Absence Of Radiographic Sacroiliitis Research Articles

Demographic, Clinical and Imaging Characteristics of Axial Spondyloarthritis in Egyptian Patients

Abstract Introduction Axial spondyloarthritis (axSpA) is a chronic, immune-mediated inflammatory disorder involving the sacroiliac (SI) joints and spine but can also involve entheses and peripheral joints. It encompasses both radiographic axial SpA (r-axSPA) and non-radiographic axial SpA (nr-axSPA), which are differentiated based upon the presence or absence of radiographic sacroiliitis, respectively. Aim To study the demographic features, clinical manifestations and imaging characteristics of axSpA in a cohort of Egyptian patients and to assess the differences between r-axSPA and nr- axSpA. Patients and Methods This cross sectional study was conducted on 80 patients who fulfilled the ASAS classification criteria for axSpA collected from Rheumatology outpatient clinic of Ain Shams University hospitals. Patients were further classified as r-axSpA or nr-axSpA based on radiographic findings according to modified New York classification criteria. All Patients were subjected to detailed medical history, assessment of disease activity, laboratory investigations & imaging. Results This study showed that the majority of r-axSpA patients were males while the majority of nr-axSpA patients were females. There is a statistically highly significant difference between both groups regarding smoking. hip arthritis was present more frequently in r-axSpA. Disease activity scores and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) were higher in r- axSpA. There is no significant difference between both groups regarding co-morbidities, age at onset of symptoms, type of first symptoms, age at diagnosis, peripheral arthritis, extra- articular manifestations, family history, type of received drug & Human leukocyte antigen (HLA-B27). Conclusion Demographic features, clinical manifestations and imaging characteristics of axSpA of Egyptian patients are comparable with those of patients from different regions across the world except for low association with HLA-B27 & presentation of psoriasis as the most common extraarticular manifestaions. By comparing r-axSpA and nr-axSPA patients, both groups are significantly different regarding sex, smoking, hip arthritis, disease activity scores (ASDAS, BASDAI & BASFI) and mSASSS. Both groups are nearly similar regarding co-morbidities, age at onset of symptoms, type of first symptoms, age at diagnosis, peripheral arthritis, extra-articular manifestations, family history, type of received drug & HLA-B27.

How is early spondyloarthritis defined in the literature? Results from a systematic review

AimTo identify all possible definitions of “early SpA” employed in the literature, including “early axial SpA (axSpA)” and “early peripheral SpA (pSpA)”. MethodsA systematic literature review was conducted in Medline, EMBASE and the Cochrane Library for studies that included any mention of “early SpA” or its subtypes. The proportion of studies including a definition was calculated, and the different definitions were assessed. ResultsOut of 9651 titles identified, 336 publications reporting data from 183 studies were included. Over time, an increasing number of publications were identified. In total, 114 (62%) studies reported a specific definition: 33% of them based it on symptom duration, 31% on radiographic damage, 28% on disease duration, 5% on both symptom/disease duration and radiographic damage, and 3% on other aspects. Overall, 61 (33%) studies included the term “early axSpA”, whereas 60 (33%) included “early ankylosing spondylitis (AS)”. Regarding the studies that referred to “early axSpA”, the most used definition was symptom/disease duration <5 years, whereas for “early AS” was symptom/disease duration <10 years. After 2010, the definition of “early axSpA” based on the absence of radiographic sacroiliitis was less used compared to before 2010 (17% vs 38%). ConclusionOver time, the term “early SpA” and its subtypes is increasingly used. More than one third of the studies did not include a definition of the term and the studies reporting one showed a large heterogeneity. These results emphasize the need for a standardised definition of early SpA.

MRI contributes to accurate and early diagnosis of non-radiographic HLA-B27 negative axial spondyloarthritis

BackgroundNonradiographic axial spondyloarthropathies (nr-axSpA) are diagnosed by the absence of radiographic sacroiliitis and the presence of bone marrow edema (BME) on magnetic resonance imaging (MRI). According to the classification criteria of the international Assessment of Spondyloarthritis Society (ASAS), structural changes to sacroiliac joints (SIJs) on MRI cannot be used as criteria in the absence of BME. However, less than half the Asian patients with clinically active axSpA show BME. The incidence of human leukocyte antigen (HLA)-B27 is low in Asian populations, which makes it more difficult to identify nr-axSpA. We used MRI to evaluate the structural damage to SIJs in patients with nr-axSpA with and without BME with the aim of identifying the best methodology for accurate diagnosis, especially in populations with less common BME and HLA-B27.MethodsOne hundred three patients with inflammatory back pain were included in this prospective study. No patient’s radiograph met the definition of positive modified New York criteria. BME and structural damage to SIJ including sclerosis and erosion were assessed independently on coronal and axial short-tau inversion recovery and T1-weighted spin echo MRI scans by two well-trained musculoskeletal radiologists using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Demographics of patients were collected. Disease characteristics and structural damage were analyzed in patients with and without BME on SIJ MRI. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of structural damage.ResultsAll individuals in the cohort had at least one abnormal finding on SIJ MRI, including BME or structural damage; 36 of 103 patients had BME. We identified a significant positive correlation between SPARCC scores and severe erosion assessed by focal joint space widening (fJSW) (p = 0.001) in these 36 patients. Fifty-eight of the 103 enrolled patients fulfilled the ASAS criteria for nr-axSpA in the either absence or presence of BME. Of these 58 patients, 57 and 19 had erosions or fJSW, respectively, and the presence of BME was significantly correlated with fJSW (phi score of 0.319 and p = 0.015). We demonstrated a significant positive correlation between fJSW and either the presence or the severity of BME in patients with nr-axSpA who met the ASAS definition. There was a positive correlation between BME and fJSW across the whole study cohort (phi score of 0.389; p < 0.001). The area under the ROC curve (AUC) for fJSW on SIJ MRI was 0.736, p < 0.001. In both HLA-B27-positive and -negative groups, BME was more common in the presence of fJSW (phi scores of 0.370 and 0.377, p = 0.018 and 0.003, respectively) and SPARCC scores were higher in patients with fJSW (p < 0.001 and p = 0.005). We also identified a positive correlation between fJSW and BME in patients with nr-axSpA and normal serum levels of C-reactive protein (phi score of 0.362 and p = 0.001).ConclusionStructural damage detected on SIJ MRI, sclerosis, erosions and fJSW may be present in patients without detectable inflammation on SIJ MRI. However, fJSW is significantly correlated with the severity of inflammation seen on SIJ MRI, which contributes to the accurate diagnosis of nr-axSpA, and it could be used as an alternative diagnostic test for nr-axSpA in the general population, especially for those who do not carry the HLA-B27 gene, Asian patients without BME, or patients with normal serum inflammatory biomarkers.

