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Does the site of magnetic resonance imaging abnormalities match the site of recent-onset inflammatory back pain? The DESIR cohort
  1. Martin Blachier1,2,
  2. Bertrand Coutanceau1,2,
  3. Maxime Dougados3,
  4. Alain Saraux4,5,6,
  5. Sylvie Bastuji-Garin1,2,
  6. Salah Ferkal7,
  7. Philippe Le Corvoisier7,
  8. Valérie Farrenq8,
  9. Cécile Poulain8,
  10. Bijan Ghaleh9,
  11. Florence Canouï-Poitrine1,2,
  12. Pascal Claudepierre1,8
  1. 1Université Paris Est, Laboratoire d'Investigation Clinique (LIC) EA4393, Créteil, France
  2. 2 AP-HP, Hôpital Henri-Mondor, Service de Santé Publique, Créteil, France
  3. 3Université Paris-Descartes, Faculté de médecine, UPRES EA-4058 ; AP–HP, hôpital Cochin, service de rhumatologie B, Paris 14, France
  4. 4Université de Brest, Faculté de Médecine et des Sciences de la Santé, EA 2216, Brest, France
  5. 5CHU Brest, Department of rheumatology, Brest, France
  6. 6Université Européenne de Bretagne, Brest, France
  7. 7Inserm, Centre d'Investigation Clinique 006, Créteil, France
  8. 8AP-HP, Hôpital Henri-Mondor, Service de Rhumatologie, Créteil, France
  9. 9AP-HP, Hôpital Henri-Mondor, Plateforme de Ressources Biologiques, Créteil, France
  1. Correspondence to Professor Pascal Claudepierre, Service de Rhumatologie, Hôpital Henri Mondor, 51 Avenue Maréchal de Lattre de Tassigny, Créteil 94010, France; pascal.claudepierre{at}hmn.aphp.fr

Abstract

Objectives To assess whether the site of axial pain (thoracic spine, lumbar spine or buttock(s)) was associated with the site of MRI lesions in patients with recent inflammatory back pain (IBP) suggesting spondyloarthritis.

Methods We conducted a cross-sectional study of baseline data in 708 patients with recent IBP from the DESIR cohort. Radiographs of the sacroiliac joints (SIJs) and MRI scans of the SIJs and thoracic and lumbar spine were obtained routinely. Associations between pain sites and sites of inflammatory and structural MRI changes were evaluated using separate multivariate logistic regressions.

Results Of the 648 patients with complete data, 61% had thoracic pain, 91.6% lumbar pain and 79.2% buttock pain. MRI inflammation was seen in 19%, 21% and 46% of patients at the thoracic, lumbar and SIJ sites, respectively. By multivariate analysis, pain was significantly associated with MRI inflammation only at the same site (adjusted OR (aOR)thoracic pain 1.71; 95% CI 1.09 to 2.67; p=0.02; aORlumbar pain 2.53; 95% CI 1.03 to 6.20; p=0.04; aORbuttock pain 2.86; 95% CI 1.84 to 4.46; p<0.0001). Pain site was not significantly associated with the site of structural MRI changes, except for buttock pain and SIJ structural MRI changes (aORbuttock pain 1.89; 95% CI 1.22 to 2.90; p=0.004). The association between pain site and site of MRI inflammation persisted in the subgroups with normal or doubtful SIJ radiographs or with Assessment of SpondyloArthritis international Society criteria for axial spondyloarthritis.

Conclusions The site of pain (thoracic spine, lumbar spine or buttock(s)) is associated with MRI inflammation at the same site in patients with recent IBP.

  • Spondyloarthritis
  • Ankylosing Spondylitis
  • Magnetic Resonance Imaging
  • Low Back Pain

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