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Axial involvement in patients with early peripheral spondyloarthritis: a prospective MRI study of sacroiliac joints and spine
  1. Thomas Renson1,2,
  2. Philippe Carron1,2,
  3. Ann-Sophie De Craemer1,2,
  4. Liselotte Deroo1,2,
  5. Manouk de Hooge1,2,
  6. Simon Krabbe3,4,
  7. Lennart Jans5,
  8. Min Chen5,
  9. Mikkel Østergaard3,4,
  10. Filip E Van den Bosch1,2,
  11. Dirk Elewaut1,2
  1. 1 Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
  2. 2 VIB-UGent Center for Inflammation Research, Ghent, Belgium
  3. 3 Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
  4. 4 Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  5. 5 Radiology, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
  1. Correspondence to Dr Thomas Renson, Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent 9000, Belgium; thomas.renson{at}


Objectives To assess axial involvement on MRI in early peripheral spondyloarthritis (pSpA) and to evaluate whether axial inflammation predicts relapse on treatment withdrawal.

Methods Fifty-six patients with early, active, newly diagnosed pSpA underwent MRI of the sacroiliac joints (SIJs) and spine prior to golimumab initiation. At sustained clinical remission of pSpA, treatment was withdrawn and a second MRI was performed. Bone marrow oedema (BME) was scored by three readers according to the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Scores were compared with an axial spondyloarthritis cohort (Belgian Arthritis and Spondylitis cohort). Structural lesions were assessed using a similar method. Furthermore, fulfilment of the Assessment of Spondyloarthritis International Society (ASAS) definition of a positive MRI for sacroiliitis was assessed. Spinal images were evaluated for BME and structural lesions using the Canada-Denmark MRI spine scoring system by two readers.

Results Thirty-six per cent showed SIJ BME at baseline, all fulfilling the ASAS definition of sacroiliitis. No association with back pain was found. Twenty-one per cent displayed SIJ structural lesions. Spinal BME was limited: the median inflammation scores were low and no patients had ≥5 inflammatory corner lesions. On clinical remission, a significant decrease in SIJ SPARCC scores was detected. On clinical remission, no significant differences in SIJ SPARCC scores were noted between patients relapsing and those maintaining remission after treatment discontinuation.

Conclusion In patients with early pSpA, a surprisingly high prevalence of sacroiliitis on MRI was observed; SPARCC scores decreased significantly on tumour necrosis factor inhibition. Residual inflammation on MRI was not predictive of relapse of peripheral manifestations. No relevant inflammatory spinal involvement was detected. Collectively, our findings suggest a higher inflammatory burden in patients with early pSpA than anticipated.

  • magnetic resonance imaging
  • arthritis
  • psoriatic
  • tumour necrosis factor inhibitors

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  • Handling editor Josef S Smolen

  • Twitter @PhilippeCarron

  • Contributors TR: analysis and interpretation of data, preparation of manuscript. TR, PC, A-SDC, LD, LJ, DE, FEVdB: study concept and design, acquisition of data. TR, MdH, MC, SK, MØ: assessment of MRI. PC, DE, FEVdB: revision of manuscript.

  • Funding This study was carried out as an investigator-initiated study with funding from Janssen Pharmaceutica NV.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.