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MRI of sacroiliac joints for the diagnosis of axial SpA: prevalence of inflammatory and structural lesions in nulliparous, early postpartum and late postpartum women
  1. Adel Hoballah1,
  2. Cédric Lukas2,
  3. Christophe Leplat1,
  4. Patrice Taourel1,
  5. Jean-Baptiste Pialat3,
  6. Nicolas Sans4,
  7. Sonia Ramos-Pascual5,
  8. Catherine Cyteval1
  1. 1 Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
  2. 2 Department of Rheumatology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
  3. 3 Department of Radiology, Groupement Hospitalier Edouard Herriot, Lyon, Rhône-Alpes, France
  4. 4 Department of Radiology, University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
  5. 5 ReSurg SA, Nyon, Switzerland
  1. Correspondence to Dr Sonia Ramos-Pascual, ReSurg SA, 1260 Nyon, Switzerland; journals{at}


Objectives To determine the prevalence of bone marrow oedema (BME) at the sacroiliac joint (SIJ) in early postpartum (EPP), nulliparous (NP) and late postpartum (LPP) women, and to identify factors associated with BME presence at the SIJ.

Methods Three groups were obtained: NP (never given birth), EPP (given birth within 12 months) and LPP (given birth more than 24 months). The primary outcome was the presence of BME and/or structural lesions (erosions, osteophytes, ankylosis and sclerosis) at the SIJ MRI.

Results BME prevalence was greater among EPP (33%) than NP (14%, p=0.001), but was not different to LPP (21%, p=0.071). The Assessment of SpondyloArthritis international Society (ASAS) MRI criteria for sacroiliitis were positive in 75%, 71% and 80%, respectively, of EPP, NP and LPP women with BME. EPP (38%) had similar prevalence of sclerosis than LPP (28%, p=0.135), but greater than NP (18%, p=0.001). Lastly, EPP (28%) had similar prevalence of osteophytes than LPP (42%) and NP (27%), although there was a difference between LPP and NP (p=0.006).

Conclusions EPP have higher BME prevalence at the SIJ than NP, EPP tend to have higher BME prevalence compared with LPP and BME presence decreases with time from delivery. Three-quarters of women with BME at the SIJ had a positive ASAS MRI criteria for sacroiliitis, indicating that BME presence as the main criterion for a positive diagnosis can lead to false-positive results. SIJ MRIs should not be interpreted in isolation, since age, time from delivery and other factors may outweigh the pertinence of MRI findings.

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  • magnetic resonance imaging
  • spondyloarthritis
  • inflammation
  • low back pain

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  • Handling editor Josef S Smolen

  • Contributors We hereby confirm that all authors have participated in the study as follows: AH: study design, data collection, manuscript editing. CL: study design, data collection, manuscript editing. CL: study design, data collection, manuscript editing. PT: study design, data collection, manuscript editing. J-BP: study design, data collection, manuscript editing. NS: study design, data collection, manuscript editing. SR-P: literature review, data interpretation, figures and tables, manuscript writing. CC: study design, data collection, manuscript editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the medical ethics committee in advance (Montpellier University Hospital: 2015-A01513-46).

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

  • Data availability statement Data are available on reasonable request.