Diagnostic technology for inflammatory changes in the skeleton with ankylosing spondylitis according to magnetic resonance imaging

Extensive use of magnetic resonance imaging (MRI) in clinical practice revolutionized our understanding of the pathogenesis of axis spondyloarthritis (aSpA) and treatment approaches. The use of MRI to diagnose non-radiographic aSpA is well established. At the same time, the possibility of its use for follow-up and treatment assessment is actively discussed.Objective: To present comparative analysis of clinical and laboratory data, reflecting the activity of the disease, and analysis of MRI results in patients with ankylosing spondylitis (AS) receiving biological disease modifying anti-rheumatic drugs therapy (bDMARDs).Patients and methods. The study included 39 patients with AS, mainly men (74.3%), 24 patients (61.5%) had late and 15 (38.5%) – advanced stage of the disease. The average age was 41.0 [34.0; 48.0] years. All patients were administered bDNARDs; inhibitors of the tumor necrosis factor α or inhibitors of interleukin 17 were drug of choice. The median of treatment duration was 1.5 [1.0; 4,5] year. All patients had sacroiliac (SI) and spinal MRI. The activity of the disease was estimated using BASDAI and ASDAS-CRP/ESR indexes, functional disorders – using the BASFI questionnaire. Results and discussion. There was no significant difference in disease activity between patients with osteitis in the SI/spine or without it: BASDAI – 4.7 [2.7; 5,5] and 4.2 [2.9; 8,1], respectively (p=0.533); ASDAS-ESR – 2.6 [2.2; 3,0] and 2.6 [2.2; 3,2], respectively (p=0.725); ASDAS-CRP – 2.5 [2.1; 3,4] and 3.1 [2.8; 3.9], respectively (p=0.172). There was no significant difference in the number of osteitis foci between group of patients who have achieved the therapeutic target (ASDAS < 2.1) and those who have not (ASDAS ≥2.1) – 1.0 [0.0; 3.5] and 1.0 [1.0; 4.0], respectively, (p=0.376), and no difference in amount of inflammatory changes – 1.0 [0.2; 1.7] and 0.1 [0.0; 1,1] cm3, respectively (p=0.124). Conclusion. The data suggests a limited MRI informative value as a method for managing the efficacy of bDMARDs treatment in patients with the advanced / late stage of the AS.

Magnetic resonance tomography capabilities and limitations in managing the efficacy of treatment with biological disease modifying anti-rheumatic drugs in ankylosing spondylitis

Шестерня

Гриценко

Astanin

et al. 2021

Radiologic methods as a tool for monitoring axial spondyloarthritis in real clinical practice

Дубинина¹,

Demina²

2022

Dissociation of clinical symptoms and magnetic resonance imaging data in axial psoriatic arthritis

Vasilieva,

Filipenko,

Kapustina

et al. 2023

Currently, there is no generally accepted definition of axial lesions in psoriatic arthritis (axPsA), and the diagnostic criteria are extrapolated from the recommendations for ankylosing spondylitis and axial spondyloarthritis.Objective: To evaluate data of magnetic resonance imaging (MRI) of spine and sacroiliac joints (SIJ) in patients with psoriasis complaining of chronic back pain of any cause.Material and methods. 143 patients were enrolled to the study, including 57 (39.9%) men and 86 (60.1%) women, median age – 47 [36; 57] years, mean duration of psoriasis was 17.4±13.4 years. In all patients, the agreement of the existing symptoms with the inflammatory back pain (IBP) criteria of A. Calin et al., M. Rudwaleit et al. and ASAS was checked. All patients underwent MRI of the spine and SIJ, determination of ESR, CRP levels, HLA-B27 and consultations with a dermatologist and a rheumatologist.Results and discussion. An association of bone marrow edema (BME) in the spine and SIJ with nail involvement (odds ratio, OR 2.32; 95% confidence interval, CI 1.12–4.81; p=0.035), palmoplantar psoriasis (OR 3.85; 95% CI 1.43–10.41; p=0.054) and a weak correlation with PASI (r=0.329, p=0.034) was found. There were no statistically significant differences in PASI between patients with BME and without BME. In patients with IBP who fulfilled the criteria of A. Calin et al., osteitis in the SIJ was present in 19 (34.5%; OR 2.79; 95% CI 1.26–6.19; p=0.01); Berlin criteria of 4 signs – 25 (28.7%; OR 2.42; 95% CI 1.00–5.84; p=0.045); Berlin criteria of 3 signs – in 18 (24.0%; OR 1.12; 95% CI 0.51–2.44; p=0.783); ASAS criteria – in 17 (34.0%; OR 2.48; 95% CI 1.12–5.49; p=0.023). In almost half of the patients with BME in the spine or SIJ, the symptoms did not fulfil the criteria for IBP. Signs such as the presence and duration of morning stiffness had a high prognostic value. Isolated spondylitis (presence of BME in vertebrae and absence of BME in SIJ) was rarely found in patients with IBP fulfilling various criteria (in 4.0–8.1% of cases).Conclusion. Considering the existing discrepancy between symptoms and MRI results, it is necessary to develop independent tools for screening and early diagnosis of axPsA.