Association Between Bone Marrow Edema and Structural Progression in the Same Quadrant in Axial Spondyloarthritis – 5-year Data from the DESIR Cohort [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/association-between-bone-marrow-edema-and-structural-progression-in-the-same-quadrant-in-axial-spondyloarthritis-5-year-data-from-the-desir-cohort/. Accessed .

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