Spine and sacroiliac joints on magnetic resonance imaging in patients with early axial spondyloarthritis: prevalence of lesions and association with clinical and disease activity indices from the Italian group of the SPACE study

Our aim was to determine the prevalence of spine and sacroiliac joint (SIJ) lesions on magnetic resonance imaging (MRI) in patients with early axial spondyloarthritis (axSpA) and their correlation with disease activity indices. Sixty patients with low back pain (LBP) (≥3 months, ≤2 years, onset ≤45 years), attending the SpA-clinic of the Unità Operativa Complessa Reumatologia of Padova [SpondyloArthritis-Caught-Early (SPACE) study], were studied following a protocol including physical examination, questionnaires, laboratory tests, X-rays and spine and SIJ MRI. Positive spine and SIJ MRI and X-rays images were scored independently by 2 readers using the SPARCC method, modified Stoke ankylosing spondylitis spine score and New York criteria. The axial pain and localization of MRI-lesions were referred to 4 sites: cervical/thoracic/lumbar spine and SIJ. All patients were classified into three groups: patients with signs of radiographic sacroiliitis (r-axSpA), patients without signs of r-axSpA but with signs of sacroiliitis on MRI (nr-axSpA MRI SIJ+), patients without signs of sacroiliitis on MRI and X-rays (nr-axSpA MRI SIJ-). The median age at LBP onset was 29.05±8.38 years; 51.6% of patients showed bone marrow edema (BME) in spine-MRI and 56.7% of patients in SIJ-MRI. Signs of enthesitis were found in 55% of patients in the thoracic district. Of the 55% of patients with BME on spine-MRI, 15% presented presented a negative SIJMRI. There was a significant difference between these cohorts with regard to the prevalence of radiographic sacroiliitis, active sacroiliitis on MRI and SPARCC SIJ score. The site of pain correlated statistically with BME lesions in thoracic and buttock districts. Since positive spine-MRI images were observed in absence of sacroiliitis, we can hypothesize that this finding could have a diagnostic significance in axSpA suspected axSpA.

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Platelet Indices Are Associated with Disease Activity Scores and the Severity of Sacroiliitis on Magnetic Resonance Imaging in Axial Spondyloarthritis Patients

Journal of Rheumatic Diseases ◽

10.4078/jrd.2016.23.5.288 ◽

2016 ◽

Vol 23 (5) ◽

pp. 288 ◽

Cited By ~ 1

Author(s):

Kwi Young Kang ◽

Joon-Yong Jung ◽

Ji Hyeon Ju ◽

Sung-Hwan Park ◽

Yeon-Sik Hong

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Resonance Imaging ◽

Platelet Indices

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Whole-body Magnetic Resonance Imaging in Axial Spondyloarthritis: Reduction of Sacroiliac, Spinal, and Entheseal Inflammation in a Placebo-controlled Trial of Adalimumab

The Journal of Rheumatology ◽

10.3899/jrheum.170408 ◽

2018 ◽

Vol 45 (5) ◽

pp. 621-629 ◽

Cited By ~ 14

Author(s):

Simon Krabbe ◽

Mikkel Østergaard ◽

Iris Eshed ◽

Inge J. Sørensen ◽

Bente Jensen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Placebo Group ◽

Magnetic Resonance ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Whole Body ◽

