Replacement of Radiographic Sacroilitis by MRI Structural Lesions: What Is the Impact on Classification of Axial Spondyloarthritis in the ASAS Classification Cohort?

Walter P. Maksymowych¹, Pedro Machado ², Robert Lambert ³, Xenofon Baraliakos ⁴, Mikkel Østergaard ⁵, Joachim Sieper ⁶, Stephanie Wichuk ³, Denis Poddubnyy ⁷, Martin Rudwaleit ⁸, Désirée van der Heijde ⁹, Robert B.M. Landewé ¹⁰, Joel Paschke ¹¹, Susanne Juhl Pedersen ¹² and Ulrich Weber ¹³, ¹University of Alberta/CARE ARTHRITIS, Edmonton, AB, Canada, ²University College London, London, United Kingdom, ³University of Alberta, Edmonton, Canada, ⁴Rheumatology Department, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany, ⁵Copenhagen Center for Arthritis Research, University of Copenhagen, Copenhagen, Denmark, ⁶Charité Universitätsmedizin Berlin, Germany, Berlin, Germany, ⁷Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany, Berlin, Germany, ⁸Klinikum Bielefeld, Charité Berlin, Gent University, Bielefeld, Germany, ⁹Leiden University Medical Center, Leiden, Netherlands, ¹⁰Amsterdam University Medical Center, Amsterdam, Netherlands, ¹¹CARE Arthritis, Edmonton, Canada, ¹²Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, Copenhagen, Hovedstaden, Denmark, ¹³Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: axial spondyloarthritis, MRI and classification criteria

Session Information

Date: Sunday, November 10, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Axial Spondyloarthritis, Clinical Features

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: xClassification of axial spondyloarthritis is based on the application of either an imaging or clinical arm. Radiographic or MRI evidence of sacroiliitis can be applied for the imaging arm. However, it is well-established that reliability for detection of radiographic sacroiliitis is inadequate, especially in early disease, and radiography is insensitive compared to MRI for detection of either active or structural lesions. Active lesions on MRI (MRI-A) are already included as an alternative to radiographic sacroiliitis in the imaging arm. We aimed to assess the impact of replacing radiographic sacroiliitis with MRI structural lesions (MRI-S) typical of axSpA on the number of patients classified as having axSpA in patients with undiagnosed back pain recruited to the ASAS Classification Cohort (ASAS-CC).

Methods: MRI images (STIR and T1-weighted sequences) of the sacroiliac joint (SIJ) enabling assessment of both active and structural lesions were available from 219 cases in the ASAS-CC, and these also had available clinical, laboratory, and radiographic data. Seven central readers from the ASAS-MRI group recorded MRI lesions in an eCRF that included wording of lesions defining active (MRI-A) and structural (MRI-S) lesions typical of axSpA. MRI-A was deemed to be present according to majority agreement (≥4/7) of central readers. MRI-S was deemed to be present according to the majority (majority reader MRI-S) and also according to any 2 central readers (2-reader MRI-S). We calculated the number of patients that were classified differently after replacement of radiographs by MRI-S for overall fulfillment of the ASAS criteria and for the imaging arm.

Results: In total,124 (56.6%) fulfilled the ASAS axSpA criteria based on local reading of radiographic sacroiliitis and central reading of MRI-A. This changed to 126 (57.5%) and 120 (54.8%) patients after replacement of radiographic sacroiliitis by 2-reader and majority reader MRI-S, respectively (Table). 9 (4.1%) and 4 (1.8%) of patients who were not classified as axSpA were then re-classified as axSpA after substitution with 2-reader and majority reader MRI-S, respectively. Conversely, 7 (3.2%) and 8 (3.7%) were re-classified as not axSpA after substitution by 2-reader and majority reader MRI-S, respectively. When fulfillment of the imaging arm was required (irrespective of the clinical arm), the number of patients reclassified from not axSpA to axSpA was 18 (8.2%) by 2-reader MRI-S and 8 (3.7%) by majority reader MRI-S, while 8 (3.7%) and 11 (5.0%) were reclassified from axSpA to not axSpA, after substitution of radiographic sacroiliitis with 2-reader and majority reader MRI-S, respectively.

Conclusion: The number of patients classified as having axSpA does not change substantially when MRI-S replaces radiographic sacroiliitis. However, it is unclear to what degree MRI structural lesions could have affected the final diagnostic ascertainment, the gold standard for assessment of the performance of the ASAS criteria.

