Friday, 22 Jun 2018

You are here

MRI Imaging for Sacroiliitis Requires Bone Marrow Edema for Reliability

de Winter and colleagues from the Netherlands have reported on magnetic resonance imaging (MRI) of the sacroiliac (SI) joints of healthy subjects, patients with axial spondyloarthritis (SpA), runners and those with chronic back pain, and found a high incidence of sacroiliitis in many, but that deep bone marrow edema was most specific for those with axial SpA.

Three trained, experienced MRI readers assessed the SI joints of 172 subjects (47 healthy controls without low back pain (LBP), 47 axial SpA, 47 controls with chronic back pain, 7 with postpartum back pain, and 24 frequent runners) and scored these according to ASAS and SPARCC methods. The results are shown below:

 nHLA-B27+MRI Sacroiliitis

SPARCC Sacroiliitis

Deep Bone Marrow Edema

Axial SpA4774,5%91.5%97.7%89.4%
Normal controls47023.4%25.5%0
Chronic LBP4706.4%10.6%0
Post-partum LBP70 57.1%57.1%14.3%
Runners24012.5% 16.7%0

While some evidence of MRI sacroiliits may be found in minority of those with LBP, it appears that only deep (extensive) bone marrow edema lesions are most specific for axial SpA patients.

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Cosentyx Gets Radiographic Protection Indication for Psoriatic Arthritis

Novartis announced today that the US Food and Drug Administration (FDA) approved the inclusion of new evidence that Cosentyx® (secukinumab) significantly slows the progression of joint structural damage at Week 24 versus placebo in those with active psoriatic arthritis (PsA).

Increased Risk of Infection in Psoriasis and Psoriatic Arthritis

As we gather more knowledge about psoriatic arthritis ( PsA) and psoriasis (PSO) over time, and achieve better outcomes with new therapies, more questions arise about quality of life, survival  and comorbidities in PsA and PSO. Similarly to RA, we learned about increased risk of CVD and malignancy. With more data compiled in cohorts it is possible now to ask the same questions as we asked in RA.

Cardiovascular Risk Factors in Psoriasis, PsA and Seronegative SpA

Not a surprise to anyone anymore, increased risk of cardiovascular disease poses a danger of significant morbidity and mortality in patients underlying inflammatory arthritides. A single center cross -sectional observational study was designed to conduct deeper analysis of Cardiovascular Risk Factors (CVRF) in patients with PsA, PSO without arthritis and SpA without PSO (THU 0297).

Cancer Risk Raised in Psoriatic Arthritis

Patients with psoriatic arthritis (PsA) were at increased risks for malignancy, and possibly more so if they were treated with conventional disease-modifying antirheumatic drugs (DMARDs), a meta-analysis found.

In nine cohort studies that included more than 43,000 PsA patients, the pooled relative risk for overall malignancy was 1.29 (95% CI 1.04-1.60) compared with the general population, according to Yunyun Fei, MD, and colleagues from Peking Union Medical College in Beijing.

Trends in Psoriatic Arthritis Treatment 2004-2015

Lee and colleagues from Brigham and Women's Hospital have analyzed the last decade of disease‐modifying antirheumatic drugs (DMARDs) use in patients with psoriatic arthritis (PsA) and found nearly 40% were treated with a bDMARD, along with a decreasing trend in complete DMARD discontinuations.