Local Inflammation Predicts Structural Damage in Axial Spondyloarthritis

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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.
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.
This article is part of Rheumatology Advisor's 2017 in-depth coverage of ACR, which took place in San Diego, CA. Our staff will be reporting on the latest treatment advancements and research initiatives for spondyloarthritis. Click here to read more of Rheumatology Advisor's conference coverage.

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."

Visit Rheumatology Advisor's conference section for our in-depth focus on spondyloarthritis at ACR 2017.

Reference

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.

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