Table 1

Disclosure: W. Maksymowych, Abbvie, 2, 5, 8, AbbVie, 2, 5, 8, AbbVie Inc., 2, 5, 8, Abbvie, Amgen, Eli Lilly, Janssen, Merck, Pfizer, Synarc, Sanofi, and UCB Pharma ], 2, 5, 8, Amgen, 2, 5, 8, Boehringer, 5, 8, Boehringer-Ingelheim, 5, 8, Canadian Research and Education Arthritis, 6, CARE ARTHRITIS, 3, 6, 9, Celgene, 5, 8, Eli Lilly, 2, 5, 8, Galapagos, 5, 8, Janssen, 2, 5, 8, Lilly, 2, 5, 8, Merck, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Sanofi, 2, 5, 8, Synarc, 2, 5, 8, UCB, 2, 5, 8, UCB Pharma, 2, 5, 8; P. Machado, None; R. Lambert, None; X. Baraliakos, AbbVie, 2, 4, 5, 8, Biocad, 2, 5, Bristol-Myers Squibb, 2, 4, 5, 8, Celgene, 2, 5, 8, Chugai, 2, 5, Eli Lilly, 2, 5, Galapagos, 2, 5, 8, Janssen, 2, 5, 8, Lilly, 2, 5, 8, MSD, 2, 5, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 2, 5, UCB, 2, 5, 8; M. Østergaard, AbbVie, 2, 8, 9, Abbvie, 2, 5, 8, Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, UCB, 5, 8, Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, 5, 8, Abbvie, Celgene, Centocor, Merck, and Novartis, 2, Abbvie, Celgene, Centocor, Merck, Novartis, 2, BMS, 2, 5, 8, 9, Boehringer Ingelheim, 5, 8, Boehringer-Ingelheim, 2, 8, Boehringer-ingelheim, 9, Celgene, 2, 5, 8, Centocor, 2, Eli Lilly, 5, 8, 9, Eli Lilly and Company, 5, 8, Eli-Lilly, 2, 8, Hospira, 2, 5, 8, Janssen, 2, 5, 8, 9, Merck, 2, 5, 8, 9, Novartis, 2, 5, 8, Novo, 2, 5, 8, Novo Nordisk, 5, 8, Orion, 2, 5, 8, Pfizer, 2, 5, 8, 9, Regeneron, 2, 5, 8, Roche, 2, 5, 8, roche, 9, Sandoz, 2, 8, Sanofi, 2, 8, UCB, 2, 5, 8; J. Sieper, AbbVie, 5, 8, Eli Lilly and Company, 5, 8, Janssen, 5, 8, Lilly, 5, 8, Merck, 5, 8, Novartis, 5, 8; S. Wichuk, None; D. Poddubnyy, Abbvie, 2, 5, 8, AbbVie, 2, 5, 8, BMS, 5, 8, Celgene, 5, 8, Eli Lilly, 5, 8, Eli Lilly and Company, 2, 5, 8, Lilly, 5, 8, MSD, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 5, 8, UCB, 5, 8; M. Rudwaleit, Abbott, 5, AbbVie, 5, 8, BMS, 5, 8, Bristol Myers-Squibb, 5, 8, Celgene, 5, 8, Chugai, 5, 8, Eli Lilly, 5, 8, Eli Lily, 5, 8, Janssen, 5, 8, MSD, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Roche, 5, 8, UCB Pharma, 5, 8; D. van der Heijde, AbbVie, 5, AbbVie, Amgen, Astellas, AstraZeneca, BMS, 5, Amgen, 5, Astellas, 5, 9, Astellas Pharma, 5, AstraZeneca, 5, BMS, 5, Boehringer Ingelheim, 5, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB, 5, Boehringer-Ingelheim, 5, Bristol-Myers Squibb, 5, Celgene, 5, Daiichi, 5, 9, Daiichi Sankyo, 5, Director of Imaging Rheumatology, 6, Director of Imaging Rheumatology bv, 9, Eli Lilly, 5, Eli Lilly and Company, 5, Eli-Lilly, 5, Galapagos, 5, Gilead, 5, Gilead Sciences, Inc., 5, GlaxoSmithKline, 5, Glaxo-Smith-Kline, 5, GSK, 5, 8, Imaging Rheumatology bv, 9, Imaging Rheumatology BV, 9, Imaging Rheumatology bv., 9, Janssen, 5, 8, Janssen Pharmaceutica, 5, Merck, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Pfizer Inc, 5, Regeneron, 5, 8, Rheumatology bv, 4, 9, Roche, 5, 8, Sanofi, 5, 8, Takeda, 5, 8, Takeda Pharmaceutical Company, 5, UCB, 5, 8, UCB Pharma, 5; R. Landewé, Abbott, 2, 5, 8, Abbott, Amgen, Bristol-Myers Squibb, Centocor, Merck, Pfizer, Roche, Schering-Plough, UCB, Wyeth, 8, Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB, Wyeth, 2, AbbVie, 5, Abbvie, 5, 8, AbbVie, Ablynx, Amgen, Astra-Zeneca, Bristol-Myers Squibb, Centocor, GSK, Novartis, Merck, Pfizer, Roche, Schering- Plough, UCB, Wyeth, 5, Ablynx, 5, Amgen, 2, 5, 8, AstraZeneca, 5, BMS, 5, 8, Bristol Myers Squibb, 5, 8, Bristol-Myers Squibb, 5, Celgene, 5, 8, Centocor, 2, 5, 8, Director of Rheumatology Consultancy BV, which is a registered company under Dutch law, 6, Eli Lilly, 5, 8, Eli Lilly and Company, 5, Eli-Lilly, 5, 8, Galapagos, 5, 8, Gilead, 5, 8, GlaxoSmithKline, 5, Glaxo-Smith-Kline, 5, 8, Janssen, 5, 8, Merck, 5, 8, MSD, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Rheumatology bv, 4, Rheumatology Consultancy BV, 9, Roche, 2, 5, 8, Schering-Plough, 2, 5, 8, UCB, 5, 8, UCB Pharma, 2, 5, 8, Wyeth, 2, 5, 8; J. Paschke, None; S. Juhl Pedersen, None; U. Weber, None.

To cite this abstract in AMA style:

Maksymowych W, Machado P, Lambert R, Baraliakos X, Østergaard M, Sieper J, Wichuk S, Poddubnyy D, Rudwaleit M, van der Heijde D, Landewé R, Paschke J, Juhl Pedersen S, Weber U. Replacement of Radiographic Sacroilitis by MRI Structural Lesions: What Is the Impact on Classification of Axial Spondyloarthritis in the ASAS Classification Cohort? [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/replacement-of-radiographic-sacroilitis-by-mri-structural-lesions-what-is-the-impact-on-classification-of-axial-spondyloarthritis-in-the-asas-classification-cohort/. Accessed .

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