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Abstract Number: 1515

Influence Of Taking Structural Lesions Into Account In Addition To Inflammatory Lesions On MRI Of The Sacroiliac Joints On The Classification Of Patients With Possible Axial Spondyloarthritis

Rosaline van den Berg1, Manouk de Hooge1, Floris van Gaalen1, Victoria Navarro-Compán1, Monique Reijnierse2, Karen Fagerli3, Robert Landewé4,5, Maikel van Oosterhout6, Roberta Ramonda7, Tom Huizinga1 and Désirée van der Heijde1, 1Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 2Radiology, Leiden University Medical Center, Leiden, Netherlands, 3Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 4Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, 5Rheumatology, Atrium Medical Center, Heerlen, Netherlands, 6Rheumatology, GHZ Hospital, Gouda, Netherlands, 7Rheumatology Unit, University of Padova, Padova, Italy

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: classification criteria and spondylarthritis, MRI

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Session Information

Session Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment: II

Session Type: Abstract Submissions (ACR)

Background/Purpose: The ASAS definition of a positive MRI of the sacroiliac joints (MRI-SI+) for the classification of axial spondyloarthritis (axSpA) patients includes inflammatory lesions only1,2. The role of structural lesions on MRI-SI in classifying patients is unclear1. We explored the potential role of structural lesions on MRI-SI in classifying axSpA patients.

Methods: Patients with back pain (≥3 months, ≤2 years, onset <45 years) from the 5 centers in the SPondyloArthritis Caught Early (SPACE)-cohort were included. Patients underwent MRI-SI. MRI were scored by 3 well-calibrated readers independently for ankylosis, sclerosis, erosions, and fatty lesions (FL) (T1-weighted images; STIR viewed simultaneously). Erosions, sclerosis and FL were defined according to the MORPHO definition3 (≥1 lesion on ≥2 consecutive slices or ≥2 lesion on 1 slice). Ankylosis was defined as ≥1 lesion on ≥1 slice. Lesions were considered present if 2/3 readers agreed. MRI was considered positive for several (combinations of) structural lesions (MRI-SI-s+) using cut-offs based on the acceptance of ≤5% false-positives in patients without SpA. Patients are considered as possible axSpA if not fulfilling the ASAS axSpA criteria3, but if ≥1 specific SpA-feature (LR+ >6) or ≥2 less specific SpA-features (LR+ <6) are present4. We classified possible axSpA patients using MRI-SI-s+ instead of MRI-SI+ and calculated the LR product with LR+ 9.0 for MRI-SI-s+ as if MRI-SI+4. Based on the LR product the probability of having axSpA was calculated4.

Results: Only possible axSpA patients with MRI-SI data were included (n=116). Depending on the used MRI-SI-s+ definition, 1% (ankylosis ≥1) to 6% (erosions ≥2 or FL ≥2) of the possible axSpA patients could be classified as axSpA (table). Combining the various definitions of MRI-SI-s+ results in 14 additional patients (12.1%) classified as axSpA (5 patients with probability ≥80%); 5 patients fulfilled 4 of the proposed MRI-SI-s+ definitions. In patients with a high number of SpA-features, using MRI-SI-s+ to calculate the LR product results in a probability ≥80%, making an axSpA diagnosis very likely. However, in patients with only 1 or a few SpA-features, the probability remains <80%.

Conclusion: These explorative data point out that structural lesions on MRI of the SI joints might play a role in classifying possible axSpA patients. However, only few additional patients are classified as axSpA with a high probability while the same number of patients with a low probability would (falsely) be classified if structural lesions would be added to the definition of a positive MRI. Further studies are needed to define the best type/combination and cut-off of structural lesions.

References: 1Rudwaleit ARD 2009;68:1520-7 2Rudwaleit ARD 2009;68:777-83 3Weber A&R 2010;62:3048-58 4Rudwaleit ARD 2004;63:535-43

ASAS axSpA+ in possible axSpA patients if structural lesions are added

Possible axSpA

n=116

Mean (range) no.

SpA-features

Probability

≥80%

Probability

50-79%

Probability

20-49%

Probability

<20%

Ankylosis ≥1

1 (0.9%)

1 (1)

–

–

–

1

Fatty lesions ≥2

7 (6.0%)

2.3 (1-4)

3

1

1

2

Erosion ≥2

7 (6.0%)

2.1 (2-3)

3

1

2

1

Sclerosis ≥1

1 (0.9%)

1 (1)

–

–

–

1

Any structural lesions ≥5

5 (4.3%)

2.4 (1-3)

2

2

–

1

Any structural lesions (except ankylosis) ≥5

4 (3.4%)

2.8 (2-3)

2

2

–

–

Fatty lesions and/or erosions ≥5

4 (3.4%)

2.8 (2-3)

2

2

–

–


Disclosure:

R. van den Berg,
None;

M. de Hooge,
None;

F. van Gaalen,
None;

V. Navarro-Compán,
None;

M. Reijnierse,
None;

K. Fagerli,
None;

R. Landewé,
None;

M. van Oosterhout,
None;

R. Ramonda,
None;

T. Huizinga,
None;

D. van der Heijde,
None.

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