Abstract | BACKGROUND: 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.
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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)
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Chemical References |
- Biomarkers
- HLA-B27 Antigen
- C-Reactive Protein
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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
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