Presence of active MRI lesions in patients suspected of non-radiographic axial spondyloarthritis with high disease activity and chance at conversion after a 6-month follow-up period

Abstract

Objectives The primary aim is to evaluate signs of inflammation on MRI of sacroiliac joints (SIJ)/spine in inflammatory back pain (IBP) patients suspected of nr-axSpA with high disease activity. Secondary aims are to describe the onset of new inflammatory lesions at MRI after 6 months and to evaluate gender differences in the presence of inflammation. Method Consecutively, patients with IBP with at least two spondyloarthritis features, high disease activity (BASDAI ≥ 4), and who were TNFi naïve, had a MRI of SIJ and spine. In the absence of active lesions, MRI was repeated after 6 months. MRI images were scored according to the Spondyloarthritis Research Consortium of Canada method. Results Sixty-nine patients were included (53% female), of whom 39% showed signs of inflammation at the first MRI: 30.9% of the SIJ, 19.1% of the spine and 2.4% at both sites, irrespective of the CRP levels. Males more often showed inflammatory signs at the MRI of the SIJ and spine compared with females (45.5% vs. 33.3%). Consistently, the median SPARCC score was higher in males: for SIJ 14.0 (IQR 2.3-25.0) and for spine 11.5 (IQR 8.5-25.6). Only one patient (4.7%) without baseline inflammatory signs showed active lesions of SIJ after 6 months. Conclusions Almost 40% of the IBP patients suspected of nr-axSpA, with high disease activity, showed inflammatory lesions on MRI of SIJ and/or spine, which occurred more often in males compared with females. In the majority (95.3%), an MRI without inflammatory lesions remained negative after 6 months despite high disease activity. Key Points • Forty percent of inflammatory back pain patients with high disease activity showed inflammatory signs on MRI of the SIJ and/or spine. • Only 4% of baseline MRIs without inflammatory signs at baseline conversed to an MRI with inflammatory signs after 6 months. • Male inflammatory back pain patients with high disease activity showed more often inflammatory signs on MRI compared with females.

Genetics and the axial spondyloarthritis spectrum

“…Alternately, it is consistent with a lower clinical diagnostic threshold for women in recent decades, leading to an increase in the misdiagnosis rate in women with AS compared with men. This would be consistent with the higher female prevalence in nr-axSpA [ 5 , 86 ], lower proportion of women with objective MRI evidence of sacroiliac inflammation among cohorts with clinical nr-axSpA [ 87 ] and the shorter retention rate of women with axSpA with biologic therapy [ 70 , 71 , 88 ].…”

Is Treatment in Patients With Suspected Nonradiographic Axial Spondyloarthritis Effective? Six‐Month Results of a Placebo‐Controlled Trial

“…Patients were excluded if they had definite AS according to the modified New York criteria (29) or had received biologic treatment in the past (Table 1). Detailed descriptions of the inclusion and exclusion criteria have been published previously (30). Because of a slow enrollment rate in the first study period, adaptations of the inclusion criteria were made in the second half of 2011, allowing patients without inflammatory lesions seen on MRI to be included in the study.…”

New Perspectives on Diagnosing Psoriatic Arthritis by Imaging Techniques

“…Clinical manifestations of axial spondyloarthritis are represented by chronic inflammatory back pain. 61 , 62 Imaging techniques could detect ankylosing spondylitis or non-radiographic spondyloarthritis. 63 Vertebral body corner oedema, fat infiltration, posterior ligaments enthesitis, aseptic spondylodiscitis, and syndesmophytes in final phases are the main findings on MRI ( Figure 3 ).…”