MRI lesions in SpA: a comparison with noninflammatory back pain using propensity score adjustment method

Ho Yin Chung; Jin Xian Huang; Kam Ho Lee; Helen Hoi Lun Tsang; Chak Sing Lau; Shirley Chiu Wai Chan

doi:10.1177/1759720X221119250

MRI lesions in SpA: a comparison with noninflammatory back pain using propensity score adjustment method

Ther Adv Musculoskelet Dis. 2022 Aug 25:14:1759720X221119250. doi: 10.1177/1759720X221119250. eCollection 2022.

Authors

Ho Yin Chung¹, Jin Xian Huang², Kam Ho Lee³, Helen Hoi Lun Tsang¹, Chak Sing Lau¹, Shirley Chiu Wai Chan⁴

Affiliations

¹ Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong.
² Division of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
³ Department of Radiology, Queen Mary Hospital, Hong Kong.
⁴ Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong.

Abstract

Background: Magnetic resonance imaging (MRI) is important in the management of axial spondyloarthritis (SpA). However, many MRI lesions are not exclusive to axial SpA. Further characterization of these lesions may lead to better clinical decisions.

Objective: The objective of this study was to compare the frequency of individual spinal MRI lesions between axial SpA and noninflammatory back pain. The factors associated with individual lesions in participants with axial SpA were also determined.

Design: This was a cross-sectional observational study.

Methods: MRI lesions in 447 participants with axial SpA and 122 participants with noninflammatory back pain were compared using the propensity score adjustment method. Individual lesions included discovertebral lesions (DVL), Modic type 1 lesions, DVL without Modic type 1 lesions, facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL). The factors associated with the lesions were determined using regression analyses.

Results: Among participants with axial SpA, 81.9% were HLA-B27-positive, 55.0% had radiographic axial SpA, and 60.5% had radiographic features of spinal damage (mSASSS >2). Almost half (48.6% in axial SpA versus 31.1% in noninflammatory back pain) had inflammatory lesions on spinal MRI. In propensity score matching with noninflammatory back pain, axial SpA had an increased occurrence of DVL without Modic type 1 lesion (OR = 3.43, p = 0.01), costovertebral lesion (OR = 11.89, p = 0.02), number of CIL (B = 1.19, p < 0.001), and number of FCL (B = 3.33, p < 0.001). Similar associations were found in the regression models in the radiographic axial SpA subgroup: DVL without Modic type 1 lesion (OR = 2.46, p = 0.001), costovertebral lesion (OR = 3.86, p < 0.001), number of CIL (B = 1.13, p < 0.001), and FCL (B = 2.29, p < 0.01).

Conclusion: MRI lesions including DVL without Modic type 1, costovertebral joint lesions, CIL, and FCL were more specific in axial SpA.

Keywords: magnetic resonance imaging; spondyloarthritis.