ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1714

Young Patients with Back Pain and Maximally 1 Spa Feature: Is It Useful to Test HLA-B27 or Image the Sacroiliac Joints?

Pauline Bakker1, Zineb Ez-Zaitouni2, Miranda van Lunteren2, Manouk de Hooge3, Rosaline van den Berg4, Inger Jorid Berg5, Robert B. M. Landewé6, Maikel van Oosterhout7, Roberta Ramonda8, Monique Reijnierse9, Floris van Gaalen1 and Désirée van der Heijde10, 1Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 2Leiden University Medical Centre, Leiden, Netherlands, 3Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands, 4Leiden University Medical Center, Leiden, Netherlands, 5Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 6Rheumatology, University Hospital Maastricht, Maastricht, Netherlands, 7Rheumatology, GHZ Hospital, Gouda, Netherlands, 8Cattedra, Voc Rheumatology, University of Padua, Padova, Italy, 9Radiology, Leiden University Medical Center, Leiden, Netherlands, 10University Hospital, Maastricht, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ,

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:
Axial SpondyloArthritis (axSpA)
is a heterogeneous disease. The likelihood of diagnosis varies depending upon
the specific findings that are present. However, it is debated whether
additional examinations (i.e. HLA-B27 testing and imaging of the sacro-iliac joints (SIJ)) should be performed in patients
with a low suspicion of axSpA: i.e. negative findings
on medical history, physical examination, CRP/ESR measurement. By this study we
aim to investigate if HLA-B27 testing and imaging of the SIJ is useful in young
patients with back pain and maximally 1 SpA feature.

Methods:
The SPACE cohort includes patients with chronic back pain (≥3 months
≤2 years, onset <45 years) recruited from 6 participating centres
across Europe. All patients underwent full diagnostic work-up: MRI and x-rays
SIJ, HLA-B27 testing and assessment of all other SpA-features.
Patients were classified according to the ASAS axSpA-criteria.

Results:
In this analysis, 133 patients from 4 participating centres were included. Of
the 38/133 (28.6%) patients with 0 SpA-features; 4/38
(10.5%) were classified according to the ASAS-axSpA
criteria after additional investigations (imaging arm only: 2MRI+/mNY+, 1MRI+/mNY-,
1MRI-/mNY+). Of the 95/133 (71.4%) patients with 1 SpA-feature; 22/95 (23.2%)
patients fulfilled the ASAS-axSpA criteria (imaging
arm only: 3MRI+/mNY+, 15MRI+/mNY-, 4MRI-/mNY+). Those patients presented the
following features: 7 IBP, 5 IBD, 4 positive family history for SpA, 3 good
response to NSAIDs, 2 raised CRP/ESR, 1 enthesitis.

Conclusion:
In patients with CBP and 0 or 1 SpA-feature after
medical history, physical examination and CRP/ESR measurement, subsequent
HLA-B27 testing and imaging led to fulfilment of the axSpA-criteria
in 11% and 23% respectively. Therefore in these patients, the disease cannot be
ruled out without additional imaging and/or HLA-B27 testing.

Table 1:
classification and diagnosis of patients with 0 and 1 SpA-feature
after HLA-B27 and SIJ-imaging

No. of SpA-features

HLA B27 status

Imaging status

ASAS axSpa YES

Rheum

Spa YES

ASAS axSpA NO

Rheum SpA NO

0

B27 +

MRI+mNY+

2

2

–

MRI+mNY–

1

1

–

MRI-mNY+

1

–

1

MRI-mNY-

–

2

3

1

B27 –

MRI+mNY+

–

–

MRI+mNY–

–

2

5

2*

MRI-mNY+

–

–

MRI-mNY-

–

26

26

1

B27 +

MRI+mNY+

2

–

1*

MRI+mNY–

4

3

–

1

MRI-mNY+

1

–

*

MRI-mNY-

–

2

15

12*

B27 –

MRI+mNY+

1

1

MRI+mNY–

11

8

3

MRI-mNY+

3

2

1

MRI-mNY-

–

1

58

57

Total

26

24

107

105
Disclosure: P. Bakker, None; Z. Ez-Zaitouni, None; M. van Lunteren, None; M. de Hooge, None; R. van den Berg, None; I. J. Berg, None; R. B. M. Landewé, None; M. van Oosterhout, None; R. Ramonda, None; M. Reijnierse, None; F. van Gaalen, None; D. van der Heijde, None.

To cite this abstract in AMA style:

Bakker P, Ez-Zaitouni Z, van Lunteren M, de Hooge M, van den Berg R, Berg IJ, Landewé RBM, van Oosterhout M, Ramonda R, Reijnierse M, van Gaalen F, van der Heijde D. Young Patients with Back Pain and Maximally 1 Spa Feature: Is It Useful to Test HLA-B27 or Image the Sacroiliac Joints? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/young-patients-with-back-pain-and-maximally-1-spa-feature-is-it-useful-to-test-hla-b27-or-image-the-sacroiliac-joints/. Accessed .

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