Imaging In Axial Spondyloarthritis Save

I'm Anthony Chan, consultant rheumatologist from The United Kingdom here at EULA twenty twenty four, in Vienna and there have been some important presentations, in the field of axial spondyloarthritis and I would like to highlight, two oral presentations and abstracts and looking at the area of imaging in axial spondyloarthritis. We know that imaging both radiographs and also MRIs have a big role to play in the diagnosis of Axial Spondyloarthritis and there are now criteria with regards to the number of lesions that should be seen on MRI to help classify patients with Axospondyloarthritis. The MRI findings of Axospondyloarthritis include fat lesions, erosions and also sclerosis. One of the challenges that we have is as we increasingly use more imaging such as MRI, there is also the possibility of false positives. These are patients who may have changes that seem or look like Axospondyloarthritis but do not have the condition.

And there are groups of patients we know who may have this from healthy controls to women after pregnancy in the postpartum phase and also from mechanical stress in, people such as runners and this has now been looked at here at EULA twenty twenty four and first is the OP222 which is the abstract number and this was looking at the presence of bone marrow edema in postpartum women and they follow these patients up for five years and the aim was to see whether there was any evolution or involvement of the bone marrow edema over a period of time. And they studied 35 patients. Now when they looked at the clinical features of these patients they did not really fit the criteria in terms of a clinical diagnosis of XBA. They did not have there was no true association from of the bone marrow edema that was found on the MRI with the inflammatory back pain symptoms. So firstly did not really fit the clinical picture but yet they had the MRI changes suggestive of XBA which was bone marrow edema.

Interestingly when they followed them up, over five years there was no change, there was no progression structurally, from this bone marrow edema. In fact in some of these patients while they remain there was also an improvement in some of them over this period of time but certainly no worsening or no changes that were typical of axial spondyloarthritis in the bone marrow edema lesions over this period of time. So this is quite a stable appearance over this time and hopefully this could also help us if we were to follow-up our patients who may have these changes at baseline but don't really have clinical features that these there should not be any real progression in these lesions. The next is the abstract OP303. Again a very nice study.

This one looks at the MRI lesions in XBA patients and also compared this to healthy controls patients who are postpartum and also in runners. In total that 172 subjects in this study and they used the spark criteria to measure and define the the lesions on the MRI and the mean findings were that in the in terms of structural lesions, these were very more prevalent in the X bar group. Seventy nine percent of them had structural lesions but very low in the non expo group. So they took these healthy controls postpartum and also runners who didn't have expo. Thirteen percent of non expo patients had this patients with chronic back pain but also it was found in people who were not symptomatic so eight percent of runners and six percent of healthy people in the study also did have some structural change but much less than the X bar group.

When they looked at more stringent criteria so the criteria of greater than three or more erosions and or five or more fatty lesions and when they raise the the standard of the the classification for the changes on the MRI then about forty three to forty five percent the, XPAR patients had these lesions but much, much much lower in the healthy and also in the postpartum group, when they were analyzed. So not only was there a reduction in some of these structural lesions that we would have seen in XBA in the healthy and also postpartum groups but also there was less of a concordance so there was a discordance between structural lesions and inflammatory lesions in the LT and postpartum group compared to the X bar group where there was more relationship between the presence of inflammatory lesions and structural lesions which was not seen in the the other groups. So I think this both these abstracts here help us because one of the issues that we also have is over diagnosis. Using the MRI solely and then making a diagnosis which isn't how it wasn't how the the study are showing that we should be doing this because there will be a small number of patients who on MRI surgery would have these changes but not clinically and also having more stringent criteria also help us to understand whether these patients fit the criteria on MRI for the condition.

And finally the linkage between structural and inflammatory lesions are also important in order for us to fully understand the condition that these patients have. I'm Anthony Chan, reporting here for RheumNow at EULA twenty twenty four.