Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Pain has found to be related to inflammatory lesions in thoracic, lumbar and sacroiliac joints (SIJ) sites and to structural lesions in the SIJ site in the DESIR cohort. Our aim was to evaluate if localisation of back pain, as indicated by patients, is related to location of BME lesions seen on MRI (in spine (MRI-spine) or sacroiliac joints (SIJ) (MRI-SI)) in patients with chronic back pain.
Methods: Chronic back pain patients (≥3 months, ≤2 years, onset <45 years) recruited from 5 participating centres were included in the SPondyloArthritis Caught Early (SPACE)-cohort. Pain was indicated by patients at different sites (thoracic, lumbar, buttock, total spine). Patients underwent MRI-spine and MRI-SI. On MRI-spine anterior/posterior BME and fatty lesions suggestive of spondylitis were scored when visible on ≥2 consecutive slices. For any other structural lesion (erosions or syndesmophytes), suggestive of spondylitis, presence on ≥ 1 slice was sufficient. On MRI-SI, BME, fatty lesions, sclerosis and erosions, suggestive of spondylitis, were scored when ≥1 lesion was present on ≥2 consecutive slices or >1 lesion on 1 slice. Presence of ankylosis on ≥1 slice was scored. MRIs were scored independently by 3 blinded, well calibrated readers. Agreement of 2/3 readers was used. Association between pain site and BME location was assessed by logistic regression analysis adjusted for gender, HLA-B27 and age at onset of back pain resulting in adjusted Odds Ratios (OR).
Results: In 296 patients, data of the location of pain, MRI-spine (n=293) and MRI-SI (n=288) was available. Mean age at pain onset was 28.9 years, 35.1% male, 38.5% HLA-B27+ and 41.9% fulfilled the ASAS axSpA classification criteria. The prevalence of pain and lesions is shown in the table. The ORs of pain and MRI lesions at same site for the different patient group are shown in the table. Pain in the thoracic site was significantly associated with BME lesions at the same site in the whole patient group. Similar ORs were found in the no-SpA and axSpA subgroups, though not significant due to the lower amount of patients. Pain was significantly associated with fatty and any structural lesions in the buttock/SIJ site in the axSpA supgroup (see table).
Conclusion: The localisation of pain in the spine (thoracic, lumbar, buttock or total spine), as indicated by the patient, is significantly related to the location of BME lesions in thoracic site in patients with chronic back pain. In addition, in the subgroup with axSpA patients there is a significant relation between buttock pain and any structural lesions seen on MRI-SI.
Reference: 1Blachier M. ARD 2013 Jun;72(6):979-985 Aug 14
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Prevalence of pain and lesions |
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Back pain |
BME lesions |
Fatty lesions |
Any structural lesion |
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Cervical |
ND |
5 (1.7%) |
9 (3%) |
16 (5.4%) |
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Thoracic |
108 (36.5%) |
52 (17.6%) |
45 (15.2%) |
80 (27%) |
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Lumbar |
244 (82.4%) |
65 (22%) |
33 (11.1%) |
59 (19.9%) |
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Buttock/SIJ |
100 (33.8%) |
67 (22.6%) |
36 (12.2%) |
49 (14.2%) |
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Total spine |
10 (3.4%) |
0 |
4 (1.4%) |
8 (2.7%) |
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Any site in the spine |
296 (100%) |
95 (32.1%) |
60 (25%) |
101 (34.1%) |
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Odds ratios of pain at the same site |
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OR (CI) all patients (n=296) |
OR (CI) axSpA patients (n=124) |
OR (CI) no-SpA patients (n=172) |
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BME lesions |
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Thoracic site |
2.07 (1.08–3.95;p<0.03) |
2.11 (0.87–5.15) |
2.54 (0.91–7.05) |
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Lumbar site |
1.39 (0.65–3.11) |
1.26 (0.47–3.40) |
1.75 (0.37–8.35) |
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Buttock/SIJ site |
0.63 (0.34–1.16) |
0.55 (0.23–1.28) |
0.27 (0.06–1.28) |
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Fatty lesions |
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Thoracic site |
1.10 (0.54–2.24) |
1.23 (0.49–3.06) |
1.13 (0.35–3.62) |
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Lumbar site |
0.62 (0.26–1.51) |
0.76 (0.23–2.44) |
0.38 (0.92–1.60) |
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Buttock/SIJ site |
1.06 (0.49–2.30) |
3.71 (1.15–11.96; p<0.03) |
0.57 (0.25–1.28) |
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Any structural lesion |
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Thoracic site |
1.23 (0.71–2.14) |
1.20 (0.53–2.70) |
1.49 (0.67–3.32) |
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Lumbar site |
0.99 (0.47–2.15) |
0.74 (0.27–2.01) |
1.08 (0.29–4.07) |
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Buttock/SIJ site |
1.62 (0.95–2.78) |
5.10 (1.45–17.92; p<0.01) |
0.56 (0.25–1.27) |
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Disclosure:
M. de Hooge,
None;
R. van den Berg,
None;
F. van Gaalen,
None;
V. Navarro-Compán,
None;
M. Reijnierse,
None;
K. Fagerli,
None;
M. C. Turina,
None;
M. van Oosterhout,
None;
R. Ramonda,
None;
T. Huizinga,
None;
D. van der Heijde,
None.
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