Axial and peripheral spondyloarthritis: does psoriasis influence the clinical expression and disease burden? Data from REGISPONSER registry.

To evaluate whether the presence of psoriasis influences the clinical expression, disease activity and disease burden in both axial and peripheral phenotypes of spondyloarthritis (SpA). Patients from the Spanish REGISPONSER registry classified as having SpA according to the ESSG criteria were included. Patients were classified as psoriatic or non-psoriatic depending on the presence of cutaneous or nail psoriasis; thereafter, they were classified as having either axial [presence of radiographic sacroiliitis OR inflammatory back pain (IBP)] or peripheral phenotype (absence of radiographic sacroiliitis AND absence of IBP AND presence of peripheral involvement). Pair-wise univariate and multivariate analyses among the four groups (psoriatic/non-psoriatic axial phenotypes and psoriatic/non-psoriatic peripheral phenotypes) were performed with adjustment for treatment intake. A total of 2296 patients were included in the analysis. Among patients with axial phenotype, psoriasis was independently associated (P < 0.05) with HLA-B27+ [odds ratio (OR) 0.27], uveitis (OR 0.46), synovitis (ever) (OR 2.59), dactylitis (OR 2.78) and the use of conventional synthetic DMARDs (csDMARDs) (OR 1.47) in comparison with non-psoriatic patients. Among patients with peripheral phenotype and adjusting for csDMARD intake, psoriasis was independently associated with higher age at disease onset (OR 1.05), HLA-B27+ (OR 0.14) and heel enthesitis (OR 0.22). Higher scores for patient-reported outcomes and greater use of treatment at the time of the study visit were observed in psoriatic patients with either axial or peripheral phenotype. These findings suggest that, among all patients with SpA, psoriasis is associated with differences in clinical expression of SpA, a greater disease burden and increased use of drugs.

AB0712 Level of Awareness of Inflammatory Back Pain and Axial Spondyloarthritis among Medical Specialties Who Frequently SEE Patients with Low Back Pain

BackgroundRecognition of inflammatory back pain (IBP) is central to early diagnosis of ankylosing spondylitis (AS), as well as to that of axial spondyloarthritis (AxSpA), which has been introduced as a...

SAT0361 Short Term Efficacy of Tumor Necrosis Factor Inhibitors in Patients with Non–Radiographic Axial Spondylarthritis and Ankylosing Spondylitis; Results from TURKBIO Registry

BackgroundAxial spondylarthritis (AxSpA) has been proposed as an umbrella term for ankylosing spondylitis (AS) and non-radiographic (nr) AxSpA. This new concept makes diagnosis of AS possible at an early stage...

SAT0236 Prevalence of Syndesmophytes in Patients with Chronic Back Pain Suspected of Axial Spondyloarthritis (AXSPA) Not Fulfilling the Modified New York (MNY) Criteria

BackgroundThe mNY criteria1, which indicate sacroiliitis of at least grade 2 bilaterally or grade 3 or 4 unilaterally, are used to classify patients (pts) as Ankylosing Spondylitis (AS). However, little...

AB0889 Low percentage of MRI changes in clinically suspected axial spondyloarthritis

BackgroundThe prevalence of Ankylosing Spondylitis (AS) reaches about 0.9%, starts at a relatively young age and the burden of the disease is considerable. A diagnostic algorithm was developed in order...

Role for imaging studies in ankylosing spondylitis

Although the diagnosis and structural monitoring of ankylosing spondylitis relies classically on standard radiography, recent classification criteria and recommendations issued by the ASAS-OMERACT working group give considerable weight to modern imaging methods, most notably magnetic resonance imaging (MRI). MRI and, more recently, ultrasonography, yield three major benefits: they ensure the early diagnosis of ankylosing spondylitis in the absence of radiographic sacroiliitis, they provide therapeutic guidance at any time during the course of the disease, and they supply objective information on the degree of inflammation and response to treatment. Prospective longitudinal studies are under way to determine the respective roles for MRI and ultrasonography in the diagnosis and monitoring of axial and peripheral forms of ankylosing spondylitis. The introduction of whole-body MRI, new MRI sequences and positron emission tomography can be expected to further benefit the diagnosis of ankylosing spondylitis.