Spinal inflammation in the absence of sacroiliac joint inflammation on magnetic resonance imaging in patients with active nonradiographic axial spondyloarthritis

Abstract

Objective: To evaluate the presence of spinal inflammation with and without sacroiliac (SI) joint inflammation on magnetic resonance imaging (MRI) in patients with active nonradiographic axial spondyloarthritis (SpA), and to compare the disease characteristics of these subgroups.

Methods: ABILITY-1 is a multicenter, randomized, controlled trial of adalimumab versus placebo in patients with nonradiographic axial SpA classified using the Assessment of SpondyloArthritis international Society axial SpA criteria. Baseline MRIs were centrally scored independently by 2 readers using the Spondyloarthritis Research Consortium of Canada (SPARCC) method for the SI joints and the SPARCC 6-discovertebral unit method for the spine. Positive evidence of inflammation on MRI was defined as a SPARCC score of ≥2 for either the SI joints or the spine.

Results: Among patients with baseline SPARCC scores, 40% had an SI joint score of ≥2 and 52% had a spine score of ≥2. Forty-nine percent of patients with baseline SI joint scores of <2, and 58% of those with baseline SI joint scores of ≥2, had a spine score of ≥2. Comparison of baseline disease characteristics by baseline SI joint and spine scores showed that a greater proportion of patients in the subgroup with a baseline SPARCC score of ≥2 for both SI joints and spine were male, and patients with spine and SI joint scores of <2 were younger and had shorter symptom duration. SPARCC spine scores correlated with baseline symptom duration, and SI joint scores correlated negatively with the baseline Bath Ankylosing Spondylitis Disease Activity Index, but neither correlated with the baseline Ankylosing Spondylitis Disease Activity Score, total back pain, the patient's global assessment of disease activity, the Bath Ankylosing Spondylitis Functional Index, morning stiffness, nocturnal pain, or C-reactive protein level.

Conclusion: Assessment by experienced readers showed that spinal inflammation on MRI might be observed in half of patients with nonradiographic axial SpA without SI joint inflammation.

Trial registration: ClinicalTrials.gov NCT00939003.

© 2014 The Authors. Arthritis & Rheumatology is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

Figures

Figure 1

Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac (SI) joint and spine magnetic resonance imaging scores by duration of spondyloarthritis symptoms.

Figure 2

Proportion of patients with a bone marrow edema score of at least 1 for each discovertebral unit (DVU) by baseline SPARCC SI joint magnetic resonance imaging (MRI) score, among those with inflammation evidenced on MRI of the spine (SPARCC score ≥2). C = cervical; T = thoracic; L = lumbar; S = sacral (see Figure 1 for other definitions).

Figure 3

Distribution of baseline SPARCC spine and SI joint magnetic resonance imaging (MRI) scores. A, Cumulative probability of various baseline SPARCC spine scores by SPARCC SI joint score. B, Cumulative probability of various baseline SPARCC SI joint scores by SPARCC spine score. See Figure 1 for other definitions.