Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Psoriatic arthritis (PsA) and spondyloarthritis (SpA) is associated with a varied pattern of axial and peripheral inflammation. Wholebody magnetic resonance imaging (WBMRI) is a new imaging modality where patients are scanned from head to toe in one single examination. The purpose was to explore the potential of WBMRI for detecting peripheral and axial inflammation.
Methods:
Patients with clinically active peripheral PsA (Moll and Wright, n=19) or axial SpA (ESSG, n=19) and healthy subjects (HS, n=12) were included. T1-weighted pre/post-contrast and STIR sequences were performed on a 3 tesla MRI unit. Synovitis and bone marrow oedema (BME) were evaluated at sites included in the 78-tender joint count (TJC). Axially, BME was evaluated dichotomously in each discovertebral unit (DVU) of the spine, and in each quadrant of the sacroiliac joints (SIJ).
Results:
Characteristics median (range): PsA/SpA/HS age 49(23-79)/42(26-61)/32(20-61) yrs. PsA/SpA disease duration: 4 (0-34)/17 (5-48) yrs; 78-TJC: 11(3-65)/3(0-17), 76-swollen joint count (SJC): 5(0-20)/1(0-5), and BASDAI score 45(9-85)/55(2-93) mm.
WBMRI assessment was done in 3800 joints included in the TJC, and synovitis/BME were detected in 593 (16%)/207 (5%) joints, synovitis/BME was absent in 1929 (51%)/1860 (49%) joints, and 1278 (34%)/1733 (54%) joints were not possible to evaluate. Evaluation was most frequently possible in the hip joints (188 joints (94%)), knees (186 (93%)), and the spine (in overall 94% of DVUs). In contrast, no temperomandibular joints, and only 17 (8%) of elbows could be evaluated.
In PsA, synovitis was found most frequently in carpometacarpal (CMC) (19 joints (61%)) and shoulder (18 (53%)) joints. In SpA, synovitis was found most frequently in 1st metatarsophalangeal joints (21 (67%)), and shoulders (17 (50%)).
In patients, the best agreement between WBMRI synovitis and clinical swelling was found at the right hand proximal interphalangeal (PIP) (kappa: 0.65), left hand 3rd distal interphalangeal joint (0.63), and the right hand 3rd PIP joints (0.62). The best agreement between WBMRI synovitis and tenderness was found at left foot 2nd and 3rd PIP (0.78; 0.47), and right hand 2nd PIP (0.70) joints.
In PsA, we found a significant correlation between SJC-28 and BME assessed in 28 and 78 joints (Spearman’s rho: 0.54, P<0.05; 0.69, P<0.005). WBMRI synovitis did not correlate significantly with clinical joint examination. Scores of BME assessed in 78 joints were significantly higher in PsA/SpA compared to HS (Mann-Whitney, P<0.05).
BME in the spine was detected in PsA/SpA in median 2 (0-6)/1 (0-11) DVU, respectively, and BME in the SIJ was detected in 0 (0-2)/0 (0-8) quadrants, respectively. Sum scores of BME detected in spine and SIJ were for PsA: 2 (0-7) and SpA: 4 (0-11), which were significantly higher than in HS (1 (0-4)) (P<0.05).
Conclusion:
Wholebody MRI scores of axial and peripheral bone marrow oedema are significantly higher in clinically active PsA and SpA patients than in healthy subjects. In PsA, we found a significant correlation between number of joints with BME and SJC, whereas TJC did not correlate. WBMRI is a promising imaging modality, as it allows simultaneous visualisation of inflammation in peripheral and axial joints.
Disclosure:
R. P. Poggenborg,
None;
S. J. Pedersen,
None;
I. Eshed,
None;
I. J. Sørensen,
None;
O. R. Madsen,
None;
J. M. Møller,
None;
M. Østergaard,
Abbott Laboratories, Amgen, Bristol-Meyers Squibb, Centocor, Genmab, Glaxo-Smith-Kline, Janssen, Merck, Mundipharma, Novartis, Novo, Pfizer, Roche, Schering-Plough, UCB, Wyeth,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/psoriatic-arthritis-and-spondyloarthritis-inflammation-assessed-by-head-to-toe-wholebody-magnetic-resonance-imaging-a-comparison-with-clinical-joint-examination/