Presence of active MRI lesions in patients suspected of non-radiographic axial spondyloarthritis with high disease activity and chance at conversion after a 6-month follow-up period

Tamara Rusman, Marie-Luise B. John, Mignon A. C. van der Weijden, Bouke J. H. Boden, Carmella M. A. van der Bijl, Stefan T. G. Bruijnen, Conny J. van der Laken, Mike T. Nurmohamed, Irene E. van der Horst-Bruinsma

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Objectives: The primary aim is to evaluate signs of inflammation on MRI of sacroiliac joints (SIJ)/spine in inflammatory back pain (IBP) patients suspected of nr-axSpA with high disease activity. Secondary aims are to describe the onset of new inflammatory lesions at MRI after 6 months and to evaluate gender differences in the presence of inflammation. Method: Consecutively, patients with IBP with at least two spondyloarthritis features, high disease activity (BASDAI ≥ 4), and who were TNFi naïve, had a MRI of SIJ and spine. In the absence of active lesions, MRI was repeated after 6 months. MRI images were scored according to the Spondyloarthritis Research Consortium of Canada method. Results: Sixty-nine patients were included (53% female), of whom 39% showed signs of inflammation at the first MRI: 30.9% of the SIJ, 19.1% of the spine and 2.4% at both sites, irrespective of the CRP levels. Males more often showed inflammatory signs at the MRI of the SIJ and spine compared with females (45.5% vs. 33.3%). Consistently, the median SPARCC score was higher in males: for SIJ 14.0 (IQR 2.3–25.0) and for spine 11.5 (IQR 8.5–25.6). Only one patient (4.7%) without baseline inflammatory signs showed active lesions of SIJ after 6 months. Conclusions: Almost 40% of the IBP patients suspected of nr-axSpA, with high disease activity, showed inflammatory lesions on MRI of SIJ and/or spine, which occurred more often in males compared with females. In the majority (95.3%), an MRI without inflammatory lesions remained negative after 6 months despite high disease activity.Key Points• Forty percent of inflammatory back pain patients with high disease activity showed inflammatory signs on MRI of the SIJ and/or spine.• Only 4% of baseline MRIs without inflammatory signs at baseline conversed to an MRI with inflammatory signs after 6 months.• Male inflammatory back pain patients with high disease activity showed more often inflammatory signs on MRI compared with females.
Original languageEnglish
Pages (from-to)1521-1529
Number of pages9
JournalClinical Rheumatology
Issue number5
Publication statusPublished - 1 May 2020


  • Gender
  • Inflammation
  • Inflammatory back pain
  • Magnetic resonance imaging
  • Spondyloarthropathy

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