Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years

ObjectiveTo investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and sacroiliac joints (SIJ) in a general population sample.MethodsAs part of a community-based cohort project (Study of Health in Pomerania), vol...

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Published in:	Annals of the rheumatic diseases Vol. 79; no. 2; pp. 186 - 192
Main Authors:	Baraliakos, Xenofon, Richter, Adrian, Feldmann, Daniel, Ott, Anne, Buelow, Robin, Schmidt, Carsten O, Braun, Juergen
Format:	Journal Article
Language:	English
Published:	England Elsevier Limited 01.02.2020
Subjects:	Adult Age Arthritis Axial skeleton Back pain Bone marrow Bone Marrow Diseases - diagnostic imaging Classification Cohort Studies Design Edema Edema - diagnostic imaging Female Humans Inflammation Inflammatory diseases Joint diseases Lesions Magnetic resonance imaging Magnetic Resonance Imaging - statistics & numerical data Male Mechanical properties Participation Patients Population Population studies Rheumatic diseases Sacroiliac Joint - diagnostic imaging Sensitivity and Specificity Skeleton Spine Spine - diagnostic imaging Spondylarthritis - diagnostic imaging Studies Trends Vertebrae Germany spondyloarthritis MRI ankylosing spondylitis
ISSN:	0003-4967, 1468-2060, 1468-2060
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Abstract	ObjectiveTo investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and sacroiliac joints (SIJ) in a general population sample.MethodsAs part of a community-based cohort project (Study of Health in Pomerania), volunteers underwent spinal (sagittal T1/T2) and SIJ (semicoronal short tau inversion recovery) MRI examinations. Two calibrated readers evaluated the images to detect BME in SIJ and vertebral corners (VC) and FL in VC suggestive of axSpA using Assessment of SpondyloArthritis international Society definitions.ResultsMRIs of 793 volunteers (49.4% males, mean age 37.3±6.3 years, 8.4% human leucocyte antigen-B27+) aged <45 years were evaluated. SIJ BME was seen in 136 (17.2%), VC BME in 218 (27.5%) and FL in 645 (81.4%) volunteers. SIJ BME in ≥1, ≥3 and ≥5 SIJ quadrants was seen in 136 (17.2%), 7 (0.9%) and 1 (0.1%) volunteers, respectively. In VC, BME≥1, ≥3 and ≥5 lesions were seen in 218 (27.5%), 38 (4.8%) and 6 (0.8%) volunteers, respectively, while FL≥1, ≥3 and ≥5 were seen in 645 (81.3%), 351 (44.3%) and 185 (23.3%) volunteers, respectively. Logistic regression analysis showed that BME and FL in VC were related to increasing age: OR 1.33, 95% CI 1.02 to 1.72, and OR 1.73, 95% CI 1.32 to 2.27, per decade increase, respectively.ConclusionsIn this large population-based study, a high frequency of inflammatory and fatty MRI lesions suggestive of axSpA was found, especially in the spine. This indicates a limited value of such MRI findings for diagnosis and classification of axSpA. The increasing frequency with age suggests that mechanical factors could play a role.
AbstractList	ObjectiveTo investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and sacroiliac joints (SIJ) in a general population sample.MethodsAs part of a community-based cohort project (Study of Health in Pomerania), volunteers underwent spinal (sagittal T1/T2) and SIJ (semicoronal short tau inversion recovery) MRI examinations. Two calibrated readers evaluated the images to detect BME in SIJ and vertebral corners (VC) and FL in VC suggestive of axSpA using Assessment of SpondyloArthritis international Society definitions.ResultsMRIs of 793 volunteers (49.4% males, mean age 37.3±6.3 years, 8.4% human leucocyte antigen-B27+) aged <45 years were evaluated. SIJ BME was seen in 136 (17.2%), VC BME in 218 (27.5%) and FL in 645 (81.4%) volunteers. SIJ BME in ≥1, ≥3 and ≥5 SIJ quadrants was seen in 136 (17.2%), 7 (0.9%) and 1 (0.1%) volunteers, respectively. In VC, BME≥1, ≥3 and ≥5 lesions were seen in 218 (27.5%), 38 (4.8%) and 6 (0.8%) volunteers, respectively, while FL≥1, ≥3 and ≥5 were seen in 645 (81.3%), 351 (44.3%) and 185 (23.3%) volunteers, respectively. Logistic regression analysis showed that BME and FL in VC were related to increasing age: OR 1.33, 95% CI 1.02 to 1.72, and OR 1.73, 95% CI 1.32 to 2.27, per decade increase, respectively.ConclusionsIn this large population-based study, a high frequency of inflammatory and fatty MRI lesions suggestive of axSpA was found, especially in the spine. This indicates a limited value of such MRI findings for diagnosis and classification of axSpA. The increasing frequency with age suggests that mechanical factors could play a role. To investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and