Significance of structural changes in the sacroiliac joints of patients with axial spondyloarthritis detected by MRI related to patients symptoms and functioning

2021 ◽  
pp. annrheumdis-2021-221406
Author(s):  
Juergen Braun ◽  
Uta Kiltz ◽  
Xenofon Baraliakos
Keyword(s):  
Bone Formation ◽  
Structural Damage ◽  
Structural Changes ◽  
Axial Spondyloarthritis ◽  
Conventional Radiography ◽  
Axial Skeleton ◽  
Interleukin 17 ◽  
New Bone Formation ◽  
Sacroiliac Joints ◽  
Magnetic Resonance Imaging Mri

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that manifests primarily in the axial skeleton, initially mostly in the sacroiliac joints (SIJ), usually later spreading to the spine. The disease is characterised by inflammation and new bone formation which are mainly assessed by conventional radiography (CR) and magnetic resonance imaging (MRI). Tumour necrosis factor inhibitors (TNFi) and interleukin-17 antagonists have been shown to be efficacious and efficient in patients with axSpA. This treatment seems to also inhibit structural damage, for example, retard radiographic progression. Indeed, a reduction of new bone formation in the spine, as assessed by CR, has been reported to occur after at least 2 years of therapy with TNFi. Recently, a reduction of erosions and ankylosis in the SIJ has also been observed in axSpA patients treated with etanercept and filgotinib. In this narrative review, we discuss the limited significance of such findings.

Axial Spondyloarthritis and New Bone Formation

2021 ◽  
Vol 30 (04) ◽  
pp. 311-318
Author(s):  
Uta Syrbe
Keyword(s):  
Bone Formation ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Clinical Symptoms ◽  
Research Work ◽  
New Bone Formation ◽  
Sacroiliac Joints ◽  
Spine Mobility ◽  
Vertebral Bodies ◽  
Inflammatory Changes

AbstractAxial spondyloarthritis is an inflammatory disease of the axial skeleton. Its pathogenesis is only partly understood. At the beginning, there are inflammatory changes in the sacroiliac joints which are followed by inflammation in vertebral bodies and in facet joints. Low back pain occurring in the morning hours is the dominant clinical symptom. In the early phase, inflammatory changes are detectably by MRI. Inflammation promotes a process of joint remodelling in the sacroiliac joints which leads to erosions, sclerosis and bony bridging, i. e. ankylosis, which are detectable by X-ray. In the spine, vertical osteophytes developing at sites of previous inflammation connect vertebral bodies as syndesmophytes. Additional ossification of longitudinal ligaments contributes to the so-called bamboo spine. Ossification of the spine promotes fixation of a severe kyphosis of the thoracic spine which strongly impairs spine mobility and quality of life. High disease activity seems a prominent risk factor for development of structural damage. However, although NSAIDs improve clinical symptoms, they do not reduce new bone formation. In contrast, TNFα and IL-17 inhibitors seem to retard new bone formation apart from their clinical efficacy. Research work of the last years identified immunological pathways of inflammation. However, the trigger and cellular components of the immune reaction in the bone marrow are still poorly defined. Osteoclasts are involved in the destruction of the subchondral bone, while osteoblasts facilitate new bone formation and cartilage ossification. This review gives an overview about diagnostics and therapy of axSpA and about risk factors for the development of structural damage. Concepts about the immune pathogenesis and joint remodeling in AS are given under recognition of genetic and histopathological studies.

scholarly journals Secukinumab in axial spondyloarthritis: a narrative review of clinical evidence

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110418
Author(s):  
Jürgen Braun ◽  
Uta Kiltz ◽  
Björn Bühring ◽  
Xenofon Baraliakos
Keyword(s):  
Ankylosing Spondylitis ◽  
Bone Formation ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Human Leukocyte ◽  
Signs And Symptoms ◽  
Axial Skeleton ◽  
Narrative Review ◽  
The European Union ◽  
New Bone Formation

