HLA-B27 status and inflammatory MRI lesions of the sacroiliac joints: a post hoc analysis in patients without axial spondyloarthritis

Abstract

ObjectiveThe assessment of inflammatory and structural lesions in the sacroiliac joint (SIJ) is crucial in axial spondyloarthritis (axSpA). HLA-B27 status plays an important role in axSpA diagnosis and has been linked to MRI lesion burden in the general population. We aimed to investigate the sex-specific influence of HLA-B27 status on inflammatory and structural MRI findings in patients with low back pain of non-inflammatory origin.MethodsThis post hoc analysis included 139 non-axSpA patients (90 women) with chronic low back pain. Two readers scored MRIs of the SIJ for the presence of sclerosis, erosion, fat metaplasia, bone marrow oedema (BMO) and ankylosis. Frequencies and extent of lesions were compared regarding the HLA-B27 status using χ2tests and t-tests. Regression models to assess the sex-dependent influence of HLA-B27 on lesion burden were computed.ResultsHLA-B27 was positive in 33 women (36.7%) and 23 men (46.9%). The overall occurrence of all SIJ lesions did not differ in HLA-B27 negative and positive individuals. There were no significant differences in the extent of lesions considering the HLA-B27 positivity, for erosion (mean sum score (MSS) of 0.91 vs 0.48; p=0.144), sclerosis (MSS 1.65 vs 1.88; p=0.576), fat metaplasia (MSS 0.56 vs 0.27; p=0.425), BMO (MSS 0.75 vs 0.59; p=0.460) and ankylosis (MSS 0.06 vs 0.04; p=0.659).ConclusionHLA-B27 status has no significant influence on the occurrence and extent of SIJ lesions in patients with low back pain of non-inflammatory origin in either men or women.

Radiological Insights into Sacroiliitis: A Narrative Review

“…Its dual-energy approach enhances sensitivity, enabling the detection of subtle inflammatory changes such as bone marrow edema and synovial enhancement [ 36 ]. Crucially, DECT excels in distinguishing between inflammatory and non-inflammatory alterations within the sacroiliac joints, aiding in the identification of sacroiliitis associated with spondyloarthritis [ 37 ]. It is also utilized in detecting nearby tophaceous deposits in conditions such as gout, thus differentiating between septic and crystal-induced sacroiliitis [ 38 ].…”