sacroiliac joints (SIJ) in a general population sample.OBJECTIVETo investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and sacroiliac joints (SIJ) in a general population sample.As part of a community-based cohort project (Study of Health in Pomerania), volunteers underwent spinal (sagittal T1/T2) and SIJ (semicoronal short tau inversion recovery) MRI examinations. Two calibrated readers evaluated the images to detect BME in SIJ and vertebral corners (VC) and FL in VC suggestive of axSpA using Assessment of SpondyloArthritis international Society definitions.METHODSAs part of a community-based cohort project (Study of Health in Pomerania), volunteers underwent spinal (sagittal T1/T2) and SIJ (semicoronal short tau inversion recovery) MRI examinations. Two calibrated readers evaluated the images to detect BME in SIJ and vertebral corners (VC) and FL in VC suggestive of axSpA using Assessment of SpondyloArthritis international Society definitions.MRIs of 793 volunteers (49.4% males, mean age 37.3±6.3 years, 8.4% human leucocyte antigen-B27+) aged <45 years were evaluated. SIJ BME was seen in 136 (17.2%), VC BME in 218 (27.5%) and FL in 645 (81.4%) volunteers. SIJ BME in ≥1, ≥3 and ≥5 SIJ quadrants was seen in 136 (17.2%), 7 (0.9%) and 1 (0.1%) volunteers, respectively. In VC, BME≥1, ≥3 and ≥5 lesions were seen in 218 (27.5%), 38 (4.8%) and 6 (0.8%) volunteers, respectively, while FL≥1, ≥3 and ≥5 were seen in 645 (81.3%), 351 (44.3%) and 185 (23.3%) volunteers, respectively. Logistic regression analysis showed that BME and FL in VC were related to increasing age: OR 1.33, 95% CI 1.02 to 1.72, and OR 1.73, 95% CI 1.32 to 2.27, per decade increase, respectively.RESULTSMRIs of 793 volunteers (49.4% males, mean age 37.3±6.3 years, 8.4% human leucocyte antigen-B27+) aged <45 years were evaluated. SIJ BME was seen in 136 (17.2%), VC BME in 218 (27.5%) and FL in 645 (81.4%) volunteers. SIJ BME in ≥1, ≥3 and ≥5 SIJ quadrants was seen in 136 (17.2%), 7 (0.9%) and 1 (0.1%) volunteers, respectively. In VC, BME≥1, ≥3 and ≥5 lesions were seen in 218 (27.5%), 38 (4.8%) and 6 (0.8%) volunteers, respectively, while FL≥1, ≥3 and ≥5 were seen in 645 (81.3%), 351 (44.3%) and 185 (23.3%) volunteers, respectively. Logistic regression analysis showed that BME and FL in VC were related to increasing age: OR 1.33, 95% CI 1.02 to 1.72, and OR 1.73, 95% CI 1.32 to 2.27, per decade increase, respectively.In this large population-based study, a high frequency of inflammatory and fatty MRI lesions suggestive of axSpA was found, especially in the spine. This indicates a limited value of such MRI findings for diagnosis and classification of axSpA. The increasing frequency with age suggests that mechanical factors could play a role.CONCLUSIONSIn this large population-based study, a high frequency of inflammatory and fatty MRI lesions suggestive of axSpA was found, especially in the spine. This indicates a limited value of such MRI findings for diagnosis and classification of axSpA. The increasing frequency with age suggests that mechanical factors could play a role. To investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and sacroiliac joints (SIJ) in a general population sample. As part of a community-based cohort project (Study of Health in Pomerania), volunteers underwent spinal (sagittal T1/T2) and SIJ (semicoronal short tau inversion recovery) MRI examinations. Two calibrated readers evaluated the images to detect BME in SIJ and vertebral corners (VC) and FL in VC suggestive of axSpA using Assessment of SpondyloArthritis international Society definitions. MRIs of 793 volunteers (49.4% males, mean age 37.3±6.3 years, 8.4% human leucocyte antigen-B27+) aged <45 years were evaluated. SIJ BME was seen in 136 (17.2%), VC BME in 218 (27.5%) and FL in 645 (81.4%) volunteers. SIJ BME in ≥1, ≥3 and ≥5 SIJ quadrants was seen in 136 (17.2%), 7 (0.9%) and 1 (0.1%) volunteers, respectively. In VC, BME≥1, ≥3 and ≥5 lesions were seen in 218 (27.5%), 38 (4.8%) and 6 (0.8%) volunteers, respectively, while FL≥1, ≥3 and ≥5 were seen in 645 (81.3%), 351 (44.3%) and 185 (23.3%) volunteers, respectively. Logistic regression analysis showed that BME and FL in VC were related to increasing age: OR 1.33, 95% CI 1.02 to 1.72, and OR 1.73, 95% CI 1.32 to 2.27, per decade increase, respectively. In this large population-based study, a high frequency of inflammatory and fatty MRI lesions suggestive of axSpA was found, especially in the spine. This indicates a limited value of such MRI findings for diagnosis and classification of axSpA. The increasing frequency with age suggests that mechanical factors could play a role.
