Performance of an MRI scoring system for inflammation of joints and entheses in peripheral SpA: post-hoc analysis of the CRESPA trial

Simon Krabbe; Thomas Renson; Lennart Jans; Dirk Elewaut; Filip Van den Bosch; Philippe Carron; Mikkel Østergaard

doi:10.1093/rheumatology/keac567

Performance of an MRI scoring system for inflammation of joints and entheses in peripheral SpA: post-hoc analysis of the CRESPA trial

Rheumatology (Oxford). 2023 Jun 1;62(6):2130-2138. doi: 10.1093/rheumatology/keac567.

Authors

Simon Krabbe¹, Thomas Renson^{2

3}, Lennart Jans⁴, Dirk Elewaut^{2

3}, Filip Van den Bosch^{2

3}, Philippe Carron^{2

3}, Mikkel Østergaard^{1

5}

Affiliations

¹ Copenhagen Center for Arthritis Research, Center for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
² Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
³ VIB Inflammation Research Center, Ghent University, Ghent, Belgium.
⁴ Department of Radiology, Ghent University Hospital, Ghent, Belgium.
⁵ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

PMID: 36200875
DOI: 10.1093/rheumatology/keac567

Abstract

Objectives: The aim of this study was to investigate the reliability, validity, and sensitivity to change of a novel MRI scoring system in early peripheral SpA (pSpA).

Methods: MRI of the pelvis and lower extremities was performed before initiation of the TNF inhibitor golimumab in 56 patients and repeated in 46 patients who achieved sustained clinical remission after 24, 36 or 48 weeks. Three readers applied a semi-quantitative MRI scoring system for lower-extremity joint and entheseal inflammation. Four lesion types were assessed: entheseal osteitis, entheseal soft-tissue inflammation, joint osteitis, and joint synovitis/effusion. MRI response was defined as a decrease in MRI lower-extremity inflammation index (sum of scores from 75 sites, each scored 0-3) above the smallest detectable change (SDC).

Results: At follow-up, the MRI index decreased in 34 of 46 patients (74%), and 15 (33%) patients achieved MRI response, i.e. a decrease above SDC of 2.8. When restricting the analysis to patients with clinical involvement of lower-extremity sites that were assessed by MRI, 13 of 28 (46%) achieved MRI response. Interreader reliability was very good, with an average-measure intraclass correlation coefficient of 0.92 (95% CI: 0.85-0.95) for status scores and 0.89 (0.80-0.94) for change in scores. The MRI index correlated with other measures of disease activity, including CRP [Spearman's rho 0.41 (0.23-0.56)], swollen joint count of 6 joints [0.47 (0.27-0.63)], tender enthesis count of 14 entheses [0.32 (0.12-0.50)] and pain score [0.28 (0.08-0.46)], all P < 0.05.

Conclusion: The proposed MRI lower-extremity inflammation index demonstrated reliability, validity, and sensitivity to change in patients with early pSpA.

Trial registration: Clinicaltrials.gov, http://clinicaltrials.gov, NCT01426815.

Keywords: MRI; ankle; hip; inflammation; knee; outcome measures; spondyloarthritis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Inflammation / diagnostic imaging
Inflammation / drug therapy
Joints
Magnetic Resonance Imaging
Osteitis* / diagnostic imaging
Osteitis* / drug therapy
Reproducibility of Results
Severity of Illness Index

Associated data

ClinicalTrials.gov/NCT01426815