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The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts
  1. Zineb Ez-Zaitouni1,
  2. Pauline AC Bakker1,
  3. Miranda van Lunteren1,
  4. Manouk de Hooge1,
  5. Rosaline van den Berg1,
  6. Monique Reijnierse2,
  7. Karen Minde Fagerli3,
  8. Robert BM Landewé4,
  9. Roberta Ramonda5,
  10. Lennart TH Jacobsson6,
  11. Alain Saraux7,
  12. Gregory Lenczner8,
  13. Antoine Feydy9,
  14. Jean Baptiste Pialat10,
  15. Fabrice Thévenin9,
  16. Floris A van Gaalen1,
  17. Désirée van der Heijde1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  4. 4Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, The Netherlands
  5. 5Department of Medicine DIMED, University of Padova, Padova, Italy
  6. 6Department of Rheumatology, University ofGöteborg, Göteborg, Sweden
  7. 7Department of Rheumatology, Laboratoire d’Immunothérapie et Pathologies, lymphocytaires B, Labex ‘Immunotherapy, Graft, Oncology’, Université Bretagneoccidentale, Bretagne, France
  8. 8Department of Radiology, Clinique Hartmann, Neuilly SurSeine, France
  9. 9Department of Radiology, Paris Descartes University, Cochin Hospital, Paris, France
  10. 10Radiology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Claude-Bernard University, Pierre-Bénite, Bernard, France
  1. Correspondence to Zineb Ez-Zaitouni, Department of Rheumatology, LeidenUniversity Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands; z.ez-zaitouni{at}


Objectives To assess the prevalence of spinal inflammation on MRI in patients with chronic back pain (CBP) of maximally 3 years duration and to evaluate the yield of adding a positive MRI-spine as imaging criterion to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA).

Methods Baseline imaging of the sacroiliac joints (X-SI), MRI of the sacroiliac joints (MRI-SI) and MRI-spine were scored by ≥2 experienced central readers per modality in the SPondyloArthritis Caught Early (SPACE) and DEvenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohorts. Inflammation suggestive of axSpA was assessed in the entire spine. A positive MRI-spine was defined by the presence of ≥5 inflammatory lesions. Alternative less strict definitions were also tested.

Results In this study, 541 and 650 patients with CBP from the SPACE and DESIR cohorts were included. Sacroiliitis on X-SI and MRI-SI was found in 40/541 (7%) and 76/541 (14%) patients in SPACE, and in DESIR in 134/650 (21%) and 231/650 (36%) patients, respectively. In SPACE and DESIR, a positive MRI-spine was seen in 4/541 (1%) and 48/650 (7%) patients. Of the patients without sacroiliitis on imaging, 3/447 (1%) (SPACE) and 8/382 (2%) (DESIR) patients had a positive MRI-spine. Adding positive MRI-spine as imaging criterion led to new classification in only one patient in each cohort, as the other patients already fulfilled the clinical arm. Other definitions of a positive MRI-spine yielded similar results.

Conclusion In two cohorts of patients with CBP with a maximum symptom duration of 3 years, a positive MRI-spine was rare in patients without sacroiliitis on MRI-SI and X-SI. Addition of MRI-spine as imaging criterion to the ASAS axSpA criteria had a low yield of newly classified patients and is therefore not recommended.

  • axial spondyloarthritis
  • ankylosing spondylitis
  • magnetic resonance imaging
  • classification criteria

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  • Contributors ZEZ designed the study, performed the statistical analyses, interpreted the data, drafted and revised the manuscript. DvdH and FvG designed the study, interpreted the data and revised the manuscript. All authors contributed to the acquisition of data, revised the manuscript and approved the final manuscript.

  • Funding The DESIR cohort was sponsored by the Département de la Recherche Clinique et du Développement de l’Assistance Publique–Hôpitaux de Paris. This study is conducted under the umbrella of the French Society of Rheumatology and INSERM (Institut National de la Santé et de la Recherche Médicale). The database management is performed within the department of epidemiology and biostatistics (Professor Paul Landais, D.I.M., Nîmes, France). An unrestricted grant from Pfizer was allocated for the 10 years of the follow-up of the recruited patients.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval All local medical ethical committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.