Longitudinal Assessment of MRI of the Sacroiliac Joints in the ASAS Classification Cohort: Evolution of Diagnostic Features and Predictive Utility for Axial Spondyloarthritis

Walter P. Maksymowych¹, Xenofon Baraliakos ², Manouk de Hooge ³, Iris Eshed ⁴, Susanne Juhl Pedersen ⁵, Ulrich Weber ⁶, Joachim Sieper ⁷, Stephanie Wichuk ⁸, Denis Poddubnyy ⁹, Martin Rudwaleit ¹⁰, Désirée van der Heijde ¹¹, Robert B.M. Landewé ¹², Joel Paschke ¹³, Robert Lambert ⁸ and Mikkel Østergaard ¹⁴, ¹University of Alberta/CARE ARTHRITIS, Edmonton, AB, Canada, ²Rheumatology Department, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany, ³Ghent University Hospital, Ghent, Belgium, ⁴Sheba Medical Center, Tel Aviv, Israel, ⁵Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, Copenhagen, Hovedstaden, Denmark, ⁶Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark, ⁷Charité Universitätsmedizin Berlin, Germany, Berlin, Germany, ⁸University of Alberta, Edmonton, Canada, ⁹Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany, Berlin, Germany, ¹⁰Klinikum Bielefeld, Charité Berlin, Gent University, Bielefeld, Germany, ¹¹Leiden University Medical Center, Leiden, Netherlands, ¹²Amsterdam University Medical Center, Amsterdam, Netherlands, ¹³CARE Arthritis, Edmonton, Canada, ¹⁴Copenhagen Center for Arthritis Research, University of Copenhagen, Copenhagen, Denmark

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: axial spondyloarthritis, diagnosis and classification criteria, Magnetic resonance imaging (MRI)

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: Follow up of the ASAS Classification Cohort (CC) indicated a high positive predictive value for the ASAS classification criteria derived from baseline patient and imaging data¹. Moreover, diagnosis of axSpA was changed by the local rheumatologist in only 11.2% of patients who were available at follow up at 4.4 years. This has raised potential concerns regarding diagnostic ascertainment bias. We aimed to determine the evolution of MRI features of axSpA from baseline to follow up by central reading of scans from this cohort, whether this reflects diagnostic assignment by the local rheumatologist, and the predictive utility of baseline MRI considered indicative of axSpA.

Methods: MRI images were available from 108 cases who had MRI performed at baseline and 4.4 years follow up and also had a local rheumatologist diagnosis at both time points. Eight experienced readers from the ASAS MRI group recorded MRI lesions in an eCRF that comprised global assessment (MRI indicative of axSpA: yes or no, active and/or structural lesion typical of axSpA present/absent according to ASAS definitions), whether the features met the criteria for an ASAS positive MRI, and detailed scoring of lesions per SIJ quadrant (SPARCC SIJ quadrantic method). MRI data from at least 2 readers and from the majority (≥5/8) was used to calculate positive and negative predictive values (PPV, NPV).

Results: MRI was considered indicative of axSpA in 52/108 (48.1%) at baseline and in 47/86 (54.7%) diagnosed as axSpA by the rheumatologist. Change in MRI diagnosis was recorded in only 10/108 (9.3%) of cases (4 from yes to no, and 6 from no to yes for axSpA) according to agreement by at least 2 readers (Table 1). Change in MRI diagnosis was recorded in only 3 cases according to a majority of readers. Change in rheumatologist diagnosis was recorded in 9/108 (8.3%), 2 of which had a change in MRI diagnosis. Baseline MRI had very high PPV for follow up diagnosis of axSpA (Table 2).

Conclusion: The lack of change in diagnostic ascertainment of rheumatologists over follow up of the ASAS-CC is supported by the evaluation of MRI scans by central reading. A positive MRI at baseline had very high PPV for a follow up diagnosis of axSpA.
1. Sepriano et al. ARD 2016;75:1034-42.