Author	Baraliakos, Xenofon Braun, Juergen Richter, Adrian Ott, Anne Schmidt, Carsten O Feldmann, Daniel Buelow, Robin
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References	Lambert, Bakker, van der Heijde 2016; 75 Hoy, Brooks, Blyth 2010; 24 Sieper, Rudwaleit, Baraliakos 2009; 68 Suppl 2 Haibel, Rudwaleit, Brandt 2006; 54 Hegenscheid, Kühn, Völzke 2009; 181 Baraliakos, Hermann, Landewé 2005; 64 Qiu, Teo, Lee 2003; 28 Baraliakos, Heldmann, Callhoff 2014; 73 de Bruin, Treyvaud, Feydy 2018; 4 Rudwaleit, van der Heijde, Landewé 2009; 68 Schmidt, Raspe, Pfingsten 2011; 15 Rudwaleit, Jurik, Hermann 2009; 68 de Bruin, ter Horst, Bloem 2016; 55 Baraliakos, Landewé, Hermann 2005; 64 de Hooge, de Bruin, de Beer 2017; 69 Braun, Bollow, Remlinger 1998; 41 Weber, Zhao, Rufibach 2015; 67 Hermann, Baraliakos, van der Heijde 2012; 71 Völzke, Alte, Schmidt 2011; 40 Ittermann, Wittfeld, Nauck 2018; 28 Regierer, Weiß, Baraliakos 2019 Weber, Jurik, Zejden 2018; 70 de Koning, de Bruin, van den Berg 2018; 77 Braun, Sieper 2007; 369 de Winter, de Hooge, van de Sande 2018; 70 Braun, Baraliakos 2018 Varkas, de Hooge, Renson 2018; 57 Lambert (10.1136/annrheumdis-2019-215553_bib3) 2016; 75 Rudwaleit (10.1136/annrheumdis-2019-215553_bib4) 2009; 68 Haibel (10.1136/annrheumdis-2019-215553_bib13) 2006; 54 Baraliakos (10.1136/annrheumdis-2019-215553_bib27) 2005; 64 10.1136/annrheumdis-2019-215553_bib16 Baraliakos (10.1136/annrheumdis-2019-215553_bib20) 2005; 64 Baraliakos (10.1136/annrheumdis-2019-215553_bib5) 2014; 73 Sieper (10.1136/annrheumdis-2019-215553_bib12) 2009; 68 Suppl 2 Weber (10.1136/annrheumdis-2019-215553_bib6) 2015; 67 de Winter (10.1136/annrheumdis-2019-215553_bib7) 2018; 70 Hegenscheid (10.1136/annrheumdis-2019-215553_bib10) 2009; 181 Rudwaleit (10.1136/annrheumdis-2019-215553_bib2) 2009; 68 Schmidt (10.1136/annrheumdis-2019-215553_bib23) 2011; 15 Weber (10.1136/annrheumdis-2019-215553_bib14) 2018; 70 Hoy (10.1136/annrheumdis-2019-215553_bib24) 2010; 24 Völzke (10.1136/annrheumdis-2019-215553_bib8) 2011; 40 10.1136/annrheumdis-2019-215553_bib26 Braun (10.1136/annrheumdis-2019-215553_bib1) 2007; 369 de Bruin (10.1136/annrheumdis-2019-215553_bib19) 2018; 4 Ittermann (10.1136/annrheumdis-2019-215553_bib9) 2018; 28 Varkas (10.1136/annrheumdis-2019-215553_bib15) 2018; 57 de Bruin (10.1136/annrheumdis-2019-215553_bib18) 2016; 55 Qiu (10.1136/annrheumdis-2019-215553_bib22) 2003; 28 de Koning (10.1136/annrheumdis-2019-215553_bib21) 2018; 77 de Hooge (10.1136/annrheumdis-2019-215553_bib17) 2017; 69 Braun (10.1136/annrheumdis-2019-215553_bib25) 1998; 41 Hermann (10.1136/annrheumdis-2019-215553_bib11) 2012; 71 31836570 - Ann Rheum Dis. 2022 Jan;81(1):e7. doi: 10.1136/annrheumdis-2019-216773. 31900303 - Ann Rheum Dis. 2022 Jan;81(1):e8. doi: 10.1136/annrheumdis-2019-216798.
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Snippet	ObjectiveTo investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and... To investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and...
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SubjectTerms	Adult Age Arthritis Axial skeleton Back pain Bone marrow Bone Marrow Diseases - diagnostic imaging Classification Cohort Studies Design Edema Edema - diagnostic imaging Female Humans Inflammation Inflammatory diseases Joint diseases Lesions Magnetic resonance imaging Magnetic Resonance Imaging - statistics & numerical data Male Mechanical properties Participation Patients Population Population studies Rheumatic diseases Sacroiliac Joint - diagnostic imaging Sensitivity and Specificity Skeleton Spine Spine - diagnostic imaging Spondylarthritis - diagnostic imaging Studies Trends Vertebrae
Title	Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years
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