Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings

Puhakka, Katriina Bøcker; Jurik, Anne Grethe; Schiøttz‐Christensen, Berit; Hansen, Gert Von Overemm; Egund, Niels; Christiansen, J; Stengaard‐Pedersen, Kristian

doi:10.1093/rheumatology/keh008

Cited by 84 publications

(50 citation statements)

References 15 publications

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“…Elevated MMP-3 was related to BASMI, but not to BASFI or BASGI. In addition, MMP-3 was not related to ESR or CRP which is consistent with other studies [30,36].…”

Section: Discussionsupporting

confidence: 92%

“…The ten AS patients who were found to lack MRI features of inXammation were clinically active, which is consistent with previous results [36,38,41]. On the other hand, some studies found AS patients with MRI features of inXammation to have normal clinical examination [37].…”

Section: Discussionsupporting

confidence: 89%

“…We may suspect that absence of correlation with other measures in the present work would rather add to the questions of inaccuracy of conventional parameters as measures of disease activity, especially that they already have well known drawbacks. APR have limited value in determining disease activity in AS [4], and previous studies have reported diVerent and contradictory Wndings regarding the relation between APR and disease activity [12,32,36]. As for the BASDAI, though easy to apply, may not perform eYciently and is totally patient dependant.…”

Section: Discussionmentioning

confidence: 99%

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Role of matrix metalloproteinase-3 (MMP-3) and magnetic resonance imaging of sacroiliitis in assessing disease activity in ankylosing spondylitis

et al. 2011

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The objective of this study is to evaluate the role of MMP-3 and MRI in assessing disease activity in sacroiliac joints of AS patients in comparison to the conventional measures Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Serum MMP-3 was measured in 30 patients who fulfilled the modified New York criteria for AS and in ten healthy volunteers. AS patients were categorized into those having high or low MMP-3 according to a cut-off value = 7.1 ng/ml. MRI of the sacroiliac joints (SIJs) was performed on all patients. SIJs were evaluated for enhancement and subchondral bone marrow edema. Results of MMP-3 and findings on MRI were correlated with multiple clinical parameters including BASDAI, ESR and CRP. Serum MMP-3 was significantly elevated in AS patients with active disease. Elevated MMP-3 levels were significantly associated with high BASDAI (P = 0.046), but not with ESR or CRP. MRI showed bone marrow edema and enhancement of SIJs in 19/30 patients with one patient showing enhancement only. These MRI findings were not correlated with MMP-3, BASDAI, CRP or ESR. In conclusion, serum MMP-3 is an objective measure reflecting clinical disease activity in AS. Bone marrow edema and enhancement detected by MRI of SIJs is another objective measure of disease activity, but are not correlated with MMP-3 or the conventional parameters as BASDAI, ESR, or CRP. Although both MMP-3 and MRI can reflect disease activity in AS they seem to be unrelated, perhaps each is reflecting a different aspect of disease activity. MMP-3 and MRI should be considered together with BASDAI in assessing disease activity and in guiding the available recommendations for initiation of biologics in AS.

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“…Elevated MMP-3 was related to BASMI, but not to BASFI or BASGI. In addition, MMP-3 was not related to ESR or CRP which is consistent with other studies [30,36].…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Role of matrix metalloproteinase-3 (MMP-3) and magnetic resonance imaging of sacroiliitis in assessing disease activity in ankylosing spondylitis

et al. 2011

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“…Therefore, an extremely important fact is that available and emerging data have shown that MRI of the SI joints are of definite diagnostic and prognostic utility in axial-SpA [14,17,18] as it defines cases with SI joint osteitis that will progress to radiographic change and a definite diagnosis of modified New York criteria AS [14,17].…”

Section: Mri In Diagnosis Of Si Joint Disease In Spamentioning

confidence: 99%

“…on STIR sequences in axial-SpA [14,18,25] (ii) Diagnostic utility on T1-weighted MRI when there are no inflammatory lesions present on STIR [37] Benefits of whole-spine MRI in the assessment of axial-SpA Prognosis (i) STIR predicts long-term AS in early IBP [14,17,18] (ii) Spinal inflammatory lesions on STIR MRI predict syndesmophyte formation [35,36] (iii) Post-inflammatory corner lesions on T1 MRI predict syndesmophyte formation [40] Treatment decisions (i) Increased spinal inflammatory lesion score on STIR sequence predicts response to anti-TNF [28] Furthermore, the role of fat-suppression MRI in influencing treatment decisions in axial-SpA/AS by identifying likely responders to anti-TNF [28] has become more established, and fat-suppressed MRI of the whole spine and SI joints has prognostic value in predicting AS in early IBP [17] and may be a predictor of spinal syndesmophyte formation and possible spinal fusion [35,36]. These are compelling reasons for the routine use of fat-suppression MRI of the whole spine in the assessment of axial-SpA.…”

