MRI evidence of structural changes in the sacroiliac joints of patients with non-radiographic axial spondyloarthritis even in the absence of MRI inflammation

Walter P Maksymowych, Stephanie Wichuk, Maxime Dougados, Heather Jones, Annette Szumski, Jack F Bukowski, Lisa Marshall, Robert G Lambert, Walter P Maksymowych, Stephanie Wichuk, Maxime Dougados, Heather Jones, Annette Szumski, Jack F Bukowski, Lisa Marshall, Robert G Lambert

Abstract

Background: Studies have shown that structural lesions may be present in patients with non-radiographic axial spondyloarthritis (nr-axSpA). However, the relevance of structural lesions in these patients is unclear, particularly without signs of inflammation on magnetic resonance imaging (MRI). We assessed the presence of structural lesions at baseline on MRI in the sacroiliac joints (SIJ) of patients with nr-axSpA with and without SIJ inflammation on MRI.

Methods: Bone marrow edema (BME) was assessed on short tau inversion recovery (STIR) scans from 185 patients with nr-axSpA, by two independent readers at baseline using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Structural lesions were evaluated on T1 weighted spin echo scans, with readers blinded to STIR scans, using the SPARCC MRI SIJ structural score. Disease characteristics and structural lesions were compared in patients with SIJ BME (score ≥2) and without SIJ BME (score <2).

Results: Both SIJ BME and structural lesions scores were available for 183 patients; 128/183 (69.9%) patients had SIJ BME scores ≥2 and 55/183 (30.1%) had scores <2. Frequencies of MRI structural lesions in patients with vs without SIJ BME were: erosions (45.3% vs 10.9%, P < 0.001), backfill (20.3% vs 0%, P < 0.001), fat metaplasia (10.9% vs 1.8%, P = 0.04), and ankylosis (2.3% vs 1.8%, P = ns). Significantly more patients with both SIJ BME and structural lesions were male and/or HLA-B27 positive than patients with only SIJ BME. Mean (SD) spinal scores (23 discovertebral units) were significantly higher in patients with SIJ structural lesions than without: 6.5 (11.5) vs 3.3 (5.1), respectively, P = 0.01.

Conclusions: In patients with nr-axSpA, SIJ structural lesions, particularly erosions, may be present on MRI when radiographs are normal or inconclusive, even in patients negative for MRI SIJ inflammation. They may reflect more severe disease with greater spinal inflammation.

Trial registration: ClinicalTrials.gov, NCT01258738 . Registered on 9 December 2010.

Keywords: Magnetic resonance imaging; Non-radiographic axial spondyloarthritis; Sacroiliac joint; Structural lesion.

Figures

Fig. 1
Fig. 1
Erosion of the left iliac bone on T1 weighted spin echo magnetic resonance imaging (MRI) (a) and in the absence of inflammation on short tau inversion recovery MRI (b)
Fig. 2
Fig. 2
Proportion of patients with erosion (a), backfill (b), fat metaplasia (c), and ankylosis (d) on T1 weighted spin echo (T1WSE) magnetic resonance imaging (MRI). ns nonsignificant, SPARCC Spondyloarthritis Research Consortium of Canada, SIJ, sacroiliac joint, BME bone marrow edema, ASAS Assessment of SpondyloArthritis international Society
Fig. 3
Fig. 3
Cumulative probability plots for structural lesions according to Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint (SIJ) score (≥2 vs <2): erosion (a), backfill (b), and fat metaplasia (c)

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