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Spondyloarthritis
Original article
Prevalence of degenerative changes and overlap with spondyloarthritis-associated lesions in the spine of patients from the DESIR cohort
  1. Freek de Bruin1,
  2. Marco O Treyvaud2,
  3. Antoine Feydy2,
  4. Manouk de Hooge3,
  5. Jean-Baptiste Pialat4,
  6. Maxime Dougados5,
  7. Laure Gossec6,
  8. Johan L Bloem1,
  9. Désirée van der Heijde3 and
  10. Monique Reijnierse1
  1. 1 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Service de radiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
  3. 3 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4 Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Lyon, Lyon, France
  5. 5 Service de Rhumatologie B, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Descartes, Paris, France
  6. 6 Department of Rheumatology, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Pitié Salpêtrière Hospital, Paris, France
  1. Correspondence to Professor Désirée van der Heijde; mail{at}dvanderheijde.nl

Abstract

Objectives To describe the prevalence of degenerative changes on MRI and conventional radiographs of the spine in a young population with suspicion of axial spondyloarthritis (axSpA) and assess whether it is possible to discriminate between degenerative changes and lesions associated with axSpA.

Methods Whole spine MRI and cervical and lumbar radiographs of patients ≥18 years with chronic back pain (≥3 months, ≤3 years, onset <50 years) were assessed for degeneration by two readers, and for SpA lesions by two other readers, all blinded for clinical information and results of the other readers. Degenerative scores were adjudicated in case of disagreement (by a third reader). Patients fulfilling and not fulfilling the Assessment of SpondyloArthritis international Society axSpA criteria were compared for prevalence of degenerative lesions. Scores for degenerative and SpA lesions were compared, and overlap was defined as the presence of both types of lesions in a single vertebral unit (VU).

Results In 456/648 (70.4%) patients (46.8% men, mean age 33.6), degenerative lesions were found with similar percentages in patients with no axSpA and with axSpA (72.4% and 69.2%, p=0.45). Modic changes were found more often in patients with no axSpA (29/239, 12.1%) versus patients with axSpA (19/409, 4.6%, p=0.01). Other lesions were evenly distributed. Overlap was minimal in 19 patients (3.0%) and 32/14 674 (0.2%) VUs for SpA reader 1 and in 23 patients (3.6%) and 34/14 674 VUs (0.2%) for SpA reader 2.

Conclusion The prevalence of degeneration is high in an early inflammatory back pain cohort. Discrimination between degeneration and axSpA lesions is very well possible with little overlap between degenerative and axSpA readings.

  • ankylosing spondylitis
  • low back pain
  • magnetic resonance imaging
  • spondyloarthritis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2018-000657

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    Footnotes

    • Contributors FdB, MOT, AF, MdH, J-BP and LG collected data for the study. MD, DvdH, AF, JLB and MR drafted the study design. FdB and DvdH drafted the manuscript. FdB performed the statistical analysis. All authors interpreted the data. All authors approved the final manuscript for submission.

    • Funding The DESIR study is conducted as a Programme Hospitalier de Recherche Clinique with Assistance Publique Hopitaux de Paris as the sponsor. The DESIR study is also under the umbrella of the French Society of Rheumatology, which financially supports the cohort. An unrestricted grant from Pfizer has been allocated for the first 10 years.

    • Competing interests None declared.

    • Ethics approval Each study center.

    • Provenance and peer review Not commissioned; externally peer reviewed.