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: only scarce data are available regarding the prevalence of MRI structural lesions of the sacroiliac joints (SIJ) or the spine suggestive of axial Spondyloarthritis (axSpA) in patients with recent onset mechanical chronic back pain (CBP). The aim was to evaluate the prevalence of MRI (SIJ and Spine) structural lesions suggestive of axSpA in a non-axSpA CBP population and to compare its prevalence to an recent onset axSpA cohort.
Methods:
Study design: Observational cross-sectional national multicentre study. Patients: a) Recent onset axSpA patients: first, a sample of 100 patients representative in terms of imaging abnormalities of the global DESIR (1) recent onset axSpA cohort (> 3 months but <3 years), based on the results of the previously published central reading of baseline films of DESIR(2) were selected (e.g. 21% of patients fulfilling the modified NY criteria (mNY)). b) Recent onset CBP patients: consecutive in- and outpatients consulting for recent (>3months but <5years) mechanical CBP, initiating before the age of 45y and with a maximum age of 50y, in four tertiary care Hospitals were included in the study. Imaging: MRI scans (T2-STIR and T1 sequences) of the SIJ and cervico-thoracic and thoraco-lumbar spine were performed in both groups with identical protocol. Central reading: an experienced reader (AM) centrally read all MRI scans, blinded for clinical diagnosis. Statistical analysis: prevalence of lesions and lesions combinations previously proposed(3) to be suggestive of axSpA was compared in both groups. Sensitivity, specificity and positive likelihood ratio (LR+) of each lesion were calculated.
Results:
Results: A total of 98 patients with recent onset CBP were included, and compared to 100 recent onset axSpA patients. Age and gender were comparable (mean (SD) 36.2 (9.9) vs. 32.2 (8.7)y, and 41.8% and 45% males, in the CBP vs. axSpA groups, respectively).Prevalence of chronic lesions of the SIJ was significantly greater in the axSpA group but up to 17% patients with CBP presented at least one chronic lesion of the SIJ (Table). The presence of at least 3 subchondral bone erosions at the SIJ performed the best for axSpA discrimination. Prevalence of chronic lesions of the spine was comparable in the two groups, with high prevalence of fatty lesions across groups; erosions were rare in both groups. The presence of at least 5 fatty lesions was the most discriminant, with a high specificity. Performances of all other structural lesions of the spine were poor.
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CBP N=98 |
SpA N=100 |
p |
Se |
Spe |
LR+ |
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MRI SIJ |
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N(%) patients with at least one structural lesion |
16/95 (16.8%) |
24 (24%) |
NS |
0.2 (0.2, 0.3) |
0.8 (0.7,0.0) |
1.4 (0.8, 2.5) |
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N(%) patients with ≥3 subchondral bone erosions |
10 /95 (10.5%) |
32 (32%) |
<0.001 |
0.32 (0.2, 0.4) |
0.9 (0.8, 1.0) |
3.0 (1.6, 5.8) |
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N(%) patients with ≥3 subchondral bone fatty lesions |
11/95 (11.6%) |
29 (29%) |
0.004 |
0.29 (0.2, 0.4) |
0.88 (0.8, 0.9) |
2.5 (1.3, 4.7) |
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N(%) patients with ≥5 subchondral bone erosions or fatty lesions) |
13/95 (13.7%) |
33 (33%) |
0.002 |
0.33 (0.2, 0.4) |
0.9 (0.8, 0.9) |
2.4 (1.4, 4.3) |
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MRI spine |
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N(%) patients with at least one structural lesion |
49 (50.0%) |
42/99 (42.4%) |
NS |
0.4 (0.3, 0.5) |
0.5 (0.4, 0.6) |
0.8 (0.6, 1.2) |
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N(%) patients with ≥3 subchondral bone erosions |
6 (6.1%) |
7/99 (7.1%) |
NS |
0.1 (0.0, 0.1) |
0.9 (0.9, 1.0) |
1.2 (0.4, 3.3) |
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N(%) patients with ≥3 subchondral bone fatty lesions |
21(21.4%) |
15/99(15.2%) |
NS |
0.2 (0.1, 0.2) |
0.8 (0.7, 0.9) |
0.7 (0.4, 1.23 |
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N(%) patients with ≥5 subchondral bone fatty lesions |
8 (8.2%) |
21/99 (21.2%) |
0.02 |
0.2 (0.1,0.3) |
0.9 (0.8, 0.9) |
2.5 (1.2, 5.4) |
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N(%) patients with ≥5 subchondral bone erosions OR fatty lesions |
19 (19.4%) |
11 /99 (11.1%) |
NS |
0.1 (0.1, 0.2) |
0.8 (0.7, 0.9) |
0.6 (0.3, 1.1) |
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Conclusion: Presence of at least 3 erosions at the MRI-SIJ and at least 5 fatty lesions at the MRI-spine seemed to performed well for axSpA recognition. This suggests that these definitions might be considered (in the future) to be integrated in axSpA classification criteria
To cite this abstract in AMA style:
Molto A, Gossec L, Foltz V, Beaufort R, Laredo JD, Richette P, Dieude P, Goupille P, Feydy A, Dougados M. Erosions at the Sacroiliac Joints and Fatty Lesions at the Spine Are the Most Discriminant Lesions for Recent Onset Axial Spondyloarthritis Recognition [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/erosions-at-the-sacroiliac-joints-and-fatty-lesions-at-the-spine-are-the-most-discriminant-lesions-for-recent-onset-axial-spondyloarthritis-recognition/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/erosions-at-the-sacroiliac-joints-and-fatty-lesions-at-the-spine-are-the-most-discriminant-lesions-for-recent-onset-axial-spondyloarthritis-recognition/