Clinical Indication ◽

Resonance Imaging ◽

Conventional Mri ◽

Smallest Detectable Change

Objective.To investigate whether adalimumab (ADA) reduces whole-body (WB-) magnetic resonance imaging (MRI) indices for inflammation in the entheses, peripheral joints, sacroiliac joints, spine, and the entire body in patients with axial spondyloarthritis (axSpA).Methods.An investigator-initiated, randomized, placebo-controlled, double-blinded 48-week followup trial included 49 patients with axSpA, who had Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4.0 despite treatment with nonsteroidal antiinflammatory drugs and a clinical indication for tumor necrosis factor inhibitor treatment. Patients were randomized to subcutaneous ADA 40 mg or placebo every other week for 6 weeks; thereafter, all patients received ADA. Conventional MRI and WBMRI were performed at weeks 0, 6, 24, and 48. The primary WBMRI endpoint was the proportion of patients with an improvement in WBMRI total inflammation index above the smallest detectable change (SDC) at Week 6.Results.The primary WBMRI endpoint (improvement of SDC > 2.3) was met in 11 (44%) patients in the ADA group and 3 (13%) patients in the placebo group (p = 0.025, Fisher’s exact test). The primary conventional MRI endpoint, the minimally important change in Spondyloarthritis Research Consortium of Canada Spine MRI Inflammation Index at Week 6, was achieved by 9 (36%) patients in the ADA group and 4 (17%) patients in the placebo group (p = 0.20). The primary clinical endpoint, BASDAI reduction > 50% or 2.0 at Week 24, was attained by 32 (65%) patients.Conclusion.ADA provided significant reductions in WBMRI indices of peripheral, axial, and whole-body inflammation in patients with axSpA. WBMRI is promising for objective assessment and monitoring of peripheral and axial disease activity in future clinical trials.

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FRI0456 Performance of magnetic resonance imaging for the detection of chronic structural changes in the sacroiliac joints as compared to conventional x-rays in axial spondyloarthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-eular.1583 ◽

2013 ◽

Vol 72 (Suppl 3) ◽

pp. A529.2-A529

Author(s):

I. Gaydukova ◽

K.-G. Hermann ◽

I.-H. Song ◽

H. Haibel ◽

J. Braun ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Structural Changes ◽

Axial Spondyloarthritis ◽

X Rays ◽

Resonance Imaging ◽

Sacroiliac Joints

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Whole-body Magnetic Resonance Imaging Inflammation in Peripheral Joints and Entheses in Axial Spondyloarthritis: Distribution and Changes during Adalimumab Treatment

The Journal of Rheumatology ◽

10.3899/jrheum.181159 ◽

2019 ◽

Vol 47 (1) ◽

pp. 50-58 ◽

Cited By ~ 4

Author(s):

Simon Krabbe ◽

Iris Eshed ◽

Inge Juul Sørensen ◽

Bente Jensen ◽

Jakob M. Møller ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Whole Body ◽

Resonance Imaging ◽

Inflammatory Lesions ◽

Joint Tenderness ◽

Body Magnetic Resonance Imaging ◽

Clinical Measures

Objective.To investigate the distribution of whole-body magnetic resonance imaging (WB-MRI) inflammatory lesions of peripheral joints and entheses, and their response to adalimumab (ADA) treatment and agreement with clinical measures of disease activity in patients with axial spondyloarthritis (axSpA).Methods.Explorative analysis of an investigator-initiated randomized controlled trial of ADA. WB-MRI was performed at weeks 0, 6, 24, and 48. Detailed analyses of WB-MRI lesions in peripheral joints and entheses were performed, including agreement with clinical measures of disease activity.Results.WB-MRI inflammatory lesions were most frequently observed in the acromioclavicular, metatarsophalangeal, and wrist joints (> 10% of joints), and at the greater trochanter, calcaneal insertion of the Achilles tendon, and ischial tuberosity (> 15% of entheses). Inflammation resolved in ≥ 2/3 of involved sternoclavicular, metacarpophalangeal, first carpometacarpal, hip, and tarsometatarsal joints, and pubic symphyses and medial femoral condyles. In contrast, inflammation resolved in ≤ 1/6 of involved acromioclavicular joints, knee joints, and supraspinatus tendon insertions at humerus. Tenderness of joints and entheses agreed poorly with WB-MRI inflammation (κ < 0.40). Joint tenderness resolved more frequently in MRI-positive than MRI-negative joints (8/13, 62% vs 9/34, 26%) after 6 weeks of active treatment.Conclusion.Inflammatory lesions of peripheral joints and entheses in patients with predominantly axSpA, and changes therein, can be mapped using WB-MRI, and it may contribute to differentiate between inflammatory and noninflammatory joint tenderness. (Trial registration: ClinicalTrials NCT01029847).

