ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 573

Identification of Factors Associated with Magnetic Resonance Images Changes Suggestive of Axial Spondyloarthritis in the Axial Skeleton of Individuals < 45 Years – Evaluation of Data from a Large Community Study

Xenofon Baraliakos1, Adrian Richter 2, Daniel Feldmann 3, Anne Ott 3, Robin Buelow 4, Carsten Oliver Schmidt 5 and Jürgen Braun 6, 1Rheumazentrum Ruhrgebiet-Ruhr-University Bochum, Herne, Germany, Herne, Germany, 2Institute for Community Medicine, University Greifswald, and German Rheumatism Research Center, Berlin, Berlin, Germany, 3Rheumazentrum Ruhrgebiet/Ruhr University Bochum, Herne, Germany, Herne, Germany, 4Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany, 5Institute for Community Medicine, University Greifswald, Greifswald, Germany, 6Rheumazentrum Ruhrgebiet/Ruhr University, Herne, Germany

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: ,

Session Information

Date: Sunday, November 10, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Axial Spondyloarthritis, Clinical Features

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Active (bone marrow edema, BME) and structural (fatty lesions, FL) lesions in the spinal and the sacroiliac joints (SIJ), as assessed by magnetic resonance imaging (MRI), have been described in patients with axSpA but may also occur in healthy individuals (1,2).

We assess factors associated with occurrence of BME and FL in spinal- and SIJ-MRIs in a population-based study.

Methods: Spinal- (sagittal T1/T2-) and SIJ- (semi-coronal STIR sequences) MRIs were evaluated by two trained blinded readers. MRIs were analyzed for BME (SIJ and spine) and FL (spine) ‘positive’ for axSpA. Degenerative lesions were excluded. BME was quantified using Berlin MRI scores. Clinical information included, sex, smoking (yes/no), spinal pain (NRS≥4/10 in last 3 months), CRP, HLA-B27 and body mass index (BMI) categories (WHO definition of under- (cat.1), normal (cat.2), overweight (cat.3)). Associations between clinical factors and MRI lesions were analyzed for the presence/absence of lesions using univariate logistic regression and for number and size of lesions using negative binomial count regression.

Results: MRIs of 793 participants (49.4% male, 5.7% CRP-positive, 8.4% HLA-B27+, 62.7% ever smokers) were evaluated. BME lesions were found in 136 SIJ-MRIs (17.2%) and 218 (27.5%) spinal MRIs, and FL in 645 spinal MRIs (81.3%). The median hsCRP was 0.09 [0.05-0.20] mg/dl, 45 (6.4%) had an elevated hsCRP level (cut off < 5 mg/dl); 8.9% were HLA-B27+; 62.7% reported smoking, 45.0% were in the under- or normal weight BMI category. 36.2% in the overweight and 18.8% in the obese BMI category. More and larger SIJ-BME lesions were independently associated with HLA-B27+ (exp(β)=2.8, 1.5-4.9), spinal pain (exp(β)=1.7, 1.2-2.6), and higher BMI (cat. 1 vs 3, exp(β)=1.7, 1.0-3.0). Also, more and larger spinal BME were associated with older age (exp(β)=1.5, 1.2-2.0), while more and larger spinal FL were associated with higher BMI, (cat. 1 to cat. 3 (exp(β)=1.9, 1.5-2.2), older age (exp(β)=1.6, 1.5-1.8) and male sex (exp(β)=1.4, 1.2-1.6). Presence of spinal BME (OR 1.3, 1.0±1.7) and/or spinal FL (OR 1.7, 1.3-2.3) was associated with older age, while alone were associated with a higher BMI (cat. 1 to cat.3, OR 3.3, 1.8-6.1). In total, 22 subjects (16.2%) had large ( >33% of surface involvement) and 114 had small (≤33% of surface involvement) SIJ-BME. Large SIJ-BME were found in 4.5% HLA-B27-positive vs. 2.6% HLA-B27-negative subjects (p=0.40). Overall, 35.3% quadrants with SIJ-BME was located in the upper sacral quadrant. Most SIJ lesions (83.4%) were small. For spinal BME, 42% was located in the lower (T7/8-T11/12) thoracic spine. Most spinal lesions (90.9%) were small.

Conclusion: In this large population-based study, higher numbers of large SIJ-BME lesions were significantly associated with HLA-B27, back pain and BMI. Spinal BME and FL were associated with older age, male sex and BMI but not HLA-B27. The association for HLA-B27 was only shown on the quadrant but not on the patient level.

  1. Weber U et al, Arthritis Rheumatol 2018
  2. De Winter J et al, Arthritis Rheumatol 2018
Disclosure: X. Baraliakos, AbbVie, 2, 5, 8, Abbvie, 2, 5, 8, BMS, 2, 5, 8, 9, Bristol-Myers Squibb, 2, 5, 8, Celgene, 2, 5, 8, 9, Chugai, 2, 5, 8, 9, Janssen, 2, 5, 8, 9, Lilly, 2, 8, 9, Merck, 2, 5, 8, MSD, 2, 5, 8, 9, Novartis, 2, 5, 8, 9, Novatis, 2, 5, 8, Pfizer, 2, 5, 8, 9, UCB, 2, 5, 8, 9, UCB Pharma, 2, 5, 8, Werfen, 2, 5, 8; A. Richter, None; D. Feldmann, None; A. Ott, None; R. Buelow, None; C. Schmidt, None; J. Braun, Abbott, 2, 5, AbbVie, 2, 5, 6, 8, Amgen, 2, 5, 8, Baxter, 2, 5, 8, Biogen, 2, 8, 9, BMS, 2, 5, 8, Boehringer, 2, 5, 8, Bristol-Myers Squibb, 2, 5, Celgene, 2, 3, 5, 8, Celltrion, 2, 5, 8, Centocor, 2, 5, 8, Chugai, 2, 5, 8, Eli Lilly and Company, 2, 5, 8, Hexal, 2, 5, 8, Janssen, 2, 5, 8, Johnson & Johnson, 2, 5, Medac, 2, 5, 8, MSD, 2, 5, MSD (Schering-Plough), 2, 5, 8, Mundipharma, 2, 5, 8, Mylan, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, Pfizer (Wyeth, Hospira), 2, 5, 8, Roche, 2, 5, 8, Sanofi-Aventis, 2, 5, 8, UCB Pharma, 2, 5, 8.

To cite this abstract in AMA style:

Baraliakos X, Richter A, Feldmann D, Ott A, Buelow R, Schmidt C, Braun J. Identification of Factors Associated with Magnetic Resonance Images Changes Suggestive of Axial Spondyloarthritis in the Axial Skeleton of Individuals < 45 Years – Evaluation of Data from a Large Community Study [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/identification-of-factors-associated-with-magnetic-resonance-images-changes-suggestive-of-axial-spondyloarthritis-in-the-axial-skeleton-of-individuals-45-years-evaluation-of-data-from-a-large-c/. Accessed .

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