Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort

Maxime Dougados, Alexandre Sepriano, Anna Molto, Miranda van Lunteren, Sofia Ramiro, Manouk de Hooge, Rosaline van den Berg, Victoria Navarro Compan, Christophe Demattei, Robert Landewé, Désirée van der Heijde, Maxime Dougados, Alexandre Sepriano, Anna Molto, Miranda van Lunteren, Sofia Ramiro, Manouk de Hooge, Rosaline van den Berg, Victoria Navarro Compan, Christophe Demattei, Robert Landewé, Désirée van der Heijde

Abstract

Objective: To estimate sacroiliac joint radiographic (X-SIJ) progression in patients with axial spondyloarthritis (axSpA) and to evaluate the effects of inflammation on MRI (MRI-SIJ) on X-SIJ progression.

Methods: X-SIJ and MRI-SIJ at baseline and after 2 and 5 years in patients with recent onset axSpA from the DESIR cohort were scored by three central readers. Progression was defined as (1) the shift from non-radiographic (nr) to radiographic (r) sacroiliitis (by modified New York (mNY) criteria) or alternative criteria, (2) a change of at least one grade or (3) a change of at least one grade but ignoring a change from grade 0 to 1. The effects of baseline inflammation on MRI-SIJ on 5-year X-SIJ damage (mNY) were tested by generalised estimating equations.

Results: In 416 patients with pairs of baseline and 5-year X-SIJ present, net progression occurred in 5.1% (1), 13.0% (2) and 10.3% (3) respectively, regarding a shift from nr-axSpA to r-axSpA (1), a change of at least one grade (2) or a change of at least one grade but ignoring a change from grade 0 to 1 (3). Baseline MRI-SIJ predicted structural damage after 5 years in human leukocyte antigen-B27 (HLA-B27) positive (OR 5.39 (95% CI 3.25 to 8.94)) and in HLA-B27 negative (OR 2.16 (95% CI 1.04 to 4.51)) patients.

Conclusions: Five-year progression of X-SIJ damage in patients with recent onset axSpA is limited but present beyond measurement error. Baseline MRI-SIJ inflammation drives 5-year radiographic changes.

Keywords: epidemiology; magnetic resonance imaging; outcomes research; spondyloarthritis.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Changes in different binary SIJ-Plain X-ray outcome measures (completers’ population). nr-axSpA, radiographic axial spondyloarthritis; r-axSpA, radiographic axial spondyloarthritis; SIJ, sacroiliac joint.
Figure 2
Figure 2
Effect of inflammation on MRI-SIJ on being mNY-positive after 5 years irrespective of baseline mNY status stratified according to the HLA-B27 status at baseline (1-level binomial multivariable GEE). Interaction between inflammation on MRI-SIJ and HLA-B27 at baseline: p=0.033. BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; CRP, creactive protein; GEE, generalised estimating equations; mNY, modified New York criteria; MRI-SIJ, magnetic resonance imaging of the sacroiliac joints; NSAIDs, non-steroidal anti-inflammatory drugs.
Figure 3
Figure 3
Net progression from nr-axSpA to r-axSpA according to baseline objective inflammatory markers and stratified on HLA-B27 ststus. BMO, bone marrow oedema; CRP, C reactive protein; MRI-SIJ, MRI of the sacroiliac joints; nr-axSpA, non-radiographic axial spondyloarthritis; r-axSpA, radiographic axial spondyloarthritis.

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