Is Sacroiliac Imaging the All-Decisive Factor in the Diagnosis of Early Axial Spondyloarthritis? Data from the Spondyloarthritis Caught Early (SPACE) Cohort

Zineb Ez-Zaitouni¹, Robert B.M. Landewé², Miranda van Lunteren¹, Pauline Bakker¹, Karen M Fagerli³, Roberta Ramonda⁴, Lennart TH Jacobsson⁵, Désirée van der Heijde⁶ and Floris van Gaalen⁷, ¹Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²Amsterdam Rheumatology & Immunology Center, Amsterdam, Netherlands, ³Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ⁴Rheumatology Unit, University of Padova, Padova, Italy, ⁵Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, ⁶Leiden University Medical Center, Leiden, Netherlands, ⁷Rheumatology, Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Ankylosing spondylitis (AS), axial spondyloarthritis and diagnostic imaging, Imaging

Session Information

Date: Monday, November 6, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II

Session Type: ACR Poster Session B

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

Background/Purpose:

Imaging of the sacroiliac joints plays a pivotal role in the recognition of axSpA. However, interpretation of imaging is challenging and has led to concerns of overreliance on imaging possibly leading to incorrect diagnoses of axSpA. Given these controversies, surprisingly little is known about how rheumatologists actually integrate sacroiliac imaging results in the diagnostic work-up of patients suspected of axSpA. Therefore, we evaluated the influence of sacroiliac imaging on diagnosis and rheumatologists’ confidence in diagnosis of patients with chronic back pain (CBP) suspected of early axSpA.

Methods:

Baseline data from 513 patients from the SPACE cohort which includes patients with CBP (≥3 months, ≤2 years, onset <45 years) were analysed. All patients underwent a full work-up including MRI and radiography of the sacroiliac joints. Rheumatologists were asked to provide a diagnosis before and after taking imaging into account. Also, a level of confidence (LoC) regarding the diagnosis on an 11-point numerical scale (0: not confident at all to 10: very confident) was documented.

Results:

Before imaging, 317/513 (62%) CBP patients were diagnosed with axSpA. Of these patients, 178/317 (56%) did not have sacroiliitis on MRI or radiography, and after imaging rheumatologists changed diagnosis to ‘no axSpA’ in 81/178 (46%) patients. Of the patients without axSpA before imaging, 35/196 (18%) had sacroiliitis on imaging. After imaging, 28/35 (80%) patients were diagnosed with axSpA and in 7/35 (20%) patients the diagnosis remained ‘no axSpA’ In general, diagnostic confidence increased significantly following imaging (all patients’ average LoC 6.2 to 7.4, p<0.001). Overall, imaging results not in line with the diagnosis (n=213) before imaging led to a change in diagnosis in 109 (51%) patients.

Conclusion:

In CBP patients suspected of axSpA sacroiliac imaging increases diagnostic confidence. However, the number of changes in diagnosis suggests that imaging is an important but not the all-decisive factor in axSpA diagnosis.

Disclosure: Z. Ez-Zaitouni, None; R. B. M. Landewé, None; M. van Lunteren, None; P. Bakker, None; K. M. Fagerli, None; R. Ramonda, None; L. T. Jacobsson, None; D. van der Heijde, None; F. van Gaalen, None.

To cite this abstract in AMA style:

Ez-Zaitouni Z, Landewé RBM, van Lunteren M, Bakker P, Fagerli KM, Ramonda R, Jacobsson LT, van der Heijde D, van Gaalen F. Is Sacroiliac Imaging the All-Decisive Factor in the Diagnosis of Early Axial Spondyloarthritis? Data from the Spondyloarthritis Caught Early (SPACE) Cohort [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/is-sacroiliac-imaging-the-all-decisive-factor-in-the-diagnosis-of-early-axial-spondyloarthritis-data-from-the-spondyloarthritis-caught-early-space-cohort/. Accessed .

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