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.
Involvement of the Anterior Chest Wall in Patients with Spondyloarthritis: Relationships between Clinical Symptoms and Imaging Features.
Ramonda2, Roberta, Lo Nigro2, Alessandro, Lorenzin2, Mariagrazia, Modesti2, Valentina, Angelini1, Federico, Campana2, Carla, Frallonardo2, Paola
The anterior chest wall (ACW) is frequently affected in spondylarthritis (SpA), although its involvement is underestimated. The wide range of disorders found in this anatomic region renders the conventional radiology frequently inadequate for the diagnosis. Plain radiography appears of limited value, due to the difficulty of multiplanar evaluation of ACW joints and a poor sensitivity in revealing the first pathological changes. Bone scintigraphy (BS) is sensitive in showing the articular involvement pattern, but its specificity is considered low. New diagnostic methods, such as magnetic resonance imaging (MRI), appear potentially more effective to study the initially changes found in early SpA.
The aim of this study was to compare the reliability of two different sensitive methods, such as BS and MRI, in assessing the involvement of ACW in patients with early SpA.
Out of 105 consecutive patients (pts) with early (<= 1 year) SpA attending the Rheumatology Unit of the Padova University, from January 2008 to April 2010, 31 (29.5%, 17 F, mean age 46.2±12.6 yrs) complained of symptoms (pain and/or tenderness) in the ACW and so were submitted to BS and targeted MRI. Eighteen pts (58.1%) were affected with psoriatic arthritis (PsA), 5 (16.1 %) with ankylosing spondylitis (AS) and 8 (25.8%) with undifferented SpA (USpA).
At clinical examination, the right sternocostoclavicular (SCCJ) was involved in 28 pts (90.3%), the left SCCJ in 25 pts (80.7 %) and the sternum in 4 pts (12.9%). Out of the 31 pts with clinical symptoms BS was positive in 26 (83.8%) and MRI in 18 (58.1%). At BS, the most frequently involved joints were the left and right SCCJ, respectively in 16 pts (51.6%); and in 19 pts (61.2%), followed by the sternum, found in 12 pts (38.7 %). MRI too showed a more frequent involvement of SCCJ, found in 17 pts (54.8%), while the sternum was involved only in 6 pts (19.4%). Main changes reflecting early signs of active disease such as bone edema with synovial hyperaemia were observed in 11 pts (35.5%), endoarticular swelling in 1 (3%), increase of thickness of capsular structure in 12 pts (38.7%) and erosions in 5 (16.1%); among other signs, marginal bone irregularities were found in 5 pts (16.1%), osteoproductive processes in 6 (19.4%), and osteophytes in 2 (6.5%). The concordance between symptoms and imaging was more evident for BS (26 pts, 83.8 %) than for MRI (18 pts, 58.1 %).
The ACW involvement in early SpA is not so rare and it is mainly found in female pts. Both two imaging methods seem useful to investigate ACW symptoms. The BS confirms its higher sensitivity and, although less specific, it can reveal a subclinical involvement. MRI may give information useful for the therapeutic approach, revealing type and extent of articular involvement, in particular the presence of bone erosions.
To cite this abstract, please use the following information:
Ramonda, Roberta, Lo Nigro, Alessandro, Lorenzin, Mariagrazia, Modesti, Valentina, Angelini, Federico, Campana, Carla, et al; Involvement of the Anterior Chest Wall in Patients with Spondyloarthritis: Relationships between Clinical Symptoms and Imaging Features. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :540