Gender-Specific Recommendations for Improving Diagnostic Accuracy in Axial Spondyloarthritis

spondyloarthritis, axial spondyloarthritis, SpA, axSpA
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Researchers evaluated the diagnostic performance of imaging markers in men and women with axial spondyloarthritis to derive data-driven imaging criteria for MRI.

Among women with axial spondyloarthritis (axSpA), the diagnostic performance of image markers on magnetic resonance imaging (MRI) is significantly lower compared with men, according to study results presented at European Alliance of Associations for Rheumatology (EULAR) Congress 2022, held from June 1 to 5 in Copenhagen, Denmark.

A gender-specific evaluation of MRI imaging criteria was conducted among men and women with axSpA. Researchers assessed the diagnostic performance of various combinations of imaging markers in men and women to derive data-driven imaging criteria for the use of MRI in patients with axSpA.

A total of 1194 participants were enrolled in the study. Once exclusion criteria were applied, 684 participants (379 in the axSpA group [55%] and 305 in the control group [45%]) were included for additional analysis. There were 2 trained readers who scored all of the MRI images separately for the presence of ankylosis, as well as for erosion, sclerosis, fat metaplasia, and bone marrow edema differentiated for the ventral, mid, and dorsal regions for the sacral-sided and iliac-sided sacroiliac joint. All of the diagnostic performances were compared with use of the diagnostic odds ratio (DOR).

Of the 379 participants in the axSpA group, 136 were women (36%) and 243 were men (64%). Results of the study showed that in men vs women with axSpA, a higher prevalence of ankylosis (24.3% vs 7.4%, respectively) and fat metaplasia (58.8% vs 42.6%, respectively) was reported. In contrast, the presence of sclerosis was more common among women than men (75.0% vs 57.6%, respectively). There were no differences between men and women in the frequency observed for erosion or bone marrow edema.

Among participants in the axSpA group, the most significant difference in individual parameters was reported for ankylosis (DOR, 40.1 in men vs 4.7 in females). The detection of erosion and fat metaplasia as markers was also better in men than in women (DOR, 17.6 vs 11.1, respectively, for erosion; DOR, 18.6 vs 6.3, respectively, for fat metaplasia). Sclerosis and bone marrow edema were both better suited in women with axSpA compared with men with axSpA (DOR, 3.0 vs 2.5, respectively, for sclerosis; DOR, 5.0 vs 3.7, respectively, for bone marrow edema). The overall diagnostic accuracy improved only when lesions in the middle and dorsal articular compartments were considered.

The study authors suggested that future revisions of imaging criteria include gender-specific recommendations, thus improving diagnostic accuracy among both men and women with axSpA.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Ulas ST, Proft, F, Diekhoff T, et al. New perspectives in axial spondyloarthritis – first results of gender-specific assessment of MRI imaging criteria. Presented at: EULAR Congress 2022; June 1-4, 2022; Copenhagen, Denmark. Abstract OP0073.