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Abstract Number: 1124

Lumbar Degenerative Changes In The Spondyloartritis Caught Early Cohort

F. de Bruin1, S. ter Horst2, Karen Fagerli3, R. Landewe4, M. van Oosterhout5, J.L Bloem1, D. van der Heijde6 and M. Reijnierse1, 1Radiology, Leiden University Medical Center, Leiden, Netherlands, 2LUMC, Leiden, Netherlands, 3Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 4Division of Clinical Immunology and Rheumatology, Academic Medical Center / University of Amsterdam, Amsterdam, Netherlands, 5Groene Hartziekenhuis, Gouda, Netherlands, 6Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: MRI, spondylarthritis and x-ray

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Session Information

Title: Imaging of Rheumatic Diseases II: Imaging in Spondyloarthritis and Osteoarthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

The early diagnosis of axial spondyloarthritis (axSpA) is difficult, however new classification criteria are available, the ASAS axSpA criteria. The SPondyloArthritis Caught Early (SPACE) cohort, back pain ≥ 3 months, ≤ 2 years, onset < 45 years, was set up to diagnose SpA early. In addition to SpA associated features on MRI and conventional radiographs, degenerative changes of the spine might be clinically important. Therefore we describe the prevalence of lumbar degenerative changes in axSpA patients (ASAS+) and no-axSpA patients (ASAS-).

Methods:

In 276 patients (pts) 1.5T T1 and STIR MRI and in 257 pts lateral radiography images of the lumbar spine and antero-posterior radiographs of the pelvis were available. Two readers scored for: disc degeneration (5 point scale of Pfirrmann), High intensity zone, bulging (extrusion and protrusion), herniation (central and lateral), Modic changes (3 point scale) and Schmorl’s nodes on MRI and loss of disc height, facet joint osteoarthrose (FJOA), osteophytes, sclerosis, Schmorl’s nodes, and sacralization on radiography.  Kappa was calculated for inter rater agreement. Chi-square test was used to test for differences between pts groups.

Results:

Table 1 lists the number of patients from the whole cohort with none, one or multiple lesions.

 

 

0

Number of lesions

1

 

≥2

Pfirrmann*

143 (51,8%)

64 (23,2%)

69 (25%)

HIZ

86 (31,2%)

89 (32,2%)

101 (36,6%)

Extrusion

218 (79,0%)

46 (16,7%)

12 (4,3%)

Protrusion

170 (61,6%)

70 (25,4%)

37 (13,4%)

Stenosis central

274 (99,3%)

2 (0,7%)

0 ()

Stenosis lateral

262 (94,9%)

14 (5,1%)

0 ()

Modic

237 (85,9%)

35 (12,7%)

4 (1,4%)

Schmorl 

111 (40,2%)

34 (12,3%)

131 (47,5%)

Loss of Disc Height

200 (66,9%)

53 (17,7%)

46 (15,4%)

FJOA

277 (92,6%)

21 (7,0%)

1 (0,3%)

Osteophytes

227 (75,9%)

49 (16,4%)

15 (5,0%)

Schmorl node

275 (92,0%)

13 (4,3%)

9 (3,0%)

Sclerosis

257 (86,0%)

34 (11,4%)

6 (2,0%)

LSTV

213 (71,2%)

86 (28,8%)

NA

On MRI, 133 pts (48%) had lower signal intensity of at least one (lumbar) intervertebral disc with or without loss of height (Pfirrmann class 3). No difference between ASAS+ (47/112, 42%) and ASAS- (86/163, 53%) pts was found (P=.078). Modic changes were seen in 39 pts (14%) and was statistically significant more present in ASAS- pts (29 vs 10, P=..038).

On X-ray, loss of disc height was found in 59 pts (23%), in 40 ASAS- pts and in 19 ASAS+ pts (P=.047). Osteophytes were present in 48 pts (19%, 13 ASAS+ and 35 ASAS-) and statistically significant more in ASAS- pts (P=.028).

Conclusion:

Pts have a high prevalence of degenerative changes. Nearly half of all pts have dehydrated intervertebral discs, a smaller proportion has loss of height on both MRI and conventional images. ASAS- pts have a higher prevalence of Modic changes, loss of disc height and osteophytes than ASAS+ pts. Prevalence of Modic changes was higher than reported in literature. The high prevalence of degenerative changes in ASAS- pts might be an explanation for the back pain, although clinical correlation is required.


Disclosure:

F. de Bruin,
None;

S. ter Horst,
None;

K. Fagerli,
None;

R. Landewe,

Pfizer, Janssen, Merck, Abbott,

2,

Pfizer, Janssen, Merck, Abbott, Amgen, Astra, BMS, Centocor, GSK, UCS, Vertex,

5;

M. van Oosterhout,
None;

J. L. Bloem,
None;

D. van der Heijde,
None;

M. Reijnierse,
None.

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