Whole-Body MRI Effectively Maps Inflammatory Lesions in Axial Spondyloarthritis

In patients with axial spondyloarthritis (axSpA), whole-body magnetic resonance imaging (MRI) can be used to map inflammatory lesions of peripheral joints and entheses, according to results published in The Journal of Rheumatology.

The results indicate that whole-body MRI can help differentiate between inflammatory and non-inflammatory joint tenderness.

The study included participants with axSpA from an investigator-initiated randomized controlled trial of adalimumab (n=49). Participants received adalimumab 40 mg or placebo subcutaneously every other week for 6 weeks, followed by adalimumab 40 mg every other week from week 6 to week 48 in both treatment groups.

Participants underwent whole-body MRI at 0, 6, 24, and 48 weeks. The researchers performed detailed analyses of whole-body MRI lesions in peripheral joints and entheses, including agreement with clinical measures of disease activity.

The researchers most frequently observed whole-body MRI inflammatory lesions in the acromioclavicular, metatarsophalangeal, and wrists joints (>10% of joints), and at the greater trochanter, calcaneal insertion of the Achilles tendon, and ischial tuberosity (>15% of entheses).

The results indicated that inflammation resolved in more than two-thirds of involved sternoclavicular, metacarpophalangeal, first carpometacarpal, hip, and tarsometatarsal joints, pubic symphyses, and medial femoral condyles. Inflammation resolved in less than one-sixth of involved acromioclavicular joints, knee joints, and supraspinatus tendon insertions at humerus.

After 6 weeks of active treatment, joint tenderness resolved more frequently in MRI-positive joints compared with MRI-negative joints (62% vs 26%).

“[Whole-body MRI] seems to be a promising objective tool for assessing the distribution and changes over time in inflammation of peripheral joints and entheses and may separate inflammation of joints and entheses from tenderness of non-inflammatory origin,” the researchers wrote.

This study was supported by AbbVie.

Reference

Krabbe S, Eshed I, Sørensen IJ, et al. Whole-body magnetic resonance imaging inflammation in peripheral joints and entheses in axial spondyloarthritis: distribution and changes during adalimumab treatment [published online April 1, 2019]. J Rheumatol. doi:10.3899/jrheum.181159