Background/Purpose:

Spondyloarthrits is characterized by inflammatory back pain. Anterior chest wall (ACW) pain is common and a previous study reported a prevalence à 35.5 % of ultrasonographic lesions of this anatomical region [1]. The objective of this study is to evaluate the prevalence of ACW ultrasonographic lesions after a follow up of 5 years and to identify factors associated with the development of new lesions.

Methods:

This a monocentric and prospective study including patients with Spondyloarthritis meeting the ASAS 2009 criteria. Patients were followed during five years. ultrasound B mode and power Doppler examination of the two sternoclavicular joint and the manubrio-sternal joint were performed by the same two examinators at baseline and five years later. The presence of erosion, synovitis, ankylosis, power Doppler signal, joint effusion and bone margin narrowing were assessed. Clinical characteristics and disease activity were evaluated at 5 years.

Results:

In the 136 patients at baseline, 30 patients were evaluated 5 years later. The mean age was 48 +/- 10 years old, with 80% of male and 85 % of HLA B27. 53,5 % of these patients had a history of pain of the ACW. The prevalence of ultrasonographic involvement of the ACW was 36,7 % at baseline and 63 % five years later. The most frequent lesions were erosions of the sternoclavicular joint (36,5 %) and ankylosis of the manubriosternal joint (33,5%). At 5 years, patients with lesions of the ACW are older but not significantly (49,9 +/- 9,9 VS 44,6 +/- 10,1, p=0,15) and use statistically more anti TNF ( p= 0,047). There were no differences concerning the presence of HLA B27 and the presence of a radiographic sacroilitis or syndesmophytes. Among these 30 patients, 14 developed a new lesion of the ACW. There is a trend on an association between a higher ASDAS CRP and new lesions of the ACW ( 1,97 +/- 1,14 VS 2,7 +/- 0,768, p = 0,07) and with the level of CRP (6,33 +/- 9,63 VS 15 +/- 20,9, p = 0,13). Nevertheless, the ASDAS CRP at baseline is not predictive of the occurrence of new lesions of the ACW.

Conclusion:

The prevalence of ultrasonographic lesions of the ACW increased after 5 years of follow up. The use of anti TNF is associated with more lesions and patients with new lesions had a trend of a more active disease. These data must be completed with a higher number of patients.

REFERENCE

Verhoeven F. et al. Ultrasonographic evaluation of the anterior chest wall in spondyloarthritis: a prospective and controlled study.J Rheumatol. 2015;42:87-92.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonographic-involvement-of-the-anterior-chest-walla-five-years-follow-up/