Baseline severity of sacroiliitis can predict acute inflammatory status of sacroiliac joint in early axial spondyloarthritis of male patients: a cross sectional study

Hong Ki Min,Sung-Hwan Park,Hyonjoung Cho

doi:10.1186/s12891-019-2549-5

Abstract

BackgroundThis study compared clinical, laboratory and radiographic features of axial spondyloarthritis (axSpA) between ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA) of young male patients. Additionally, we sought factors which can predict the baseline inflammatory status of sacroiliac joint (SIJ) in axSpA.MethodsWe retrospectively reviewed the medical records of 322 patients who visited our hospital due to inflammatory back pain, and 159 male patients with axSpA were enrolled. Enrolled patients were divided into two groups, AS group and nrAxSpA group, and medical records, laboratory data, radiologic findings were collected and analyzed.ResultsAlternating buttock pain and CRP elevation were significantly frequent in AS patients than nrAxSpA patients (68.8% vs 41.3%, P = 0.001, 63.5% vs 37.1%, P = 0.002), and SPondyloArthritis Research Consortium of Canada (SPARCC) score of SIJ was higher in AS patients than nrAxSpA patients (14.0 vs 5.0, P < 0.0001). Baseline sacroiliitis severity, psoriasis, and CRP elevation had positive association in univariate and multivariate regression analysis for SIJ inflammatory SPARCC score.ConclusionAS patients were more frequently in acute inflammatory state than nrAxSpA patients according to laboratory and MRI finding. Baseline sacroiliitis grade was significantly associated with baseline inflammatory SPARCC score of SIJ. AS patients might need more intense initial treatment to resolve active inflammatory lesion of SIJ and prevent further radiologic progression.

Highlights

This study compared clinical, laboratory and radiographic features of axial spondyloarthritis between ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis of young male patients
SpondyloArthritis International Society (ASAS) has established classification criteria to identify patients with early stages of axial spondyloarthritis (axSpA): the imaging arm of the criteria requires the presence of sacroiliitis on magnetic resonance imaging (MRI) or radiographs in addition to one SpA feature for patients with chronic low back pain with onset at age ≤ 45 years, while the clinical arm requires instead the presence of Human leukocyte antigen (HLA) B27 positivity in addition to two SpA features, and could include earlier disease, non-radiographic axial SpA [3]
The present study revealed that AS has higher inflammatory status than non-radiographic axial spondyloarthritis (nrAxSpA), and severity of sacroiliitis in plain radiography was positively associated with inflammatory score of sacroiliac joint (SIJ) MRI

Summary

Introduction

This study compared clinical, laboratory and radiographic features of axial spondyloarthritis (axSpA) between ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA) of young male patients. The Assessment of SpondyloArthritis International Society (ASAS) has established classification criteria to identify patients with early stages of axSpA: the imaging arm of the criteria requires the presence of sacroiliitis on magnetic resonance imaging (MRI) or radiographs in addition to one SpA feature for patients with chronic low back pain with onset at age ≤ 45 years, while the clinical arm requires instead the presence of HLA B27 positivity in addition to two SpA features, and could include earlier disease, non-radiographic axial SpA (nrAxSpA) [3]. NrAxSpA, including the proportion of sex and inflammatory markers [6, 7] Due to these different characteristics of nrAxSpA from AS and low progression rate to AS, some studies reported that nrAxSpA and AS might belong to different disease spectra [8], whereas most studies reported that nrAxSpA is a milder or an earlier form of the disease on the same spectrum of AS [9]

Objectives

Methods

Conclusion