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SAT0235 Prevalence of Inflammatory Lesions MRI-SPINE in Patients with Chronic Back Pain of <2 Years Duration Included in the Space-Cohort
  1. M. De Hooge1,
  2. R. Van Den Berg1,
  3. M. Reijnierse2,
  4. M. V. Navarro Compán1,
  5. F. van Gaalen1,
  6. K. M. Fagerli3,
  7. M. Turina4,
  8. M. van Oosterhout5,
  9. R. Ramonda6,
  10. T. Huizinga1,
  11. D. Van Der Heijde1
  1. 1Rheumatology
  2. 2Radiology, LUMC, Leiden, Netherlands
  3. 3Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  4. 4Clinical Immunology and Rheumatology, AMC, Amsterdam
  5. 5Rheumatology, GHZ, Gouda, Netherlands
  6. 6Rheumatology, University of Padova, Padova, Italy


Background Inflammatory lesions of the spine are not included in the ASAS definition of a positive MRI for fulfilment of the ASAS axial spondyloarthritis (axSpA) criteria1. However, inflammatory lesions in the spine on MRI (MRI-spine) may occur in the absence of affected sacroiliac joints (SIJ).

Objectives To determine the prevalence of inflammatory lesions on MRI-spine and to investigate if axSpA patients (pts) with inflammatory lesions in the spine only exist.

Methods The SPondyloArthritis Caught Early (SPACE)-cohort includes pts with chronic back pain (≥3 months, ≤2 years, onset <45 years) recruited from 5 participating centres. All pts underwent MRI of the SIJ (MRI-SI) and MRI-spine scored by 3 well-calibrated readers independently. MRIs-SI were scored according to the ASAS definition1 (≥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 on ≥2 consecutive slices). Lesions were considered present if 2/3 readers agreed.

Results All pts with MRI-spine (n=306) were included to determine the prevalence of BME lesions in pts grouped according to the ASAS axSpA criteria (radiographic, non-radiographic (imaging & clinical arm), no-SpA and possible SpA (table 1). 292 pts had both MRI-SI and MRI-spine. There were 51 pts with a positive MRI-spine, of which 30 pts (58.8%) had a negative MRI-SI. Nine of these 30 fulfil the ASAS axSpA criteria via the clinical-arm. Of the remaining 21 pts, 3 pts had no SpA features at all, 7 had 1 SpA feature, 8 had 2 SpA features, 1 had 3 SpA features and 2 had 4 SpA features. Only the sole patient with 4 SpA features had a probability (calculated from the Likelihood Ratio (LR) product) >80%. When using the ASAS consensus definition of a positive MRI-spine in post-test probability calculations, another 6 pts would reach a probability ≥80% of having axSpA.

Conclusions A cut-off of ≥3 BME lesions discriminates well between pts with and without axSpA. A positive MRI-spine can be present in pts without inflammation on MRI-SI. MRI-spine might have additional value to MRI-SI in a group of pts with a certain level of suspicion of axSpA.


  1. Rudwaleit ARD 2009;68:1520-7

  2. Hermann ARD 2012;71:1278-88

Disclosure of Interest None Declared

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