Baseline and 1-year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. Relationship between symptoms, HLA-B27 and disease extent and persistence.

Abstract

BACKGROUND:

The precise anatomical location of pathology associated with inflammatory back pain (IBP) in early spondyloarthropathy (SpA) remains unclear.

OBJECTIVE:

To use MRI to study the sacroiliac joint (SIJ) and lumbar spine (LS) and explore the relationship between sites and extent of inflammation and HLA-B27 status over 12 months.

METHODS:

54 patients with IBP; median duration 24 weeks (54% HLA-B27 positive; median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 5.65) and 22 control subjects (11 with mechanical back pain; 11 volunteers) were recruited and 63% (n = 34) were reassessed at 1 year. Fat saturation and T1-weighted MRI was performed with images being scored for active bone marrow oedema (BMO) lesions representative of inflammation.

RESULTS:

At baseline 46/54 (85%) patients had BMO (SIJs and LS) compared with 40% in the control group. The majority of affected patients had inflammation at the SIJ level (96% (n = 44); 23.5% (n = 12) LS) and 28.3% (n = 13) at both sites simultaneously. The SIJ activity score confirmed more severe inflammation (BMO grade 2 or 3: 52.2%) in the IBP group (controls = BMO grade 1: 100%; p<0.001). HLA-B27 was associated with both the severity (p = 0.009) and number of baseline SIJ lesions (p = 0.045) and with persistence (SIJ or LS) at 1 year (p = 0.02). 90% of reattenders fulfilled European Spondyloarthropathy Study Group criteria; 73.5% showed MRI inflammation despite clinical improvement (median BASDAI 5.65 to 3.05; p<0.009).

CONCLUSION:

LS and SIJ involvement may occur simultaneously in very early SpA and may be differentiated from non-inflammatory back pain by the severity of MRI lesions. HLA-B27 is associated with both the severity of osteitis and its persistence.

• Authors: H Marzo-Ortega, D McGonagle, P O'Connor, E M A Hensor, A N Bennett, M J Green, P Emery
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 68 Issue 11 Pg. 1721-7 (Nov 2009) ISSN: 1468-2060 [Electronic] England
• PMID: 19019894 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• HLA-B27 Antigen
• C-Reactive Protein

Topics

• Adolescent
• Adult
• Biomarkers (blood)
• Bone Marrow Diseases (etiology)
• C-Reactive Protein (metabolism)
• Edema (etiology)
• Female
• Follow-Up Studies
• HLA-B27 Antigen (analysis)
• Humans
• Lumbar Vertebrae (pathology)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Sacroiliac Joint (pathology)
• Severity of Illness Index
• Spondylarthropathies (complications, genetics, pathology)
• Young Adult