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by inflammation and new bone formation in the axial skeleton. AxSpA is considered a spectrum of disease that includes two subtypes identified by the Assessment in SpondyloArthritis International Society classification criteria, namely, radiographic (r-axSpA usually referred to as ankylosing spondylitis) and non-radiographic axSpA (nr-axSpA). Although the burden of disease appears similar between the two classified subtypes, the degree of inflammation, as assessed by magnetic resonance imaging and C-reactive protein, and the degree of new bone formation are significantly higher in r-axSpA than in nr-axSpA. Nevertheless, axSpA is considered one disease with different courses. International guidelines for the management of axSpA have outlined treatment goals focused on control of signs and symptoms, inflammation, prevention of progressive structural damage, preservation of physical function, normalization of social participation and improvement of quality of life. The pathogenesis of axSpA has not been completely elucidated to date. A strong link between human leukocyte antigen B27 and axSpA, however, has been identified, and the success of anti-tumour necrosis factor and anti-interleukin (IL)-17A therapy has highlighted some of the key pro-inflammatory cytokines involved. The anti-IL-17A monoclonal antibody secukinumab is approved for the treatment of ankylosing spondylitis and nr-axSpA in the European Union and United States. In this narrative review, we discuss data for secukinumab in axSpA from randomized controlled trials, including MEASURE trials in AS and PREVENT in nr-axSpA, and real-world evidence.

Detection of Erosions in Sacroiliac Joints of Patients with Axial Spondyloarthritis Using the Magnetic Resonance Imaging Volumetric Interpolated Breath-hold Examination

2019 ◽  
Vol 46 (11) ◽  
pp. 1445-1449 ◽  
Author(s):  
Xenofon Baraliakos ◽  
Florian Hoffmann ◽  
Xiaohu Deng ◽  
Yan-Yan Wang ◽  
Feng Huang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Structural Changes ◽  
Axial Spondyloarthritis ◽  
Linear Regression Analysis ◽  
Cartilage Defects ◽  
Breath Hold ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Magnetic Resonance Imaging Mri

Objective.The volumetric interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) technique can visualize erosive cartilage defects in peripheral joints. We evaluated the ability of VIBE to detect erosions in sacroiliac joints (SIJ) of patients with axial spondyloarthritis (axSpA) compared to the established T1-weighted MRI sequence and computed tomography (CT).Methods.MRI (T1-weighted and VIBE) and CT scans of SIJ of 109 patients with axSpA were evaluated by 2 blinded readers based on SIJ quadrants (SQ). Erosions were defined according to Assessment of Spondyloarthritis international Society (ASAS) definitions. Scores were recorded if readers were in agreement.Results.Erosions were less frequently detected by CT (153 SQ) than by T1-weighted MRI (182 SQ; p = 0.008) and VIBE-MRI (199 SQ; p < 0.001 vs CT and p = 0.031 vs T1-weighted MRI). Taking CT as the gold standard, the sensitivity of VIBE-MRI (71.2%) was higher than that for T1-weighted MRI (63.4%), with similar specificity (87.3% vs 88%, respectively). In linear regression analysis, younger age was significantly associated with occurrence of erosions independently in VIBE-MRI (β = 0.384, p < 0.001) and T1-weighted MRI (β = 0.369, p < 0.001) compared to CT.Conclusion.The VIBE-MRI sequence was more sensitive than T1-weighted MRI in identifying erosive damage in the SIJ, especially in younger patients. This might be due to the ability of VIBE-MRI to identify structural changes in the cartilage that have not yet extended to the underlying bone, where CT seems to be superior.

Pathology: bone

2016 ◽  
Author(s):  
Rik J. Lories ◽  
Georg Schett
Keyword(s):  
Bone Formation ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Signalling Pathways ◽  
New Bone Formation ◽  
Different Types ◽  
Significant Burden ◽  
Current Therapies ◽  
Developmental Signalling ◽  
Biomechanical Factors

Axial spondyloarthritis is associated with different types of skeletal damage. Inflammation at the affected sites is linked with both loss of trabecular bone and new bone formation on the cortical side, potentially leading to joint or spine ankylosis. Both aspects of the disease can result in a significant burden for the patient. Bone loss is directly linked to proinflammatory cytokines and activation of osteoclasts. Control of inflammation is therefore the best strategy to prevent loss of bone. The nature of the new bone formation process is less defined. A prominent role for developmental signalling pathways has been proposed. Current therapies have limited or no impact on this process. However, emerging data suggest that early control of disease activity may be part of a window of opportunity to prevent structural damage, as biomechanical factors and instability following inflammation may also play a role.

scholarly journals Dual Blockade of TNF and IL-17A Inhibits Inflammation and Structural Damage in a Rat Model of Spondyloarthritis

2022 ◽  
Vol 23 (2) ◽  
pp. 859
Author(s):  
Ihsan Hammoura ◽  
Renee H. Fiechter ◽  
Shaughn H. Bryant ◽  
Susan Westmoreland ◽  
Gillian Kingsbury ◽  
...  
Keyword(s):  
Bone Formation ◽  
Rat Model ◽  
Structural Damage ◽  
Structural Changes ◽  
Ct Imaging ◽  
Control Treatment ◽  
Micro Ct ◽  
New Bone Formation ◽  
Dual Blockade ◽  
Dual Inhibition

