Imaging Outcomes for Axial Spondyloarthritis and Sensitivity to Change: A Five‐Year Analysis of the DESIR Cohort

Abstract

Objective To compare the sensitivity to change of different imaging scoring methods in patients with early axial spondyloarthritis (SpA). Methods Patients from the Devenir des Spondylarthropathies Indifferérenciées Récentes (DESIR) cohort fulfilling the Assessment of SpondyloArthritis international Society criteria for axial SpA were included. Radiographs and magnetic resonance imaging (MRI) of the sacroiliac (SI) joints and spine were obtained at baseline, 1, 2, and 5 years. Each image was scored by 2 or 3 readers in 3 separate reading waves. The rate of change of outcomes measuring inflammation of the spine and SI joints (e.g., Spondyloarthritis Research Consortium of Canada [SPARCC] score) and structural damage on MRI (e.g., ≥3 fatty lesions) and radiographs (e.g., modified New York grading) was assessed using multilevel generalized estimating equation models (taking all readers and waves into account). To allow comparisons across outcomes, rates were standardized (difference between the individual's value and the population mean divided by the SD). Results In total, 345 patients were included. Inflammation detected on MRI of the SI joints (MRI‐SI joints) (standardized rate range –0.278, –0.441) was more sensitive to change compared to spinal inflammation (range –0.030, –0.055). Structural damage in the SI joints showed a higher standardized rate of change on MRI‐SI joints (range 0.015, 0.274) compared to radiography of the SI joints (range 0.043, 0.126). MRI‐SI joints damage defined by ≥3 fatty lesions showed the highest sensitivity to change (0.274). Spinal structural damage slowly progressed over time with no meaningful difference between radiographic (range 0.037, 0.043) and MRI structural outcomes (range 0.008, 0.027). Conclusion Structural damage assessed in pelvic radiographs has low sensitivity to change, while fatty lesions detected on MRI‐SI joints are a promising alternative. In contrast, MRI of the spine is not better than radiography of the spine in detecting structural changes in patients with early axial SpA.

Sacroiliac joint radiographic progression in axial spondyloarthritis is retarded by the therapeutic use of TNF inhibitors: 12-year data from the SCQM registry

“…We took advantage of the same large national observational cohort of patients with axSpA and a similar methodology that enabled us to demonstrate deceleration of spinal radiographic progression in r-axSpA previously,24 while spinal progression in nr-axSpA was too limited to enable any inhibition to be identified 9. From the different definitions of progression that have been described for the mNY grading system,6–8 we have chosen the one that proved to be the most sensitive to change8 21: worsening of ≥1 grade in ≥1 SIJ and ignoring a change from 0 to 1 over 2 years. Moreover, progression between nr-axSpA and r-axSpA during a 2-year interval is low,7 and the existing cut-off differentiating them proved of limited benefit to predict important outcomes in a recent analysis of our cohort 22…”

“…Second, we have recently shown that the cut-off of SIJ scoring differentiating between nr-axSpA and r-axSpA seems suboptimal to predict clinically relevant outcomes 22. Finally, as already mentioned, sensitivity to change of progression between disease states is much lower than for the outcome chosen 8 21…”

“…The scoring was performed according to the mNYc: grade 0=normal; grade 1=suspicious changes; grade 2=minimal abnormalities; grade 3=unequivocal abnormalities; and grade 4=complete ankylosis 6. Informed by differences in the sensitivity to change of different definitions of radiographic progression at the level of the SIJ,8 21 the following primary outcome for progression was chosen: worsening of at least one grade in at least one SIJ and ignoring a change from 0 to 1 over 2 years. It was only considered to be present if both readers agreed.…”

Axial spondyloarthritis: one year in review 2023

“…Taking into account the evaluation of structural damage, fatty lesions detected on MRI of SIJ had a significantly higher sensitivity to change than pelvic radiographs. Interestingly, this difference was not confirmed for the evaluation of structural changes at spinal level, where MRI was not superior to radiography (42).…”

MicroRNAs in Axial Spondylarthritis: an Overview of the Recent Progresses in the Field with a Focus on Ankylosing Spondylitis and Psoriatic Arthritis

“…Imaging is an essential resource in the diagnosis, as the detection of radiographic sacroiliitis or of active inflammation of SIJ at MRI represents a criterion for classification of axSpA [24]. Moreover, it allows to monitor inflammation and structural damage [31]. Nonetheless, earlier and finer recognition of changes in disease course is needed, preferably with markers that reflect MRI inflammation in the spine [32].…”