Local Inflammation Predicts Structural Damage in Axial Spondyloarthritis
At 5-year follow-up, the rate of progression to structural damage ranged from 20% to 24% in patients with baseline bone marrow edema at the sacroiliac joints.
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SAN DIEGO – In patients with axial spondyloarthritis, early signs of local inflammation were shown to be associated with structural damage in the spine and sacroiliac joints after 5 years, according to research presented at the American College of Rheumatology 2017 Annual Meeting, November 3-8.
Researchers recruited patients with recent onset axial spondyloarthritis (≤3 years) from the DESIR cohort (DEvenir des Spondyloarthrites Indifférenciées Récentes) and conducted magnetic resonance imaging (MRI) of the spine (n=145) or MRI of the sacroiliac joints (n=151) at baseline, 2 years, and 5 years. Inflammation was assessed at baseline based on the presence of bone marrow edema (>3 lesions) and C-reactive protein levels. Structural damage was defined as >3 fatty lesions in the spine or sacroiliac joints.
At 5-year follow-up, the rate of progression to structural damage ranged from 20% to 24% in patients with baseline bone marrow edema at the sacroiliac joints. In patients with no evidence of bone marrow edema at the sacroiliac joints, progression to structural damage was reported for 0% to 3.8%.
After adjusting for baseline C-reactive protein positivity, baseline bone marrow edema at sacroiliac joints (odds ratio [OR] 4.2, 95% CI 2.4-7.3) and bone marrow edema at the spine (OR 8.9, 95% CI 2.1-38.7) were associated with 5-year structural progression in the sacroiliac joints and spine, respectively.
The study investigators concluded that "local inflammation is strongly associated with the development of structural damage over 5 years both in the [sacroiliac joints] and spine in early [axial spondyloarthritis,] and … this effect is independent of systemic inflammation."
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Sepriano A, Ramiro S, Landewé RBM, Dougados M, van der Heijde D. Inflammation on MRI of spine and sacroiliac joints is highly predictive of structural damage in axial spondyloarthritis: the 5 years data of the DESIR cohort. Presented at: 2017 ACR/ARHP Annual Meeting; November 3-8, 2017; San Diego, California. Poster 591.