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Association of Bone Edema with the Progression of Bone Erosions Quantified by Hand Magnetic Resonance Imaging in Patients with Rheumatoid Arthritis in Remission

The Journal of Rheumatology ◽

10.3899/jrheum.130902 ◽

2014 ◽

Vol 41 (8) ◽

pp. 1623-1629 ◽

Cited By ~ 14

Author(s):

Maria Pilar Lisbona ◽

Anna Pàmies ◽

Jesús Ares ◽

Miriam Almirall ◽

Maria Navallas ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Disease Activity ◽

Clinical Remission ◽

Sustained Remission ◽

Resonance Imaging ◽

Bone Erosions ◽

Significant Difference ◽

Bone Edema

Objective.To evaluate the association of synovitis, bone marrow edema (BME), and tenosynovitis in the progression of erosions quantified by hand magnetic resonance imaging (MRI) at 1 year in patients with early rheumatoid arthritis (RA) in remission.Methods.A total of 56 of 196 patients with early RA in remission at 1 year and with available MRI data at baseline and at 12 months were included. MRI images were assessed according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Persistent remission was defined as 28-joint Disease Activity Score-erythrocyte sedimentation rate ≤ 2.6 and/or Simplified Disease Activity Index ≤ 3.3 and/or the new boolean American College of Rheumatology/European League Against Rheumatism remission criteria for a continuous period of at least 6 months. Progression of bone erosions was defined as an increase of 1 or more units in annual RAMRIS score for erosions compared to baseline.Results.At 1 year, the majority of patients with RA in sustained remission showed some inflammatory activity on MRI (94.6% synovitis, 46.4% BME, and 58.9% tenosynovitis) and 19 of the 56 patients (33.9%) showed MRI progression of bone erosions. A significant difference was observed in MRI BME at 1 year, with higher mean score in patients with progression compared to nonprogression of erosions (4.8 ± 5.6 and 1.4 ± 2.6, p = 0.03).Conclusion.Subclinical inflammation was identified by MRI in 96.4% of patients with RA in sustained clinical remission. Significantly higher scores of BME after sustained remission were observed in patients with progression of erosions compared to patients with no progression. The persistence of higher scores of BME may explain the progression of bone erosions in patients with persistent clinical remission.

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AB0007 VALUE OF ULTRASOUND IN ASSESSMENT OF ACTIVE SACROILIITIS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3990 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1307.3-1307

Author(s):

