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"Pain. Joints. Spine." 1 (21) 2016

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Relationship between disease activity and MRI inflammatory changes in patients with spondyloarthritis

Authors: Shynkaruk I., Iaremenko O., Fedkov D. - Bogomolets National Medical University, Kyiv, Ukraine

Categories: Rheumatology, Traumatology and orthopedics

Sections: Medical forums

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The article was published on p. 84


Background. The correlation between magnetic resonance imaging (MRI) inflammatory lesions of sacroiliac joints (SIJ) and clinical disease activity in spondyloarthritis (SpA) have been discussing since last decade. The Ankylosing Spondylitis Disease Activity Score (ASDAS) performed better in most of the studies in SpA patients and outperformed all the other measures of disease activity, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and C-reactive protein (CRP) [1]. In some studies MRI sacroiliac joints (SIJ) scores correlated negatively with BASDAI, but correlated neither with ASDAS nor CRP level [2]. Another studies showed a positive correlation of the Spondyloarthritis Research Consortium of Canada (SPARCC) score with BASDAI [3] and ASDAS indices [4].

Objectives. The aim of this study was to evaluate relationships between MRI inflammatory changes and clinical/biological parameters in SpA patients.
Materials and methods. 40 patients with SpA consulted for the first time at the Department of Internal Medicine of Dental Faculty of the Bogomolets National Medical University were recruited. There were 22 patients with axial SpA (according to Assessment of Spondyloarthritis International Society (ASAS) 2009 criteria) and 18 with peripheral SpA (according to ASAS 2011 criteria). SPARCC MRI (scoring method for active inflammatory lesions in SIJ), erythrocyte sedimentation rate (ESR), CRP, BASDAI, Bath Ankylosing Spondilitis Functional Index (BASFI) and ASDAS indices were analyzed. Spearman coefficients for correlation were calculated. 
Results. Mean value (M ± σ) of indices and laboratory parameters in all SpA patients were: ASDAS-CRP — 2.90 ± 0.94, ASDAS-ESR — 2.75 ± 0.96, BASDAI — 4.39 ± 1.86, BASFI — 2.57 ± 2.15, CRP — 15.0 ± 22.4, ESR — 22.5 ± 21.9. In axial SpA mean value were: ASDAS-CRP — 2.80 ± 0.88, ASDAS-ESR — 2.65 ± 0.91, BASDAI — 4.06 ± 1.88, BASFI — 2.55 ± 2.18, CRP — 11.7 ± 12.0, ESR — 23.1 ± 20.2. In peripheral SpA patient mean value were: ASDAS-CRP — 3.03 ± 1.02, ASDAS-ESR — 2.86 ± 1.02, BASDAI — 4.81 ± 1.78, BASFI — 2.54 ± 2.21, CRP — 18.9 ± 30.6, ESR — 21.7 ± 24.3.
SPARCC score was 26.5 ± 11.9, without significant differences between axial (28.7±12.3) and peripheral (23.8 ± 11.3) SpA.
SPARCC MRI SIJ score showed correlation only with ASDAS-CRP (r = 0.319, p = 0.045) in all SpA patients, and with BASFI (r = 0.566, p = 0.014) in patients with the involvement of peripheral joints.
Conclusion. For the all SpA patients MRI inflammatory changes of SIJ (SPARCC score) showed significant correlation only with ASDAS-CRP but not with any others classical clinical and biological parameters. Correlation between SPARCC score and functional status (BASFI) was also determined but only in patients with peripheral SpA.


1. Muntean L., Valeanu M., Lungu A. et al. The value of the ankylosing spondylitis disease activity score (ASDAS) in evaluating disease activity in patient with axial spondyloarthritis // Romanian Journal of Rheumatology. — 2015. — Vol. XXIV(3). — P. 173-180.
2. Van der Heijde D., Sieper J., Maksymowych W.P. et al. Spinal inflammation in the absence of sacroiliac joint inflammation on magnetic resonance imaging in patients with active nonradiographic axial spondyloarthritis // Arthritis Rheumatol. — 2014. — Vol. 66(3). — P. 667-673.
3. Zhang P., Yu K., Guo R. et al. Ankylosing spondylitis: correlations between clinical and MRI indices of sacroiliitis activity // Clin. Radiol. — 2015. — Vol. 70(1). — P. 62-66.
4. Cui Y., Zheng J., Zhang X. et al. Evaluation of treatments for sacroiliitis in spondyloarthropathy using the Spondyloarthritis Research Consortium Canada scoring system // Arthritis Research & Therapy. — 2016. — doi: 10.1186/s13075-016-0916-2.   

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