Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Magnetic Resonance Imaging (MRI) of the Spine May Be Useful in Patients with Non-Radiographic Axial Spondyloarthritis (NRASpA) without Active Sacroiliitis on MRI.

Direz1,  Guillaume, Couchot2,  Manuel, Cotty1,  Philippe, Mulleman3,  Denis, Goupille1,  Philippe M.

University Hospital, Tours, Tours, France
University Hospital, Tours, Tours, France
University Hospital, Tours, Tours, France

Background:

MRI of the sacroiliac joints (SIJ) is useful for the diagnosis of axial spondyloarthritis (SpA) in patients who don't fulfil the modified New York criteria (1). However, about 25 to 30 % of patients with NRASpA have no active sacroiliitis on MRI, according to ASAS/OMERACT criteria (2). MRI of the spine may show lesions such as Romanus and fatty Romanus which, when multiple or severe, may be highly suggestive of the diagnosis of axial SpA.

Objective:

To assess, in a NRASpA cohort without active sacroiliitis on MRI, the prevalence of spine lesions on MRI highly suggestive of axial SpA.

Methods:

Retrospective analysis of the MRI of SIJ and of the thoracic and lumbar spine, performed between 2005 and 2009, in patients with NRASpA. Blind analysis was performed by two independent radiologists (SIJ and spine were independently assessed). Active sacroiliitis on MRI was defined according to ASAS/OMERACT criteria, and a positive spinal MRI was defined according to the presence of highly suggestive lesions (Romanus, fatty Romanus, Andersson spondylitis, inflammatory posterior lesions) and the experience of the two radiologists (study performed before the definition of a positive spinal MRI by the ASAS group).

Results:

MRI of 93 NRASpA patients were analysed. Mean age was 39.4 years, mean disase duration was 4.5 years; 39% of the patients were HLA B27 positive, all patients fulfilled ASAS criteria or Amor criteria of SpA and had a diagnosis of NRASpA by their rheumatologist. Thirty-eight of 93 patients (40.8%) had active sacroiliitis on MRI, 25/93 (26.8%) had sacroiliitis and spine lesion highly suggestive of SpA, 10/93 (10.7%) had a normal MRI of SIJ and spine, 10/93 (10.7%) had some inflammatory lesions of SIJ and/or spine not sufficient for the diagnosis of SpA.

Ten of 93 patients (10.7%) had spine lesion highly suggestive of SpA without active sacroiliitis on MRI (6/10 had other lesions of the SIJ (enthesitis, erosions, sclerosis) suggestive of inflammatory involvement). Eight of these 10 patients fulfilled the recently presented ASAS criteria of positive spinal MRI (3) because they had at least 3 Romanus lesions. Therefore, according to new ASAS criteria, 8/93 patients (8.6%) had a positive spinal MRI without active sacroiliitis. More interesting, on 30/93 patients without active sacroiliitis on MRI, 8/30 (26.6%) had at least 3 Romanus lesions on spinal MRI, leading to the diagnosis of axial SpA. There was no significant association between the presence of psoriasis, uveitis, disease duration, HLA B27 or increased CRP and isolated positive spinal MRI.

Conclusions:

In NRASpA patients, only 10% had isolated positive spinal MRI. However, in case of suspicion of SpA without active sacroiliitis on MRI, spine MRI may allow the diagnosis of SpA in about 25% of patients.

References:

1.Rudwaleit, M et al. Ann Rheum Dis 2009;68:777-83.

2.Rudwaleit, M et al. Ann Rheum Dis 2009;68:1520-7.

3.Hermann, KG et al. EULAR 2010 abstractOP0149

To cite this abstract, please use the following information:
Direz, Guillaume, Couchot, Manuel, Cotty, Philippe, Mulleman, Denis, Goupille, Philippe M.; Magnetic Resonance Imaging (MRI) of the Spine May Be Useful in Patients with Non-Radiographic Axial Spondyloarthritis (NRASpA) without Active Sacroiliitis on MRI. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :130
DOI: 10.1002/art.27899

Abstract Supplement

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