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Lorenzin M, Ortolan A, Vio S, Cozzi G, Scapin V, De Conti G, Doria A, Ramonda R. Psoriasis and Imaging Progression in early Axial Spondyloarthritis: Results from a 48-month follow-up (Italian arm of SPACE study). Rheumatology (Oxford) 2021; 61:2375-2387. [PMID: 34605894 DOI: 10.1093/rheumatology/keab728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/13/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the influence of psoriasis on spinal/pelvic radiographic progression and magnetic resonance imaging (MRI) features in early-stage axial spondyloarthritis (axSpA). METHODS Analysis of baseline data from the Italian SPACE cohort, including patients with chronic-back-pain (CBP; duration ≥ 3 months and ≤2 years; onset <45 years) was performed. Patients underwent a diagnostic work-up, including MRI and X-rays of the sacroiliac joints (SIJ), to establish diagnosis of axSpA (ASAS criteria). Clinical features, disease activity and functional indices, imaging were collected at baseline and yearly during 48-months. Spinal and SIJ X-rays and MRIs were scored by 2 readers following SPARCC, mSASSS and mNY-criteria. Characteristics of axSpA patients with/without psoriasis were compared over-time with descriptive statistics; multivariate-logistic-regression model was constructed to assess predictors of spinal/pelvic radiographic progression. RESULTS 88 patients had axSpA (84.1% non-radiographic; 15.9% radiographic); 36.4% had psoriasis. Patients with psoriasis were older; less frequently had HLA-B27+ and radiographic sacroiliitis with unilateral/asymmetric pattern and more signs of spondylitis. Functional and disease activity indices decreased with slightly higher BASDAI and BASFI in axSpA with psoriasis. All patients showed slight spinal/pelvic radiographic progression. Patients without psoriasis showed increased sacroiliitis progression and low-grade spinal progression. More inflammatory corner lesions on cervical/thoracic MRI-spine were observed in patients with psoriasis. Significant downtrend of SPARCC SIJ/spine scores in all patients was found. Psoriasis was a predictor of increased spinal progression (OR = 0.18; 95%CI : 0.04-0.78). CONCLUSIONS Psoriasis was associated with distinct axSpA features, increased spinal radiographic progression and low-grade radiographic sacroiliitis.
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Affiliation(s)
- Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Giustiniani 2, Padova, 35128, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Giustiniani 2, Padova, 35128, Italy
| | - Stefania Vio
- Radiology Unit, Padova University Hospital, Giustiniani 2, Padova, 35128, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Giustiniani 2, Padova, 35128, Italy
| | - Vanna Scapin
- Radiology Unit, Padova University Hospital, Giustiniani 2, Padova, 35128, Italy
| | - Giorgio De Conti
- Radiology Unit, Padova University Hospital, Giustiniani 2, Padova, 35128, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Giustiniani 2, Padova, 35128, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Giustiniani 2, Padova, 35128, Italy
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Renson T, Carron P, De Craemer AS, Deroo L, de Hooge M, Krabbe S, Jans L, Chen M, Østergaard M, Van den Bosch FE, Elewaut D. Axial involvement in patients with early peripheral spondyloarthritis: a prospective MRI study of sacroiliac joints and spine. Ann Rheum Dis 2020; 80:103-108. [PMID: 33115761 DOI: 10.1136/annrheumdis-2020-218480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess axial involvement on MRI in early peripheral spondyloarthritis (pSpA) and to evaluate whether axial inflammation predicts relapse on treatment withdrawal. METHODS Fifty-six patients with early, active, newly diagnosed pSpA underwent MRI of the sacroiliac joints (SIJs) and spine prior to golimumab initiation. At sustained clinical remission of pSpA, treatment was withdrawn and a second MRI was performed. Bone marrow oedema (BME) was scored by three readers according to the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Scores were compared with an axial spondyloarthritis cohort (Belgian Arthritis and Spondylitis cohort). Structural lesions were assessed using a similar method. Furthermore, fulfilment of the Assessment of Spondyloarthritis International Society (ASAS) definition of a positive MRI for sacroiliitis was assessed. Spinal images were evaluated for BME and structural lesions using the Canada-Denmark MRI spine scoring system by two readers. RESULTS Thirty-six per cent showed SIJ BME at baseline, all fulfilling the ASAS definition of sacroiliitis. No association with back pain was found. Twenty-one per cent displayed SIJ structural lesions. Spinal BME was limited: the median inflammation scores were low and no patients had ≥5 inflammatory corner lesions. On clinical remission, a significant decrease in SIJ SPARCC scores was detected. On clinical remission, no significant differences in SIJ SPARCC scores were noted between patients relapsing and those maintaining remission after treatment discontinuation. CONCLUSION In patients with early pSpA, a surprisingly high prevalence of sacroiliitis on MRI was observed; SPARCC scores decreased significantly on tumour necrosis factor inhibition. Residual inflammation on MRI was not predictive of relapse of peripheral manifestations. No relevant inflammatory spinal involvement was detected. Collectively, our findings suggest a higher inflammatory burden in patients with early pSpA than anticipated.
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Affiliation(s)
- Thomas Renson
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium .,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Philippe Carron
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Ann-Sophie De Craemer
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Liselotte Deroo
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Manouk de Hooge
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lennart Jans
- Radiology, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Min Chen
- Radiology, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip E Van den Bosch
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Dirk Elewaut
- Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
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Prevalence of sacroiliitis and acute and structural changes on MRI in patients with psoriatic arthritis. Sci Rep 2020; 10:11580. [PMID: 32665619 PMCID: PMC7360582 DOI: 10.1038/s41598-020-68456-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/25/2020] [Indexed: 01/15/2023] Open
Abstract
Sacroiliac joint involvement is one of the earliest manifestations of psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) is a useful tool in the early diagnosis of axial disease due to its sensitivity for detecting acute and chronic changes associated with sacroiliitis. In this study, we evaluated the prevalence of sacroiliitis, acute and structural image changes on MRI in PsA patients and identified predictive clinical, laboratory and disease activity factors. Cross-sectional study on PsA patients submitted to MRI of the sacroiliac joints. The scans were evaluated by two blinded radiologists and the level of agreement was calculated (kappa). Clinical, disease activity and quality-of-life indices (DAS28, BASDAI, PASI, MASES, HAQ, CRP, ESR) were estimated. The sample consisted of 45 PsA patients with a mean age of 50.1 ± 11.5 years. The prevalence of sacroiliitis was 37.8% (n = 17), 47% of which was unilateral. The kappa coefficient was 0.64. Only 5 (29.4%) of the 17 patients with sacroiliitis on MRI had back pain. The most prevalent acute and chronic changes on MRI were, respectively, subchondral bone edema (26.7%) and enthesitis (20%), periarticular erosions (26.7%) and fat metaplasia (13.3%). CRP levels were higher among sacroiliitis patients (p = 0.028), and time of psoriasis was positively associated with chronic lesions (p = 0.006). Sacroiliitis on MRI was highly prevalent in our sample of PsA patients. Raised CRP levels were significantly associated with sacroiliitis, and longer time of psoriasis was predictive of chronic sacroiliitis lesions. Most sacroiliitis patients displayed no clinical symptoms.
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