Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging.

427

314

Objective. To develop a feasible magnetic resonance imaging (MRI)-based scoring system for sacroiliac joint inflammation in patients with ankylosing spondylitis (AS) that requires minimal scan time, does not require contrast enhancement, evaluates lesions separately at each articular surface, and limits the number of sacroiliac images that are scored. Methods. A scoring method based on the assessment of increased signal denoting bone marrow edema on T2-weighted STIR sequences was used. MRI films were assessed blindly in random order at 2 sites by multiple readers. Intra-and interreader reliability was assessed by intraclass correlation coefficient (ICC); the 24-week response of patients with AS randomized to placebo:infliximab (3:8) was assessed by effect size and standardized response mean. The reliability and responsiveness of the scoring method were compared for STIR and gadolinium diethylenetriaminepentaacetic (Gd-DTPA)-enhanced MRI sequences. Results. We scanned 11 patients with AS with clinically active disease and 11 additional patients randomized to the trial of infliximab therapy. ICC for total sacroiliac joint STIR score ranged from 0.90 to 0.98 (P < 0.00001) and interobserver ICC for combined readers from the 2 sites was 0.84 (P < 0.0001). ICC for change scores was lower for STIR (ICC 0.53) than for Gd-DTPA-enhanced sequences (ICC 0.79). Responsiveness was poor, although fusion was evident in one-third of patients who received treatment (placebo:infliximab) and inflammation scores were low. Conclusion. The Spondyloarthritis Research Consortium of Canada MRI index is a feasible and reproducible index for measuring sacroiliac joint inflammation in patients with AS.

Section: Introductionmentioning

confidence: 99%

Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis

Maksymowych¹,

Inman²,

Salonen³

et al. 2005

427

314

“…Because AS is a slowly progressing disease as far as radiographic changes are concerned, definite sacroiliitis on plain radiographs appears relatively late, which is one reason for the long diagnostic delay of 5-10 years in AS (10,11). In early disease without definite radiographic changes, active inflammation of the SI joints can be visualized using magnetic resonance imaging (MRI) technology (12). Clinical experience and limited data (13) suggest that in a sizeable proportion of patients who have inflammation of the SI joints on MRI but in whom radiographic findings are normal or suspicious, radiographically defined sacroiliitis will develop later and thus evolve to AS.…”

mentioning

confidence: 99%

The early disease stage in axial spondylarthritis: Results from the german spondyloarthritis inception cohort

Rudwaleit¹,

Haibel²,

Baraliakos³

et al. 2009

643

406

Objective. Ankylosing spondylitis (AS) is diagnosed late, because radiographs of the sacroiliac joints often do not show definite sacroiliitis at the time of disease onset. The aim of this study was to investigate whether patients without definite radiographically defined sacroiliitis, referred to as nonradiographic axial spondylarthritis (SpA), are different from patients with AS with regard to clinical manifestations and disease activity measures. Moreover, we sought to identify determinants of the development of radiographic sacroiliitis.Methods. In a cross-sectional analysis of 462 patients, we compared 226 patients with nonradiographic axial SpA (symptom duration <5 years) and 236 patients with AS (symptom duration <10 years) who are participants in the German Spondyloarthritis Inception Cohort. Radiographs of the sacroiliac joints and the spine were assessed by 2 readers in a blinded manner. Logistic regression analysis was applied to identify parameters associated with structural damage.Results. The 2 groups did not differ in the frequency of HLA-B27 positivity, inflammatory back pain, arthritis, enthesitis, and uveitis and had similar levels of disease activity, using measures such as the Bath Ankylosing Spondylitis Disease Activity Index. In both groups, HLA-B27 positivity determined the age at disease onset. Conclusion. Clinical manifestations and disease activity measures are highly comparable between patients with early nonradiographic axial SpA and those with early AS, suggesting that these 2 entities are part of the same disease. Male sex and an elevated CRP level are associated with structural damage on radiographs, whereas HLA-B27 positivity determines the age at disease onset.

“…Magnetic resonance imaging (MRI) has promising sensitivity and specificity but is limited by cost and accessibility (3). Plain radiography is readily accessible and relatively inexpensive but detects only structural changes in established disease.…”

mentioning

confidence: 99%

Cartilage biomarkers in ankylosing spondylitis: Relationship to clinical variables and treatment response

Kim

Stone

Payne

et al. 2005

Objective. Ankylosing spondylitis (AS) is a progressive disease in which chronic inflammation can lead to extensive new bone formation throughout the spine. At present, few measures of the activity or extent of the disease are available. In this study, we sought to determine whether markers of cartilage synthesis and degradation could provide such quantitative measures.Methods. Serum samples from 23 patients receiving infliximab treatment for AS were obtained at baseline and at weeks 2, 6, 14, and 22. Conclusion. In AS, elevated serum levels of CPII and the 846 epitope may be related to biosynthetic turnover of hyaline cartilage and the intervertebral discs but may also reflect progressive bone formation as a result of endochondral ossification. The correlation of the CPII:C2C ratio with CRP suggests that the CPII: C2C ratio might prove to be a useful marker of disease activity in AS.The hallmark of ankylosing spondylitis (AS) is acute and chronic inflammation in the sacroiliac joints as well as enthesitis, defined as inflammation at the sites of ligamentous and tendinous insertions onto bone. To a varying degree, peripheral joint synovitis can also be a prominent feature. Previously, pathologic studies revealed the presence of T cells and macrophages and local expression of tumor necrosis factor ␣ (TNF␣) in biopsy specimens from the sacroiliac joints of patients with active AS (1).