Session Information
Date: Monday, November 9, 2015
Title: Spondylarthropathies and Psoriatic Arthritis - Comorbidities and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Magnetic resonance imaging (MRI) has
become an invaluable tool for early diagnosis of axial
spondyloarthritis (axSpA) and several MRI-based studies have identified SpA-related
inflammatory or structural findings in the spine. However, the exact frequency of degenerative changes
(DCs) at the spine in pts with axSpA as a potential cause of low back pain (LBP)
is not completely clarified. Therefore, the aim of this study was to document DCs on lumbar MRI in pts with axSpA and non-specific mechanical
(mLBP).
Methods: Pts with chronic
LBP were consecutively recruited from our out-patient clinic. All of the pts
were assessed for ASAS classification criteria for axSpA and all underwent
lumbar spinal MRI. Patients with a history of spinal surgery or injections were
excluded. A qualified reader (unaware of the clinical diagnosis and variables)
scored anonymized sagittal and axial T1 and
T2-weighted MR scans of the lumbar spine. Degree of disc
degeneration (DD) (Pfirrmann 5 point scale, class
≤2 considered normal), endplate changes (Modic
3 point scale) and presence of annular rupture, disc bulging, protrusion
or extrusion at each spinal level from L1-L2 to L5-S1 were assessed. Patients
without definite sacroiliitis on pelvic X-ray were defined as nr-axSpA, and patients
with definite sacroiliitis on pelvic X-ray according to modified New York
criteria were defined as AS (pelvic X-rays were
scored upon consensus of three readers).
Results: Two
hundred sixty-seven pts with axSpA (123 nr-axSpA, 144 AS) and 105 pts with mLBP were
included (age 18 to 60). Pts with nr-axSpA were
younger (35.43+8.72, years) than pts with AS and mLBP
(38.78+7.99, p=0.0008; 41.37+10.77 years, p<0.0001, respectively). Pts with
AS had longer symptom duration (11.33+6.93, years) than pts with nr-axSpA and mLBP (6.74,
p<0.0001 and 6.13, p<0.0001, respectively). The prevalence of lumbar
herniated nucleus pulposus (protrusion or extrusion
at any level) in nr-axSpA was higher than pts with AS. In the multivariate
logistic regression analysis (adjusted for confounding variables), the presence
of MCs (OR, 6.76; 95%
CI; 2.09-21.83,
p=0.001), LHNP (protrusion or extrusion) (OR , 3.67; 95%
CI; 1.57-8. 26,
p=0.028), as
well as advance age (>50 years) (OR, 33.54; 95%
CI; 3.83-293.97
p=0.001) were factors associated with the risk
of DD in axSpA. BASMI and BASFI scores were higher
and Schober test was more restricted in patients with axSpA who had coexisting
DD.
Conclusion: Prevalence
of DCs is higher in pts with mLBP than pts with axSpA.
However substantial proportion of pts with axSpA had DD at the lumbar spine
which increased with age. Spinal DCs might be an alternative explanation for
complaints and might interfere with diagnostic decision making in pts with
axSpA.
Table 1. The crude percentages of
degenerative changes at the lumbar spine
|
axSpA (n=267)
|
mLBP (n=105)
|
p
|
|
|
N(%) |
N(%) |
|
|
|
DD-L1-L2
|
117(43.8) |
63(60.0) |
0.005 |
|
DD-L2-L3
|
119(42.3) |
64(61.0) |
0.004 |
|
DD-L3-L4
|
125(46.8) |
71(67.6) |
<0.0001 |
|
DD-L4-L5
|
144(53.9) |
71(67.6) |
0.016 |
|
DD-L5-S1
|
144(53.9) |
71(67.6) |
0.016 |
|
DD-any level
|
163(61.0) |
74(70.5) |
0.089 |
|
LHNP-L1-L2 (bulg./ prot./ extr.)
|
12(4.5)/3(1.1)/0(0) |
12(11.4)/1(1.0)/0(0) |
0.014/ 1.0 /NA |
|
LHNP-L2-L3 (bulg./ prot./ extr.)
|
22(8.2)/3(1.1)/0(0) |
18(17.1)/2(1.9)/0(0) |
0.013/ 0.624/ NA |
|
LHNP-L3-L4 (bulg./ prot./ extr.)
|
44(16.5)/8(3.0)/2(0.7) |
33(31.4)/11(10.5)/0(0.0) |
0.0014/ 0.003/ 1.0 |
|
LHNP-L4-L5 (bulg./ prot./ extr.)
|
89(33.3)/41(15.4)/1(0.4) |
40(38.1)/32(30.5)/3(2.9) |
0.385/0.0009 /0.070 |
|
LHNP-L5-S1 (bulg./ prot./ extr.)
|
86(32.2)/53(19.8)/3(1.1) |
30(28.6)/47(44.8)/5(4.8) |
0.495/0.0001 / 0.043 |
|
LHNP-any level protrusion or extrusion
|
80(30.0) |
65(61.9) |
<0.0001 |
|
Annuler Fissur/rupture-any level
|
81(30.3) |
51(48.6) |
0.001 |
|
Modic change Type 1 any level
|
16(6.0) |
6(5.7) |
0.918 |
|
Modic change Type 2 any level
|
57(21.3) |
16(15.2) |
0.182 |
|
Modic change Type 3 any level
|
1(0) |
0(0) |
1.000 |
|
Modic changes-any level
|
69(25.8) |
20(19.0) |
0.167 |
To cite this abstract in AMA style:
Senol S, Kilic G, Baspinar S, Kilic E, Ozgocmen S. Degenerative Changes at the Lumbar Spine in Patients with Axial Spondyloarthritis and Non-Specific Mechanical Low Back Pain: A Magnetic Resonance Imaging Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/degenerative-changes-at-the-lumbar-spine-in-patients-with-axial-spondyloarthritis-and-non-specific-mechanical-low-back-pain-a-magnetic-resonance-imaging-study/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/degenerative-changes-at-the-lumbar-spine-in-patients-with-axial-spondyloarthritis-and-non-specific-mechanical-low-back-pain-a-magnetic-resonance-imaging-study/