Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: A cut-off value of ³3 inflammatory lesions was suggested by the ASAS/OMERACT group, as positive MRI of the spine (MRI-spine). Moreover, fatty lesions on MRI-spine are associated with axial Spondyloarthritis (axSpA). In this study the aim was to determine the prevalence of inflammatory (BME) and fatty lesions on MRI-spine in patients (pts) with and without axSpA.
Methods: Pts aged 18-50 with inflammatory back pain (³3 months, ²3 years) from 25 participating centers in France were included in the DESIR-cohort (n=708). All available baseline MRIs were independently scored by 2 well-calibrated readers, blinded to any other data. In case of disagreement, an experienced radiologist served as adjudicator. BME and fatty lesions typical for axSpA were scored when visible on ³2 consecutive slices. Prevalence of MRI lesions was calculated based on several cut-offs and lesions were considered present if 2/3 readers agreed.
Results: All pts with symptom onset <45 yrs with MRI-spine (n=549) were included in the analyses. Pts fulfilling the ASAS criteria could either fulfill both arms, only the imaging arm or only the clinical arm. The first 2 groups were subdivided; pts with radiographic sacroiliitis (mNY+) & sacroiliitis on MRI (MRI+), pts with mNY+ & no sacroiliitis on MRI (MRI-), pts without radiographic sacroiliitis (mNY-) & MRI+. BME lesions occur in all different subgroups of the ASAS criteria and in pts without axSpA (table). The prevalence in no SpA group (which can be seen as false positives) is only 6.1%. With a cut-off ³2 BME lesions false positives drop below 5% while the prevalence in the ASAS axSpA groups is still reasonable. Especially prevalence in pts with mNY+ & MRI+ is very high; 61.9% (both arms positive) and 43.8% (imaging arm only positive). Fatty lesions are seen slightly less often seen in all patient groups. However the same trend is seen as with BME lesions; Even with cut-off ³1 the prevalence in no SpA group is low (5.5%), with cut-off ³2 false positives drop below 5% and again pts with mNY+ & MRI+ have the highest percentage of spinal fatty lesions.
Conclusion: In a low percentage of pts without axSpA BME and fatty lesions is found indicating that spinal BME and fatty lesions are specific for patients with axSpA. These lesions are especially prevalent in pts with sacroiliitis on imaging. In this cohort, a cut-off ³2 or ³3 BME lesions and similarly ³2 or ³3 fatty lesions discriminate best between pts with and without axSpA.
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ASAS axSpA
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No SpA N=164 |
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Both arms positive: |
Imaging arm only positive: |
Clinical arm positive N=166 |
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mNY+, MRI+ N=63 |
mNY+, MRI- N=24 |
mNY-, MRI+ N=48 |
mNY+, MRI+ N=16 |
mNY+, MRI- N=15 |
mNY-, MRI+ N=53 |
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BME ³1
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42 (66.7%)
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14 (58.3%)
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14 (29.2%)
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7 (43.8%)
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3 (20.0%)
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7 (13.2%)
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28 (16.9%) |
10 (6.1%) |
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BME ³2
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39 (61.9%)
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10 (41.7%)
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10 (20.8%)
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7 (43.8%)
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2 (13.3%)
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2 (3.8%)
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22 (13.3%) |
7 (4.3%) |
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BME ³3
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32 (50.8%)
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7 (29.2%)
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6 (12.5%)
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5 (31.3%)
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1 (6.7%)
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1 (1.9%)
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12 (7.2%) |
4 (2.4%) |
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Fat ³1
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25 (39.7%)
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6 (25.0%)
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7 (14.6%)
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5 (31.3%)
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2 (13.3%)
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6 (11.3%)
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17 (10.2%) |
9 (5.5%) |
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Fat ³2
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22 (34.9%)
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6 (25.0%)
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4 (8.3%)
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3 (18.8%)
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1 (6.7%)
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5 (9.4%)
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11 (6.6%) |
7 (4.3%) |
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Fat ³3
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20 (31.7%)
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5 (20.8%)
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2 (4.2%)
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2 (12.5%)
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1 (6.7%)
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4 (7.5%)
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6 (3.6%) |
6 (3.7%) |
Disclosure:
M. de Hooge,
None;
J. B. Pialat,
None;
A. Feydy,
None;
M. Reijnierse,
None;
P. Claudepierre,
None;
A. Saraux,
None;
M. Dougados,
None;
D. van der Heijde,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-mri-spinal-lesions-typical-for-axial-spondyloarthritis-in-patients-with-inflammatory-back-pain/