M. Chen ◽

S. M. Dai

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Axial Spondyloarthritis ◽

Resonance Imaging ◽

Predictive Values ◽

Significant Difference ◽

The Us ◽

Active Sacroiliitis ◽

Magnetic Resonance Imaging Mri ◽

Research Consortium

Background:The inflammatory of the sacroiliac joints (SIJs) called sacroiliitis, is a characteristic of axial Spondyloarthritis (axSpA). The detection of sacroiliitis is meaningful to prevent irreversible changes. The tool of assessment of sacroiliitis including radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Ultrasound (US) has also been used in the evaluation of sacroiliitis in recent years.Objectives:We aimed to evaluate the value of US in the assessment of active sacroiliitis in axSpA patients.Methods:Fifty-one patients fulfilling Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria for the classification of axSpA were recruited1. All the patients underwent MRI and US evaluation of bilateral SIJs. MRI was performed using the sequences of T1WI, T2WI and fat suppression T2WI (FS-T2WI). MRI sacroiliitis was defined according to ASAS criteria of active sacroiliitis2. The Spondyloarthritis research Consortium of Canada (SPARCC) scoring was used to evaluate the inflammatory lesions in SIJs3. US were performed by an ultrasonographer with 10 years of experience in musculoskeletal ultrasound, and resistive index (RI) value was recorded. The US sacroiliitis was defined as the presence of more flow signals at SIJ with an RI ≤ 0.75. The HLA-B27, erythrocyte sedimentation rate (ESR) and hypersensitive C-reactive protein (hsCRP) were also evaluated. Consistency rate, sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV)for the diagnosis of sacroiliitis by US were calculated, using MRI as the gold standard.Results:Of the 51 patients, 24 were female and 27 were male. The HLA-B27 positive rate was 90.2% (46/51). The consistency rate of US and MRI sacroiliitis was 55.88 (57/102). The sensitivity and specificity of US for the diagnosis of sacroiliitis were 55.93 (33/59) and 55.81 (24/43) respectively. The PPV and NPV were 63.46 (33/52) and 48 (24/50) respectively. There was no significant difference in ESR and hsCRP between the US positive sacroiliitis and the others (P= 0.7477 and 0.2268, respectively). The SPARCC scores have no significant difference between the US positive sacroiliitis and the others (P= 0.2206). The RI was not significantly associated with the MRI SPARCC score (P=0.4236).Conclusion:US may be an optional method for preliminary screening sacroiliitis. But its reliability as a diagnostic method needs further verification.References:[1]Rudwaleit M, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009; 68(6):777-83[2]Rudwaleit M, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 2009;68(10):1520–7[3]Maksymowych WP, et al. Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum.2005;53(5):703-9.Acknowledgments:This project was supported by grants from National Natural Science Foundation of China (81900795)Disclosure of Interests:None declared

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Procollagen I N-terminal peptide correlates with inflammation on sacroiliac joint magnetic resonance imaging in ankylosing spondylitis but not in non-radiographic axial spondyloarthritis: A cross-sectional study

Modern Rheumatology ◽

10.1093/mr/roab044 ◽

2021 ◽

Author(s):

Xuegang Li ◽

Anqi Liang ◽

Yufeng Chen ◽

Nelson SiuKei Lam ◽

Xinxin Long ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ankylosing Spondylitis ◽

Magnetic Resonance ◽

Disease Activity ◽

Sacroiliac Joint ◽

Axial Spondyloarthritis ◽

Serum Alkaline Phosphatase ◽

Type I ◽

Resonance Imaging ◽

Inflammatory Score

ABSTRACT Objectives To identify disease activity scores and biomarkers that reflect magnetic resonance imaging (MRI)-determined sacroiliac joint (SIJ) inflammation in ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). Methods Patients who had AS and nr-axSpA were enrolled. All the patients underwent SIJ MRI. SpondyloArthritis Research Consortium of Canada (SPARCC) method was used to score bone marrow edema in the inflammatory lesions on MRI. Radiographic assessment of the spine was performed using modified Stoke Ankylosing Spondylitis Spine Score. Clinical variables, inflammatory markers, serum alkaline phosphatase, osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX-I), and procollagen I N-terminal peptide (PINP) were measured. Correlation analysis between MRI-determined SIJ inflammation scores and disease activity scores and laboratory variables was performed. Results Thirty-five patients had AS and 36had nr-axSpA. Significant differences were noted between the AS group and the nr-axSpA group in terms of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Ankylosing Spondylitis Disease Activity Score (ASDAS)-ESR, ASDAS-CRP, PINP, and SPARCC (p < .001, p = .004, p < .001, p < .001, p = .030, p < .001, respectively). MRI-determined SIJ inflammatory scores correlated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), OC, CTX-I, and PINP in AS (p = .036, p = .023, p = .002, p = .041, p = .004, respectively) and correlated with ESR, CRP, ASDAS-ESR, ASDAS-CRP, BASDAI, and BASFI in nr-axSpA (p = .003, p = .002, p < .001, p < .001, p = .010, p = .007, respectively). Multivariate analysis showed that PINP exhibited a positive correlation independent of the MRI inflammatory score and that age exhibited a negative correlation independent of the MRI inflammatory score. Conclusions In AS, PINP and age independently correlated with active inflammation on SIJ MRI. PINP may be useful as a marker of objective inflammation in AS.

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