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

Tamara Rusman; Marie-Luise B John; Mignon A C van der Weijden; Bouke J H Boden; Carmella M A van der Bijl; Stefan T G Bruijnen; Conny J van der Laken; Mike T Nurmohamed; Irene E van der Horst-Bruinsma

doi:10.1007/s10067-019-04885-8

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

Clin Rheumatol. 2020 May;39(5):1521-1529. doi: 10.1007/s10067-019-04885-8. Epub 2020 Jan 8.

Authors

Tamara Rusman¹, Marie-Luise B John¹, Mignon A C van der Weijden¹, Bouke J H Boden², Carmella M A van der Bijl¹, Stefan T G Bruijnen¹, Conny J van der Laken¹, Mike T Nurmohamed^{1

3}, Irene E van der Horst-Bruinsma⁴

Affiliations

¹ Amsterdam Rheumatology & Immunology Center, Department of Rheumatology 3a-64, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
² Onze Lieve Vrouwe Gasthuis (OLVG), Radiology, Amsterdam, The Netherlands.
³ Reade, Rheumatology, Amsterdam, The Netherlands.
⁴ Amsterdam Rheumatology & Immunology Center, Department of Rheumatology 3a-64, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. IE.vanderHorst@amsterdamumc.nl.

PMID: 31916108
DOI: 10.1007/s10067-019-04885-8

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.

Keywords: Gender; Inflammation; Inflammatory back pain; Magnetic resonance imaging; Spondyloarthropathy.

MeSH terms

Adult
Back Pain / etiology
Female
Follow-Up Studies
Humans
Inflammation / pathology
Linear Models
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Netherlands
Sacroiliac Joint / pathology*
Severity of Illness Index
Spine / pathology*
Spondylarthritis / diagnosis*
Spondylarthritis / pathology*