Abstract
The aim of this study was to compare the validity of MRI in the early detection of sacroiliitis with laboratory findings of human leukocyte antigen-B27 (HLA-B27), conventional radiography, and clinical assessment. Sixty patients with spondyloarthropathy (group II) with duration of illness less than 2 years and 20 healthy controls (group I) were included in this study. Both groups were subjected to assessment of history, clinical examination, and laboratory investigations (erythrocyte sedimentation rate, C-reactive protein titer, rheumatoid factor, HLA-B27). Conventional radiography and MRI of the sacroiliac joints were performed. Spondyloarthropathic patients were divided according to MRI as follows: group IIA, which included patients with sacroiliitis, and group IIB, which included patients without sacroiliitis. In our study, ankylosing spondylitis was diagnosed in 22 (36.6%) patients, followed by undifferentiated spondyloarthropathy in 12 (20%) patients, reactive arthritis in 10 (16.7%) patients, psoriatic arthropathy in 10 (16.7%) patients, and enteropathic arthropathy in six (10%) patients. Evidence of sacroiliitis was found in 66.6% (40/60) of patients by MRI, which was higher than the result obtained by plain radiography 20% (12/60). HLA-B27 positivity found in 53.3% (32/60) of patients. There was a significant difference between the two groups in HLA-B27 and radiological sacroiliitis; there was no sacroiliitis in the control group. MRI showed sacroiliitis even in patients with no inflammatory back pain. There was a highly statistically significant difference between patient subgroups in disease duration (P= 0.001) and primary complaints and clinical sacroiliitis (P = 0.001). MRI is the preferred modality in the detection of early sacroiliitis in spondyloarthropathy and HLA-B27 positivity is a highly useful predictor of early sacroiliitis
Highlights
Spondyloarthropathy (SPA) are a group of interrelated rheumatic conditions including ankylosing spondylitis (AS),reactivearthritis,psoriaticarthritis,andSPAassociated with inflammatory bowel disease (Crohn’s disease or ulcerative colitis), undifferentiated spondyloarthropathy (USPA), and juvenile-onset spondyloarthritis [1]
human leukocyte antigen-B27 (HLA-B27) is a polymorphic form of the HLA-B molecule that is found in only 8% of the general population worldwide [4]
All patients were subjected to assessment of all the following indices: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI),and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) [12]
Summary
Spondyloarthropathy (SPA) are a group of interrelated rheumatic conditions including ankylosing spondylitis (AS),reactivearthritis,psoriaticarthritis,andSPAassociated with inflammatory bowel disease (Crohn’s disease or ulcerative colitis), undifferentiated spondyloarthropathy (USPA), and juvenile-onset spondyloarthritis [1]. There is a tendency toward familial aggregation as well as varying associations with human leukocyte antigen-B27 (HLA-B27) [3]. Over 25 molecular subtypes of HLA-B27 have been described far [5]. The most common subtypes (HLA-B*2705, HLA-B*2702, HLA-B*2704, HLA-B*2707) are clearly associated with a risk for spondyloarthritis. Two subtypes of HLA-B27, HLA-B*2706 (found in Southeast Asia) and HLA-B*2709 (found in Sardinia), appear not to be associated with spondylitis, possibly because of amino acid differences in the ‘B’ pocket of the HLA antigen-binding cleft that alter the composition of peptides presented by these HLA-B27 subtypes.
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