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Classification of axial SpA based on positive imaging (radiographs and/or MRI of the sacroiliac joints) by local rheumatologists or radiologists versus central trained readers in the DESIR cohort
  1. Rosaline van den Berg1,
  2. Grégory Lenczner2,
  3. Fabrice Thévenin3,
  4. Pascal Claudepierre4,5,
  5. Antoine Feydy3,
  6. Monique Reijnierse6,
  7. Alain Saraux7,
  8. Alain Rahmouni8,
  9. Maxime Dougados9,10,11,
  10. Désirée van der Heijde1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Radiology Department, Clinique Hartmann, Neuilly Sur Seine, France
  3. 3Radiology B Department, Paris Descartes University, Cochin Hospital, Paris, France
  4. 4Department of Rheumatology, AP-HP, Chenevier-Mondor Hospital, Créteil, France
  5. 5EA4393 Laboratoire d'Investigation Clinique (LIC), Université Paris Est Créteil, Créteil, France
  6. 6Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  7. 7Rheumatology Unit, Hôpital de la Cavale Blanche, CHU Brest and EA 2216, Université de Bretagne Occidentale, Brest, France
  8. 8Department of Radiology, Hôpital Henri Mondor, Créteil, France
  9. 9Paris Descartes University
  10. 10Department of Rheumatology, Hôpital Cochin, Assistance Publique—hôpitaux de Paris, Paris, France
  11. 11INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
  1. Correspondence to Dr Désirée van der Heijde, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands; mail{at}


Objective Investigating changes in patient classification (ASAS (Assessment of SpondyloArthritis international Society) axSpA criteria) based on evaluation of images of the sacro-iliac joints (MRI-SI and X-SI) by local and central readers.

Methods The DESIR cohort included patients with inflammatory back pain (IBP; ≥3 months, but <3 years), suggestive of axSpA. Local radiologists/rheumatologists (local-reading) and two central readers (central-reading) evaluated baseline images. Agreement regarding positive MRI (pos-MRI) between central readers and between local-reading and central-reading was calculated (κs). Number of patients classified differently (ASAS criteria) by using local-reading instead of central-reading was calculated.

Results Inter-reader agreement between the two central readers and between local-reading and central-reading was substantial (κ=0.73 and κ=0.70, respectively). In 89/663 MRI-SIs (13.4%) local-reading and central-reading disagreed; 38/223 patients (17.0%) with pos-MRI (local-reading) were negative by central-reading; 51/440 patients (11.6%) with neg-MRI (local-reading) were positive by central-reading.

In 163/582 patients eligible for applying ASAS criteria (28.0%), local-reading and central-reading disagreed on positive imaging (MRI-SI and/or X-SI; κ=0.68). In 46/582 patients (7.9%) a different evaluation resulted in a different classification; 18/582 patients (3.1%) classified no-SpA (central-reading) were axSpA by local-reading; 28/582 patients (4.8%) classified axSpA (central-reading) were no-SpA by local-reading. Among axSpA patients (central-reading), 16/419 patients (3.8%) fulfilling imaging-arm by central-reading fulfilled clinical-arm by local-reading; 29/419 patients (6.9%) fulfilling clinical-arm by central-reading fulfilled also imaging-arm by local-reading.

Conclusions In patients with recent onset IBP, trained readers and local rheumatologists/radiologists agree well on recognising a pos-MRI. While disagreeing in 28% of the patients on positive imaging (MRI-SI and/or X-SI), classification of only 7.9% of the patients changed based on a different evaluation of images, showing the ASAS axSpA criteria's robustness.

  • Spondyloarthritis
  • Magnetic Resonance Imaging
  • Ankylosing Spondylitis

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