Session Information
Date: Monday, November 9, 2015
Title: Spondylarthropathies and Psoriatic Arthritis - Comorbidities and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: The ASAS classification criteria have provided new insights in the classification of axial spondyloarthropathy (axSpA). MR imaging (MRI) is an intrinsic component of the imaging arm of the classification criteria for non-radiographic (nr)-axSpA. The scheme classifies these patients by the imaging arm if the MRI is positive or by the clinical arm if such MRI evidence is lacking. The current algorithm does not address the clinical utility of MRI in patients who meet the clinical criteria, in which B27 is mandatory. The main aim of our study was to compare clinical features and outcomes of nr-axSpA patients stratified into MRI-Pos, MRI-Neg, and MRI-ND (not done) subsets. The study provided the opportunity to define clinical commonalities and differences between these three subsets, and to address the added value of MRI in the management of nr-axSpA.
Methods: Patients who met the criteria for nr-axSpA by the imaging arm or the clinical arm were included. Patients who met the NY criteria for AS were excluded. X-rays and MRIs were scored by two rheumatologists, blinded to clinical diagnosis. Discordant results were settled by a third reader. Patients classified as nr-axSpA were further stratified into the imaging or clinical arms. The clinical arm was further stratified into MRI-Neg and MRI-ND groups. Clinical characteristics were then obtained for each group from the clinical database.
Results: There were 107 patients fulfilling ASAS criteria for nr-axSpA. The median age of the patients was 35.2 (18-64) years, 51.4% were male and 85% were B27+. There were 37 patients in the imaging arm and 70 patients in the clinical arm. The intraclass correlation coefficient of the readers for right and left SIJ were 0.75 and 0.73 respectively. The kappa value of the readers for MR classification was 0.74. Age, sex distribution and disease duration were similar between the three groups (Table 1). Extra-articular features, acute phase reactants, BASDAI and BASMI were also comparable between the three groups. There were 45 (42.1%) patients who were treated with TNF inhibitors. Subgroup analysis of the patients who received TNFi treatment showed that biological treatment utilization, biologic switch frequencies, and rates of biologic non-response were similar between the three groups.
Conclusion: The clinical profiles of nr-axSpA patients with and without MRI confirmation are comparable, including response to biologic therapy. This suggests that there is a degree of homogeneity in the nr-axSpA cohort when patients are classified on clinical grounds alone. Including B27 as a mandatory inclusion criterion likely underlies this homogeneity, and does so to a greater extent than imaging studies.
Table 1: Clinical and demographical characteristics of the groups
|
|
MR(+), n=37 |
Clinical arm MR(-) n=38 |
Clinical arm MR ND n=32 |
p |
|
Age (years) |
33.9 (18-56) |
40.4 (18-64) |
37.5 (18-63) |
0.42 |
|
Disease duration (years) |
4 (1.5-28) |
11 (1-34) |
7 (1-38) |
0.15 |
|
Sex (M %) |
54.1 |
47.4 |
53.1 |
0.82 |
|
B27 (%) |
56.8 |
100 |
100 |
<0.0001 |
|
Smoking (%) |
40 |
29 |
29.6 |
0.59 |
|
BASFI |
2.7 (0-10) |
1.9 (0-8) |
2.3 (0-7.8) |
0.6 |
|
BASDAI |
4.5 (0.6-9.8) |
3 (0-9.2) |
3.8 (0-9.2) |
0.81 |
|
BASMI |
2 (0-5) |
1 (0-5) |
1 (0-2) |
0.19 |
|
ESR |
6.5 (1-122) |
5 (1-52) |
6.5 (1-63) |
0.81 |
|
CRP |
3 (0-135) |
3 (0-38) |
3 (0-28) |
0.62 |
|
Biologic ever (%) |
43.2 |
47.4 |
34.4 |
0.54 |
|
Biologic switch ever (%) |
43.8 |
44.4 |
36.4 |
0.9 |
|
Biologic switch, LOE, % |
85.7 |
71.4 |
75 |
0.8 |
|
NSAIDs, continuous use (%) |
86.4 |
79.2 |
71.4 |
0.48 |
|
Arthritis (%) |
48.6 |
47.4 |
59.4 |
0.56 |
|
Uveitis, % |
16.2 |
28.9 |
34.4 |
0.21 |
|
Psoriasis, % |
13.5 |
18.4 |
12.5 |
0.75 |
|
Dactilytis, % |
8.1 |
2.7 |
6.3 |
0.59 |
|
IBD, % |
8.1 |
2.6 |
3.1 |
0.47 |
|
Enthesitis, % |
33.3 |
32.1 |
25 |
0.76 |
|
Family history, % |
5.7 |
22.2 |
45.2 |
0.001 |
|
Subgroup analysis of the patients receiving TNFi treatment |
||||
|
|
Mr+, n=16 |
Mr-, n=18 |
Mr (ND), n=11 |
p value |
|
Current TNF, % |
68.8 |
55.6 |
90.9 |
0.14 |
|
Switch ever, % |
43.8 |
44.4 |
36.4 |
0.9 |
|
Switch, LOE, % |
85.7 |
71.4 |
75 |
0.8 |
|
Number of switch |
2 (1-4) |
2 (1-4) |
1.5 (1-4) |
0.87 |
|
ΔBASDAI |
-1.5 (-7.8-3.2) |
-2.6 (-6.6-3.4) |
-3.6 (-4.8-3.8) |
0.69 |
|
ΔCRP |
0 (-23-0) |
0 (-10-1) |
-2 (-32-0) |
0.13 |
Continous data are presented with median with minimum-maximum values
To cite this abstract in AMA style:
Sari I, Omar A, Chan J, Bedaiwi M, Ayearst R, Haroon N, Inman RD. What Is the Clinical Utility of MR Imaging in the Management of Nr-Axspa Patients? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/what-is-the-clinical-utility-of-mr-imaging-in-the-management-of-nr-axspa-patients/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-is-the-clinical-utility-of-mr-imaging-in-the-management-of-nr-axspa-patients/