Quantification of Bone Marrow Edema by Magnetic Resonance Imaging Only Marginally Reflects Clinical Neck Pain Evaluation in Rheumatoid Arthritis and Ankylosing Spondylitis.

Abstract

OBJECTIVE:

Neck pain is common in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). We investigated the correlation of bone marrow edema (BME) on magnetic resonance imaging (MRI) in RA and AS and its association with clinical complaints of neck pain.

METHODS:

Cervical spine short-tau inversion recovery-MRI and T1w-MRI of 34 patients with RA and 6 patients with AS complaining about neck pain were obtained. Clinical and laboratory data were available. BME was scored by 2 blinded readers using a modification of a published score, including various cervical sites. Degenerative changes were also quantified.

RESULTS:

Patients were predominantly women (82.5%), and mean ± SD age was 57.5 ± 11.8 years, C-reactive protein (CRP) was 0.8 ± 1.3 mg/dl, and pain score was 46.0 ± 17.5. BME was detected in 24/40 patients (60%) involving the atlantoaxial region (21%), vertebral bodies (75%), facet joints (29%), and spinous processes (46%). Degenerative changes were identified in 21/40 patients (52.5%), 13 (62%) of whom also had BME in vertebral bodies. No differences were found between patients with versus without cervical BME for clinical assessments: numeric rating scale pain (median ± interquartile range) 5.5 ± 3.0 vs 6.0 ± 4.0 (p = 0.69), Funktionsfragebogen Hannover 68.2 ± 41.0 vs 42.0 ± 55.5 (p = 0.19), Northwick pain score 44.4 ± 21.8 vs 47.2 ± 27.0 (p = 0.83), or CRP 0.40 ± 0.80 vs 0.60 ± 0.66 (p = 0.94). For patients with degenerative changes, symptom duration was longer than for patients without (10 ± 12.5 vs 5.0 ± 18.0 yrs, p = 0.73).

CONCLUSION:

In this small study of patients with RA and AS complaining about neck pain, BME was found in many different cervical sites, including the facet joints and the spinous processes. However, the occurrence and severity of BME did not correlate with the severity of neck pain.

• Authors: Xenofon Baraliakos, Frank Heldmann, Johanna Callhoff, Ravi Suppiah, Fiona Marion McQueen, Dietmar Krause, Claudia Klink, Elmar Schmitz-Bortz, Manfred Igelmann, Ludwig Kalthoff, Uta Kiltz, Anna Schmuedderich, Juergen Braun
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 43 Issue 12 Pg. 2131-2135 (12 2016) ISSN: 0315-162X [Print] Canada
• PMID: 27744396 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Arthritis, Rheumatoid (complications, diagnostic imaging, pathology)
• Bone Marrow (diagnostic imaging, pathology)
• Edema (complications, diagnostic imaging, pathology)
• Female
• Humans
• Hypertelorism (diagnostic imaging, pathology)
• Intellectual Disability (diagnostic imaging, pathology)
• Kyphosis (diagnostic imaging, pathology)
• Magnetic Resonance Imaging
• Male
• Megalencephaly (diagnostic imaging, pathology)
• Middle Aged
• Neck Pain (complications, diagnostic imaging, pathology)
• Severity of Illness Index
• Spondylitis, Ankylosing (complications, diagnostic imaging, pathology)
• Tongue (abnormalities, diagnostic imaging, pathology)