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SAT0195 Is IT Worth to Include MRI of the Spine in the ASAS Classification Criteria for Axial Spondyloarthritis; Data from the Desir-Cohort
  1. M. de Hooge1,
  2. J. Pialat2,
  3. A. Feydy3,
  4. M. Reijnierse1,
  5. P. Claudepierre4,
  6. A. Saraux5,
  7. M. Dougados3,
  8. D. van der Heijde1
  1. 1LUMC, Leiden, Netherlands
  2. 2Hôpital Edouard Herriot, Lyon
  3. 3Descartes University, Côchin Hospital, Paris
  4. 4Henri Mondor Teaching Hospital, Créteil
  5. 5CHU de la Cavale Blanche, Brest Cedex, France

Abstract

Background Spinal MRI lesions suggestive of axial Spondyloarthritis (axSpA) are not included in the ASAS definition of a positive MRI, but do occur in the absence of affected sacroiliac joints (SIJ). It is unknown how often this happens and if it is useful to perform a MRI of the spine in patients (pts) with negative MRI-SIJ

Objectives To investigate the prevalence of a positive MRI-spine in pts with short symptom duration and a negative MRI-SIJ

Methods Pts aged 18-50 with inflammatory back pain (IBP) (≥3 months, ≤3 years) from 25 participating centers in France were included in the DESIR-cohort (n=708). All available baseline MRIs of the spine were independently scored by 2 well-calibrated central readers who were blind to any other data. MRIs-SI were scored according to the ASAS definition1 (lesions highly suggestive of sacroiliitis plus ≥1 lesion on ≥2 consecutive slices or >1 lesion on 1 slice). Inflammatory lesions on MRI-spine suggestive of spondylitis were scored when visible on ≥2 consecutive slices and according to the ASAS consensus definition2 (≥3 lesions). In case of disagreement, an experienced radiologist served as adjudicator. MRI was considered positive if 2/3 readers agreed

Results All pts with MRI-spine and MRI-SIJ (n=650) were included in the analyses. There were 231 pts (35,5%) with a positive MRI-SIJ and 102 pts (15.7%) with a positive MRI-spine; 67 pts (10.3%) were positive for both MRI-SIJ and MRI-spine, 384 (59.1%) were negative for both; and 35 pts (5.4%) had a positive MRI-spine but a negative MRI-SI. Thirty of these were <45 years at symptom onset (entry criterion for ASAS axSpA criteria); 8 of these 30 pts fulfilled the modified New York criteria, 16 of these 30 pts fulfilled the clinical arm of the ASAS axSpA criteria and 6 pts did not fulfil the criteria. All these 6 pts were HLA-B27 negative. Therefore, if the MRI-spine would be considered to count for imaging for the ASAS criteria, 6 additional pts would have been classified and 16 pts would have fulfiled both the imaging and clinical arm; Two of the 5 pts with age >45 years at symptom onset fulfilled the mNY criteria.

Overall, only 25 pts (3.8%) had a pos MRI-spine without sacroiliitis on MRI or radiographs

Conclusions In 3.8% of IBP pts aged 18-50 ≥3 spinal inflammatory lesions suggestive of axSpA are found in absence of sacroiliitis on MRI or radiograph. Therefore the yield of including MRI-spine as additional imaging criterion in the ASAS axSpA classification criteria is considered unacceptably low

References

  1. Rudwaleit, ARD 2009;68:1520-7.

  2. Hermann, ARD 2012;71:1278-88.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.4054

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