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Abstract Number: 2886

Prevalence Of Structural Lesions On MRI Of The Sacroiliac Joints In Patients With Early Axial Spondyloarthritis and Patients With Back Pain

Rosaline van den Berg1, Manouk de Hooge1, Victoria Navarro-Compán1, Monique Reijnierse2, Floris van Gaalen1, Karen Fagerli3, Maureen Turina4, Maikel van Oosterhout5, Roberta Ramonda6, Tom Huizinga1 and Désirée van der Heijde1, 1Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 2Radiology, Leiden University Medical Center, Leiden, Netherlands, 3Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 4Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, Netherlands, 5Rheumatology, GHZ Hospital, Gouda, Netherlands, 6Rheumatology Unit, University of Padova, Padova, Italy

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: MRI and spondylarthritis

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Session Information

Session Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment: Imaging in Axial Spondylarthropathies: Challenges, Advances

Session Type: Abstract Submissions (ACR)

Background/Purpose: Little is known about the prevalence of structural lesions on MRI in the SI joints (MRI-SI) in recent onset axial spondyloarthritis (axSpA) patients and patients with back pain of other origin. Therefore, we investigated the prevalence of structural lesions on MRI-SI in these patients.

Methods: Patients with back pain (≥3 months, ≤2 years, onset <45 years) from the 5 centers  the SPondyloArthritis Caught Early (SPACE)-cohort were included. Patients underwent MRI-SI. Available MRIs-SI were scored by 3 well-calibrated readers independently for ankylosis, sclerosis, erosions, and fatty lesions  (MRI T1-weighted images; STIR images viewed simultaneously). Erosions, sclerosis and fatty lesions were defined according to the MORPHO definition1 (≥1 lesion on ≥2 consecutive slices or ≥2 lesion on 1 slice); ankylosis as 1 lesion on ≥1 slice. Lesions were considered present if 2/3 readers agreed. Prevalence based on several cut-offs of structural lesions was calculated. Patients were grouped according to the ASAS axSpA criteria2[imaging-arm (mNY+, mNY-), clinical arm], no-SpA and possible SpA.

Results: Patients with MRI-SI data were included (n=299). If defined as ≥1, all structural lesions except ankylosis were frequent in all groups; in decreasing frequency in mNY+, MRI+mNY-, clinical arm, possible SpA and no-SpA (table). The higher the cut-offs, the better discrimination between the imaging-arm and no/possible SpA, with the clinical arm close to no/possible SpA. To define a proper cut-off for the presence of structural lesions in axSpA, the false-positive percentage in no-SpA patients should be low. We defined possible cut-offs based on the acceptance of ≤10% (italics) and ≤5% (bold) false-positives (table). E.g. if ≥4 structural lesions are present, false-positives are 6.0% and 5.2% respectively, with a frequency of 61.5% and 43.5% in the mNY+ and MRI+mNY- subgroups.

Conclusion: Prevalence of erosions, sclerosis and fatty lesions on MRI-SI is high in axSpA patients but also in no-SpA patients. Higher cut-offs than ≥1 lesion are needed to reduce false-positives; also with higher cut-offs structural lesions are frequent in early axSpA patients. These data suggest that with appropriate cut-offs, structural lesions might be helpful in defining sacroiliitis on MRI.

References: 1Weber A&R 2010;62:3048-58 2Rudwaleit ARD 2009;68:777-83

AxSpA (ASAS), n=123

Possible SpA n=116

No SpA n=60

mNY+ (n=26)

mNY- (n=46)

Clinical arm

(n=51)

Fatty lesion ≥1, n (%)

11 (42.3)

12 (26.1)

7 (13.7)

8 (6.9)

6 (10.0)

Fatty lesion ≥2, n (%)

11 (42.3)

10 (21.7)

6 (11.8)

7 (6.0)

2 (3.3)

Erosion ≥1, n (%)

18 (69.2)

30 (65.2)

11 (21.6)

22 (19.0)

5 (8.3)

Erosion ≥2, n (%)

13 (50.0)

24 (52.2)

3 (5.9)

8 (6.9)

3 (5.0)

Sclerosis ≥1, n (%)

1 (3.8)

3 (6.5)

1 (2.0)

2 (1.7)

2 (3.3)

Ankylosis ≥1, n (%)

2 (7.7)

1 (2.2)

0 (0.0)

1 (0.9)

1 (1.7)

Fatty lesion and/or erosion ≥1, n (%)

19 (73.1)

32 (69.9)

14 (27.5)

28 (24.1)

11 (18.3)

Fatty lesion and/or erosion ≥3, n (%)

16 (61.5)

20 (43.5)

6 (11.8)

9 (7.8)

6 (10.0)

Fatty lesion and/or erosion ≥4, n (%)

16 (61.5)

18 (39.1)

5 (9.8)

4 (3.4)

4 (6.7)

Fatty lesion and/or erosion ≥5, n (%)

16 (61.5)

18 (39.1)

3 (5.9)

4 (3.4)

0 (0.0)

Any structural lesion ≥1, n (%)

20 (76.9)

36 (78.3)

16 (31.4)

34 (29.3)

14 (23.3)

Any structural lesion ≥4, n (%)

16 (61.5)

20 (43.5)

7 (13.7)

7 (6.0)

5 (8.3)

Any structural lesion ≥5, n (%)

16 (61.5)

20 (43.5)

5 (9.8)

6 (5.2)

2 (3.3)

Any structural lesion, no ankylosis ≥1, n (%)

19 (73.1)

35 (76.1)

15 (29.4)

29 (25.0)

13 (21.7)

Any structural lesion, no ankylosis ≥4, n (%)

16 (61.5)

19 (41.3)

6 (11.8)

6 (5.2)

5 (8.3)

Any structural lesion, no ankylosis ≥5, n (%)

16 (61.5)

19 (41.3)

4 (7.8)

5 (4.3)

1 (1.7)

Any structural lesion, no sclerosis ≥1, n (%)

20 (76.9)

32 (69.6)

16 (31.4)

32 (27.6)

12 (20.0)

Any structural lesion, no sclerosis ≥3, n (%)

17 (65.4)

21 (45.7)

7 (13.7)

11 (9.5)

6 (10.0)

Any structural lesion, no sclerosis ≥5, n (%)

16 (61.5)

19 (41.3)

4 (7.8)

4 (3.4)

1 (1.7)

Italics represents ≤10% false-positives in the group of no SpA patients. Bold represents ≤5% false-positives in the group of no SpA patients


Disclosure:

R. van den Berg,
None;

M. de Hooge,
None;

V. Navarro-Compán,
None;

M. Reijnierse,
None;

F. van Gaalen,
None;

K. Fagerli,
None;

M. Turina,
None;

M. van Oosterhout,
None;

R. Ramonda,
None;

T. Huizinga,
None;

D. van der Heijde,
None.

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