The tumor necrosis factor (TNF) and IL-23/IL-17 axes are the main therapeutic targets in spondyloarthritis. Despite the clinical efficacy of blocking either pathway, monotherapy does not induce remission in all patients and its effect on new bone formation remains unclear. We aimed to study the effect of TNF and IL-17A dual inhibition on clinical disease and structural damage using the HLA-B27/human β2-microglobulin transgenic rat model of SpA. Immunized rats were randomized according to arthritis severity, 1 week after arthritis incidence reached 50%, to be treated twice weekly for a period of 5 weeks with either a dual blockade therapy of an anti-TNF antibody and an anti-IL-17A antibody, a single therapy of either antibody, or PBS as vehicle control. Treatment-blinded observers assessed inflammation and structural damage clinically, histologically and by micro-CT imaging. Both single therapies as well as TNF and IL-17A dual blockade therapy reduced clinical spondylitis and peripheral arthritis effectively and similarly. Clinical improvement was confirmed for all treatments by a reduction of histological inflammation and pannus formation (p < 0.05) at the caudal spine. All treatments showed an improvement of structural changes at the axial and peripheral joints on micro-CT imaging, with a significant decrease for roughness (p < 0.05), which reflects both erosion and new bone formation, at the level of the caudal spine. The effect of dual blockade therapy on new bone formation was more prominent at the axial than the peripheral level. Collectively, our study showed that dual blockade therapy significantly reduces inflammation and structural changes, including new bone formation. However, we could not confirm a more pronounced effect of dual inhibition compared to single inhibition.

Sacroiliitis in Axial Spondyloarthritis: Assessing Morphology and Activity

2018 ◽  
Vol 22 (02) ◽  
pp. 180-188 ◽  
Author(s):  
Niels Egund ◽  
Iris Eshed ◽  
Iwona Sudoł-Szopińska ◽  
Anne Jurik ◽  
Lennart Jans
Keyword(s):  
Structural Changes ◽  
Bone Marrow Edema ◽  
Axial Spondyloarthritis ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Mri Features ◽  
Magnetic Resonance Imaging Mri ◽  
Active Inflammation ◽  
Marrow Edema

Objective To review the strengths, limitations, and new insights in the anatomy and magnetic resonance imaging (MRI) features of active and structural lesions of sacroiliitis in spondyloarthritis. Discussion MRI plays a key role in the diagnosis and follow-up of sacroiliitis in spondyloarthritis. MRI of the sacroiliac joints in affected patients may show active lesions such as bone marrow edema, capsulitis, enthesitis, or synovitis as well as structural changes such as erosion, fat infiltration, sclerosis, backfill, and ankylosis. Active lesions of sacroiliitis on MRI are particularly important for the diagnosis and assessment of ongoing active inflammation. Structural lesions increasingly gain importance for diagnosis and follow-up. Conclusion Active lesions remain the hallmark for assessment of inflammation in sacroiliitis. Structural lesions increasingly play a role in the diagnosis of spondyloarthritis.

scholarly journals Axial Spondyloarthritis: Mimics and Pitfalls of Imaging Assessment

2021 ◽  
Vol 8 ◽  
Author(s):  
António Proença Caetano ◽  
Vasco V. Mascarenhas ◽  
Pedro M. Machado
Keyword(s):  
Bone Marrow ◽  
Structural Changes ◽  
Axial Spondyloarthritis ◽  
Early Stage ◽  
Fatty Infiltration ◽  
Conventional Radiography ◽  
Axial Skeleton ◽  
Inflammatory Disorder ◽  
Imaging Evaluation ◽  
Early Stage Disease

Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that predominantly involves the axial skeleton. Imaging findings of axSpA can be divided into active changes, which include bone marrow edema, synovitis, enthesitis, capsulitis, and intra-articular effusion, and structural changes, which include erosions, sclerosis, bone fatty infiltration, fat deposition in an erosion cavity, and bone bridging or ankylosis. The ability to distinguish between imaging lesions suggestive of axSpA and artifacts or lesions suggestive of other disorders is critical for the accurate diagnosis of axSpA. Diagnosis may be challenging, particularly in early-stage disease and magnetic resonance imaging (MRI) plays a key role in the detection of subtle or inflammatory changes. MRI also allows the detection of structural changes in the subchondral bone marrow that are not visible on conventional radiography and is of prognostic and monitoring value. However, bone structural changes are more accurately depicted using computed tomography. Conventional radiography, on the other hand, has limitations, but it is easily accessible and may provide insight on gross changes as well as rule out other pathological features of the axial skeleton. This review outlines the imaging evaluation of axSpA with a focus on imaging mimics and potential pitfalls when assessing the axial skeleton.

