Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Inflammatory lesions of the spine are not included in the ASAS definition of a positive MRI for fulfilment of the ASAS axial spondyloarthritis (axSpA) criteria1. However, inflammatory lesions in the spine on MRI (MRI-spine) may occur in the absence of affected sacroiliac joints (SIJ). Therefore the aim of this study is to determine the prevalence of inflammatory lesions on MRI-spine and to investigate if axSpA patients with inflammatory lesions in the spine only exist.
Methods: The SPondyloArthritis Caught Early (SPACE)-cohort includes patients with chronic back pain (≥3 months, ≤2 years, onset <45 years) recruited from 5 participating centres in Europe. All patients underwent MRI of the SIJ (MRI-SI) and MRI-spine scored by 3 well-calibrated readers independently. MRI-SI were scored according to the ASAS definition1 (the presence of ≥1 lesion on ≥2 consecutive slices or the presence of >1 lesion on a single slice). Inflammatory lesions on MRI-spine suggestive of spondylitis were scored when visible on ≥2 consecutive slices and according to the ASAS/OMERACT consensus definition2 (the presence of ≥3 lesions on ≥2 consecutive slices). Lesions were considered present if 2/3 readers agreed.
Results: All patients with MRI-spine (n=306) were included to determine the prevalence of BME lesions in patients grouped according to the ASAS axSpA criteria (radiographic, non-radiographic (imaging & clinical arm), possible SpA (presence of ≥1 SpA features with a Likelihood Ratio (LR+) of ≥6 or ≥2 SpA features with a LR+ <6) and no-SpA (see table). In 292 patients MRI-SI and MRI-spine data were both available. There were 51 patients with a positive MRI-spine, of which 30 patients (58.8%) had a negative MRI-SI. Nine of these 30 patients fulfilled the ASAS axSpA criteria via the clinical-arm. Of the remaining 21 patients, 3 patients had no SpA features at all, 7 patients had 1 SpA feature, 8 patients had 2 SpA features, 1 patient had 3 SpA features and 2 patients had 4 SpA features. Only the sole patient with 4 SpA features had a probability (calculated from the LR+) ≥80%. When using the ASAS consensus definition of a positive MRI-spine in post-test probability calculations, another 6 patients would reach a probability ≥80% of having axSpA.
Conclusion: A cut-off of ≥3 BME lesions discriminates well between patients with and without axSpA. A positive MRI-spine can be present in patients without inflammation on MRI-SI. MRI-spine might have (limited) additional value to MRI-SI in a group of patients with a certain level of suspicion of axSpA.
Reference: 1Rudwaleit ARD 2009;68:1520-7 2Hermann ARD 2012;71:1278-88
|
MRI-Spine
|
AxSpA (ASAS axSpA) n=126 |
Possible axSpA (≥1 SpA features with LR+ ≥6 or 2 with LR+ <6) n=116 |
No-SpA n=64 |
||
|
Imaging-arm n=72 |
Clinical-arm, n=54 |
||||
|
|
mNY+ n=26 |
mNY- n=46 |
|||
|
BME lesion >1 |
12 (46.2%) |
23 (50%) |
17 (31.5%) |
29 (25%) |
17 (26.6%) |
|
BME lesion >2 |
10 (38.5%) |
16 (34.8%) |
11 (20.4%) |
21 (18.1%) |
9 (14.1%) |
|
BME lesion >3 |
8 (30.8%) |
11 (23.9%) |
3 (5.6%) |
12 (10.3%) |
4 (6.3%) |
|
BME lesion >4 |
7 (26.9%) |
7 (15.2%) |
2 (3.7%) |
5 (4.3%) |
3 (4.7%) |
|
BME lesion >5 |
6 (23.1%) |
4 (8.7%) |
1 (1.9%) |
3 (2.6%) |
2 (3.1%) |
|
BME lesion >6 |
4 (15.4%) |
3 (6.5%) |
1 (1.9%) |
2 (1.7%) |
1 (1.6%) |
|
BME lesion >7 |
4 (15.4%) |
2 (4.3%) |
1 (1.9%) |
2 (1.7%) |
0 |
Disclosure:
M. de Hooge,
None;
R. van den Berg,
None;
M. Reijnierse,
None;
V. Navarro-Compán,
None;
F. van Gaalen,
None;
K. Fagerli,
None;
M. C. Turina,
None;
M. van Oosterhout,
None;
R. Ramonda,
None;
T. Huizinga,
None;
D. van der Heijde,
None.
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-inflammatory-lesions-mri-spine-in-patients-with-chronic-back-pain-of-%e2%89%a42-years-duration-included-in-the-space-cohort/