Session Information
Date: Sunday, November 5, 2017
Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: At the SI joint (SIJ) level, several methods exist for evaluating structural damage, e.g., MRI, CT scan, radiographs. In EMBARK (NCT01258738) and DESIR (NCT01648907), MRI and radiographs were available at baseline and Week 104. We evaluated: (1) the association between presence/absence of erosion on MRI and presence/absence of erosion or sacroiliitis on radiographs at the SIJ at baseline and Week 104, and (2) the association between decrease/increase in erosion on MRI and decrease/increase in erosion or sacroiliitis on radiographs at the SIJ between baseline and Week 104.
Methods: Patients in both studies had early axial SpA (axSpA). EMBARK included a 12-week double-blind placebo-controlled period, then open-label etanercept for 92 weeks. DESIR patients had no history of biologic therapy and did not receive biologics for 2 years. MRI and radiographs of the SIJ from DESIR and EMBARK were combined and anonymized; readers were unaware of film chronology and original patient cohort. Three experienced readers evaluated T1 weighted MRI images using the SpondyloArthritis Research Consortium of Canada (SPARCC) SIJ Structural Score (SSS), graded radiographic sacroiliitis using the modified New York grading system, and recorded the presence/absence of individual radiographic lesions (erosion, sclerosis, ankylosis) for each SIJ. Presence/absence of lesions at each time point and decrease/increase in lesions was identified for each patient based on agreement of 2 out of 3 readers. Statistical analyses included kappa coefficient of agreement and McNemar’s test for asymmetry.
Results: 224 patients had MRI and radiographs available. At baseline, concordance for presence or absence of erosion was observed in 162/224 (72.3%) (κ=0.42) (Table). In cases of discordance, erosion was more frequent on MRI (21.4%) than radiographs (6.3%; P<0.0001). Week 104 data were similar to baseline. Decrease in erosion from baseline to 104 weeks was more frequent than increase only when assessed by MRI, and was significantly more frequent on MRI than radiographs. Similarly, decrease in erosion on MRI was significantly more frequent than decrease in sacroiliitis grade.
Conclusion: In patients with early axSpA, erosion was present more often on MRI than on radiographs at baseline and Week 104. Decrease in erosion at Week 104 was noted more frequently on MRI than radiographs.
Table. Concordance between MRI and radiographs; baseline, Week 104, and change between baseline and Week 104
|
N |
Present / Present |
Absent / Absent |
Absent / Present |
Present / Absent |
Kappa (95% CI) |
P-value for discordance asymmetry* |
|
|
Erosion on MRI / Erosion on x-ray at BL |
224 |
50 (22.3%) |
112 (50.0%) |
14 (6.3%) |
48 (21.4%) |
0.42 (0.30, 0.53) |
<0.0001 |
|
Erosion on MRI / Erosion on x-ray at Week 104 |
222 |
44 (19.8%) |
119 (53.6%) |
15 (6.8%) |
44 (19.8%) |
0.41 (0.29, 0.53) |
0.0002 |
|
Erosion on MRI / sacroiliitis on x-ray at BL |
224 |
60 (26.8%) |
97 (43.3%) |
29 (12.9%) |
38 (17.0%) |
0.39 (0.26, 0.51) |
0.27 |
|
Erosion on MRI / sacroiliitis on x-ray at Week 104 |
222 |
56 (25.2%) |
99 (44.6%) |
35 (15.8%) |
32 (14.4%) |
0.37 (0.25, 0.50) |
0.71 |
|
Erosion decrease on MRI / Erosion decrease on x-ray |
221 |
4 (1.8%) |
162 (73.3%) |
6 (2.7%) |
49 (22.2%) |
0.06 (-0.05, 0.16) |
<0.0001 |
|
Erosion increase on MRI / Erosion increase on x-ray |
221 |
2 (0.9%) |
187 (84.6%) |
17 (7.7%) |
15 (6.8%) |
0.03 (-0.12, 0.18) |
0.72 |
|
Erosion decrease on MRI / sacroiliitis grade decrease on x-ray |
221 |
8 (3.6%) |
154 (69.7%) |
14 (6.3%) |
45 (20.4%) |
0.08 (-0.05, 0.21) |
<0.0001 |
|
Erosion increase on MRI / sacroiliitis grade increase on x-ray |
221 |
4 (1.8%) |
180 (81.4%) |
24 (10.9%) |
13 (5.9%) |
0.09 (-0.07, 0.25) |
0.07 |
|
*McNemar’s test. BL, baseline. |
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To cite this abstract in AMA style:
Maksymowych WP, Claudepierre P, de Hooge M, Lambert RG, Landewé RBM, Molto A, van der Heijde D, Bukowski JF, Jones H, Logeart I, Marshall L, Pedersen R, Szumski A, Vlahos B, Dougados M. Detection of Structural Lesions on T1 Weighted MRI Versus Radiography of the Sacroiliac Joints in Early Axial Spa: 2-Year Data [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/detection-of-structural-lesions-on-t1-weighted-mri-versus-radiography-of-the-sacroiliac-joints-in-early-axial-spa-2-year-data/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/detection-of-structural-lesions-on-t1-weighted-mri-versus-radiography-of-the-sacroiliac-joints-in-early-axial-spa-2-year-data/