scholarly journals Role of Physical Evaluation in the Early Identification of Axial Spondyloarthritis: A Research Proposal

2015 ◽  
Vol 8 ◽  
pp. CMAMD.S28347 ◽  
Author(s):  
Marcelo P. Castro ◽  
Simon M. Stebbings ◽  
Stephan Milosavljevic ◽  
Melanie D. Bussey
Keyword(s):  
Axial Spondyloarthritis ◽  
Pelvic Girdle Pain ◽  
Functional Tests ◽  
Clinical Tests ◽  
Sacroiliac Joints ◽  
European Guidelines ◽  
Pain Provocation ◽  
Magnetic Resonance Imaging Mri ◽  
Active Inflammation

The aim of this study was to present a rationale to explore the use of clinical tests for the sacroiliac joints to detect early axial spondyloarthritis (SpA) and to suggest a protocol to validate these clinical tests. Based on the European Guidelines for Diagnosis and Treatments of Pelvic Girdle Pain, we propose a set of six clinical tests to identify the likely presence of inflammation in the sacroiliac joints associated with early axial SpA. As magnetic resonance imaging (MRI) is the current gold standard used to identify inflammation in the sacroiliac joints, the results of the proposed set of clinical tests are compared with those from the MRI examinations. We hypothesize that specific clinical tests, which combine pain provocation and functional tests, for assessing the sacroiliac joints will help to identify early active inflammation at the sacroiliac joints in axial SpA. If such tests prove to be sensitive and specific, they could add further value to the diagnostic classification criteria for axial SpA.

scholarly journals Canada-Denmark MRI scoring system of the spine in patients with axial spondyloarthritis: updated definitions, scoring rules and inter-reader reliability in a multiple reader setting

RMD Open ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e001057 ◽  
Author(s):  
Simon Krabbe ◽  
Mikkel Østergaard ◽  
Susanne J Pedersen ◽  
Ulrich Weber ◽  
Georg Kröber ◽  
...  
Keyword(s):  
Bone Formation ◽  
Scoring System ◽  
Axial Spondyloarthritis ◽  
Comprehensive Evaluation ◽  
Bone Erosion ◽  
Intraclass Correlation ◽  
New Bone Formation ◽  
Good Reliability ◽  
Single Measure ◽  
Reader Reliability

ObjectiveTo validate the Canada-Denmark (CANDEN) MRI scoring system for the spine in axial spondyloarthritis with updated lesion definitions.MethodsLesion definitions in the CANDEN system were updated and illustrated by a consensus set of reference images. Sagittal spine MRIs of 40 patients with axial spondyloarthritis obtained at baseline and at week 52 after initiation of treatment with the tumour necrosis factor inhibitor golimumab were evaluated in unknown chronology by seven readers blinded to all other data.ResultsCANDEN MRI spine inflammation score had very good reliability for status scores (single-measure intraclass correlation coefficient (ICC) of 21 reader pairs median of 0.91 (IQR 0.88–0.92)) and change scores (ICC 0.88 (0.86–0.92)). CANDEN MRI spine fat score had good to very good reliability for status scores (ICC 0.79 (0.75–0.86)) and moderate to good reliability for detecting change (ICC 0.59 (0.46–0.73)). CANDEN MRI spine bone erosion score and CANDEN MRI spine new bone formation score had slight to moderate reliability for status scores (ICC 0.38 (0.32–0.52) and 0.39 (0.27–0.49), respectively).ConclusionThe CANDEN MRI spine scoring system allows a comprehensive evaluation of inflammation, fat, bone erosion and new bone formation of the spine in patients with axial spondyloarthritis. It demonstrated very good reliability for detecting change in inflammation, moderate to good reliability for detecting change in fat, and slight to moderate reliability for detecting bone erosions and new bone formation. Studies with longer follow-up or patients with more advanced spinal involvement may be needed to reliably detect change in bone erosion and new bone formation scores.Trial registration numberNCT02011386.

Sign in / Sign up

Export Citation Format

Share Document