Section: Diagnosis (I) Proven Diagnostic Utility Of Mri Lesionsmentioning

confidence: 99%

The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy

Bennett¹,

Marzo‐Ortega²,

Rehman³

et al. 2010

Rheumatology

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, on behalf of the Leeds Spondyloarthropathy Group AbstractIn the past decade, fat-suppression MRI techniques have been increasingly used for the assessment of axial-SpA. Indeed, newly proposed classification criteria have suggested the inclusion of fat-suppression MRI for the evaluation of the SI joint in inflammatory back pain (IBP) of suspected axial-SpA. However, recent data on the whole spine have identified certain MRI spinal lesions to be highly diagnostic of axial-SpA; that the SI joint can be spared in axial-SpA; and that IBP may originate in the lumbar spine rather than SI joint. Therefore, it is proposed that MRI of the whole spine and not just the SI joint should now become a routine part of the assessment of axial-SpA. Not only is spinal MRI of great diagnostic utility in axial-SpA but there is also increasing evidence to suggest that it can play a significant role in the management, in particular directing anti-TNF therapy in AS, and also it may be prognostically useful in axial-SpA. With the wider availability, improving technology and falling cost of MRI, and the difficulty that clinical assessment of axial-SpA poses, especially in early disease, there is now a strong case for the use of whole-spine MRI in the diagnosis and management of axial-SpA.

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Severity of baseline magnetic resonance imaging–evident sacroiliitis and HLA–B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years

Bennett

McGonagle

O’Connor

et al. 2008

Arthritis & Rheumatism

332

177

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Objective. Magnetic resonance imaging (MRI) is increasingly used to detect sacroiliitis earlier. This study was undertaken to investigate what proportion of patients with MRI-evident sacroiliitis develop ankylosing spondylitis (AS) in the long term and whether there are predictors of outcome.Methods. Consecutive undiagnosed patients with early inflammatory back pain (IBP) (of <2 years' duration) were assessed clinically and radiologically. Baseline imaging assessments included fat-suppressed MRI sequences of the sacroiliac joints and lumbar spine that were scored for active bone marrow edema representative of acute inflammation, and anteroposterior radiographs of the pelvis and lateral radiographs of the lumbar spine, which were scored using the Stoke Ankylosing Spondylitis Spine Score. Patients were reassessed clinically and radiographically after 8 years. The primary outcome was the modified New York criteria for AS at followup.Results. Fifty patients were assessed at the beginning of the study, and 40 patients were followed up after a mean of 7.7 years. Of these 40 patients, 58% were HLA-B27 positive, and 98% met the European Spondylarthropathy Study Group criteria. The current diagnostic criteria for ankylosing spondylitis (AS), the modified New York criteria (1), rely on the presence of radiographically evident sacroiliitis, which may only appear after years of inflammatory back pain (IBP) (2). However, it is known that much of the pathologic condition in axial spondylarthritis (SpA) is related to perifibrocartilage osteitis, and magnetic resonance imaging (MRI) has been proven to be supe-1 A.

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Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings

Abstract: In patients with early SpA, MRI was able to detect inflammatory and destructive changes of the SIJs, but the changes were not associated to clinical findings. Our results suggest a role of MRI in the detection of early-stage sacroiliitis.

Cited by 84 publications

References 15 publications

Role of matrix metalloproteinase-3 (MMP-3) and magnetic resonance imaging of sacroiliitis in assessing disease activity in ankylosing spondylitis

Role of matrix metalloproteinase-3 (MMP-3) and magnetic resonance imaging of sacroiliitis in assessing disease activity in ankylosing spondylitis

The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy

Severity of baseline magnetic resonance imaging–evident sacroiliitis and HLA–B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years

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