MRI's structural lesions of sacroiliac joints can be used to classify patients according to the ASAS axial spondyloarthritis criteria

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MRI's structural lesions of sacroiliac joints can be used to classify patients according to the ASAS axial spondyloarthritis criteria

Axial Spondyloarthritis is an inflammatory arthritis condition of the spine and pelvic joints that causes severe pain and muscle stiffness. To decrease severe pain and unnecessary therapeutic procedures, early diagnosis and therapeutic interventions are very important. This early diagnosis can be achieved using MRI examinations. In radiographs, inflammation of the spine and structural lesions of sacroiliac joints can be visible, even before the structural damage.

Therefore, to serve the case, a study was conducted to check the reliability of structural lesions seen on MRI for classification of patients in accordance with (ASAS) axial Spondyloarthritis (axSpA) criteria in DESIR cohort.

A total of 582 patients were included in the study. The patients aged below 50 years and showed symptoms lasting for 3 months to 3 years were included in the study. The diagnostic approaches such as MRI T1-w images (structural lesions, MRI-SI-s) MRI STIR (inflammation, MRI-SI) and sacroiliac joints radiographs (X-SI) were scored by two well– -calibrated readers. Further, the MRI-SI and X-SI difference was adjudged by a third reader. For the study, formerly proposed cut-offs of positive MRI-SI-s with more than 5 erosions & fatty lesions (E/FL ≥5) were taken.

The analysis was performed and out of 582 patients, only 418 fulfilled the ASAS axSpA criteria. Out of which 127 patients were evaluated as modified New York (mNY) positive and 134 (according to reader 1) & 75 (according to reader 2) were as MRI-SI-s positive. The mNY and MRI-SI-s agreement was in the balance with each other (reader1, k:0.39; reader2,k:0.44). Therefore, if E/FL≥5 cut-off was used rather than mNY, no change in classification was seen in 478 patients of reader 1 and 469 of reader 2. Furthermore, in the condition of mNY replacement, where only MRI-SI-s was performed, 12 patients of reader 1 & 10 of reader 2 might not classify as axial Spondyloarthritis. On the other hand, in both scenarios, 3 patients of reader 1 & 6 of reader 2 might be additionally classified as axial Spondyloarthritis. The same kind of results was noticed for E≥3 and FL≥3 cut-offs.

The whole analysis reached to a conclusion that the structural lesions of sacroiliac joints on MRI are reliable for axSpA diagnosis either as additionally or as a substitute for radiographs in the ASAS axSpA classification.

Source:

Annals of Rheumatic Diseases

Link to the source:

http://ard.bmj.com/content/76/2/392.short?rss=1

The original title of the article:

Can we use structural lesions seen on MRI of the sacroiliac joints reliably for the classification of patients according to the ASAS axial spondyloarthritis criteria? Data from the DESIR cohort

Authors:

Pauline A C Bakker; rosaline van den berg et al.

SearchTags: 
Diagnostic, Axial Spondyloarthritis, Spine and pelvic joints
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