Table 1

Table 2

Disclosure: W. Maksymowych, Abbvie, 2, 5, 8, AbbVie, 2, 5, 8, AbbVie Inc., 2, 5, 8, Abbvie, Amgen, Eli Lilly, Janssen, Merck, Pfizer, Synarc, Sanofi, and UCB Pharma ], 2, 5, 8, Amgen, 2, 5, 8, Boehringer, 5, 8, Boehringer-Ingelheim, 5, 8, Canadian Research and Education Arthritis, 6, CARE ARTHRITIS, 3, 6, 9, Celgene, 5, 8, Eli Lilly, 2, 5, 8, Galapagos, 5, 8, Janssen, 2, 5, 8, Lilly, 2, 5, 8, Merck, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Sanofi, 2, 5, 8, Synarc, 2, 5, 8, UCB, 2, 5, 8, UCB Pharma, 2, 5, 8; X. Baraliakos, AbbVie, 2, 4, 5, 8, Biocad, 2, 5, Bristol-Myers Squibb, 2, 4, 5, 8, Celgene, 2, 5, 8, Chugai, 2, 5, Eli Lilly, 2, 5, Galapagos, 2, 5, 8, Janssen, 2, 5, 8, Lilly, 2, 5, 8, MSD, 2, 5, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 2, 5, UCB, 2, 5, 8; M. de Hooge, None; I. Eshed, None; S. Juhl Pedersen, None; U. Weber, None; J. Sieper, AbbVie, 5, 8, Eli Lilly and Company, 5, 8, Janssen, 5, 8, Lilly, 5, 8, Merck, 5, 8, Novartis, 5, 8; S. Wichuk, None; D. Poddubnyy, Abbvie, 2, 5, 8, AbbVie, 2, 5, 8, BMS, 5, 8, Celgene, 5, 8, Eli Lilly, 5, 8, Eli Lilly and Company, 2, 5, 8, Lilly, 5, 8, MSD, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 5, 8, UCB, 5, 8; M. Rudwaleit, Abbott, 5, AbbVie, 5, 8, BMS, 5, 8, Bristol Myers-Squibb, 5, 8, Celgene, 5, 8, Chugai, 5, 8, Eli Lilly, 5, 8, Eli Lily, 5, 8, Janssen, 5, 8, MSD, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Roche, 5, 8, UCB Pharma, 5, 8; D. van der Heijde, AbbVie, 5, AbbVie, Amgen, Astellas, AstraZeneca, BMS, 5, Amgen, 5, Astellas, 5, 9, Astellas Pharma, 5, AstraZeneca, 5, BMS, 5, Boehringer Ingelheim, 5, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB, 5, Boehringer-Ingelheim, 5, Bristol-Myers Squibb, 5, Celgene, 5, Daiichi, 5, 9, Daiichi Sankyo, 5, Director of Imaging Rheumatology, 6, Director of Imaging Rheumatology bv, 9, Eli Lilly, 5, Eli Lilly and Company, 5, Eli-Lilly, 5, Galapagos, 5, Gilead, 5, Gilead Sciences, Inc., 5, GlaxoSmithKline, 5, Glaxo-Smith-Kline, 5, GSK, 5, 8, Imaging Rheumatology bv, 9, Imaging Rheumatology BV, 9, Imaging Rheumatology bv., 9, Janssen, 5, 8, Janssen Pharmaceutica, 5, Merck, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Pfizer Inc, 5, Regeneron, 5, 8, Rheumatology bv, 4, 9, Roche, 5, 8, Sanofi, 5, 8, Takeda, 5, 8, Takeda Pharmaceutical Company, 5, UCB, 5, 8, UCB Pharma, 5; R. Landewé, Abbott, 2, 5, 8, Abbott, Amgen, Bristol-Myers Squibb, Centocor, Merck, Pfizer, Roche, Schering-Plough, UCB, Wyeth, 8, Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB, Wyeth, 2, AbbVie, 5, Abbvie, 5, 8, AbbVie, Ablynx, Amgen, Astra-Zeneca, Bristol-Myers Squibb, Centocor, GSK, Novartis, Merck, Pfizer, Roche, Schering- Plough, UCB, Wyeth, 5, Ablynx, 5, Amgen, 2, 5, 8, AstraZeneca, 5, BMS, 5, 8, Bristol Myers Squibb, 5, 8, Bristol-Myers Squibb, 5, Celgene, 5, 8, Centocor, 2, 5, 8, Director of Rheumatology Consultancy BV, which is a registered company under Dutch law, 6, Eli Lilly, 5, 8, Eli Lilly and Company, 5, Eli-Lilly, 5, 8, Galapagos, 5, 8, Gilead, 5, 8, GlaxoSmithKline, 5, Glaxo-Smith-Kline, 5, 8, Janssen, 5, 8, Merck, 5, 8, MSD, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Rheumatology bv, 4, Rheumatology Consultancy BV, 9, Roche, 2, 5, 8, Schering-Plough, 2, 5, 8, UCB, 5, 8, UCB Pharma, 2, 5, 8, Wyeth, 2, 5, 8; J. Paschke, None; R. Lambert, None; M. Østergaard, AbbVie, 2, 8, 9, Abbvie, 2, 5, 8, Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, UCB, 5, 8, Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, 5, 8, Abbvie, Celgene, Centocor, Merck, and Novartis, 2, Abbvie, Celgene, Centocor, Merck, Novartis, 2, BMS, 2, 5, 8, 9, Boehringer Ingelheim, 5, 8, Boehringer-Ingelheim, 2, 8, Boehringer-ingelheim, 9, Celgene, 2, 5, 8, Centocor, 2, Eli Lilly, 5, 8, 9, Eli Lilly and Company, 5, 8, Eli-Lilly, 2, 8, Hospira, 2, 5, 8, Janssen, 2, 5, 8, 9, Merck, 2, 5, 8, 9, Novartis, 2, 5, 8, Novo, 2, 5, 8, Novo Nordisk, 5, 8, Orion, 2, 5, 8, Pfizer, 2, 5, 8, 9, Regeneron, 2, 5, 8, Roche, 2, 5, 8, roche, 9, Sandoz, 2, 8, Sanofi, 2, 8, UCB, 2, 5, 8.

To cite this abstract in AMA style:

Maksymowych W, Baraliakos X, de Hooge M, Eshed I, Juhl Pedersen S, Weber U, Sieper J, Wichuk S, Poddubnyy D, Rudwaleit M, van der Heijde D, Landewé R, Paschke J, Lambert R, Østergaard M. Longitudinal Assessment of MRI of the Sacroiliac Joints in the ASAS Classification Cohort: Evolution of Diagnostic Features and Predictive Utility for Axial Spondyloarthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/longitudinal-assessment-of-mri-of-the-sacroiliac-joints-in-the-asas-classification-cohort-evolution-of-diagnostic-features-and-predictive-utility-for-axial-spondyloarthritis/. Accessed .

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