Prevalence of inflammatory posterior arch abnormalities on lumbar spine MRI in spondyloarthritis patients compared with low back pain patients
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This study was conducted in order to compare the prevalence of inflammatory posterior arch abnormalities on lumbar spine MRI between axial spondyloarthritis (axSpA) patients and low back pain (LBP) patients.
Patients—axSpA patients meeting the 2009 ASAS criteria and chronic LBP patients who had a lumbar spine MRI were selected. MRI—STIR and T1 sagittal images up to T8–T9 were reviewed by two experienced rheumatologists blinded to the diagnosis and clinical data to identify inflammatory posterior arch abnormalities. Analyses—The prevalence of inflammatory posterior arch abnormalities between axSpA and LBP patients was compared. Clinical data were compared in the axSpA group depending on whether or not inflammatory posterior arch abnormalities were present.
Ninety-five patients were enrolled in each group. The prevalence of all inflammatory posterior arch abnormalities was the same in the axSpA and LBP groups (58% in the SpA group versus 70% in the LBP group, p = 0.1). However, differences in terms of the prevalence of costotransverse joint arthritis, pedicle oedema above L3 and transverse and spinous process oedema were observed between the two groups (axSpA 27% versus LBP 6%, p = 0.0004). Patients with inflammatory posterior arch abnormalities in the axSpA group had a longer disease duration (11 versus 8 years, p = 0.02), higher CRP levels (median 11 versus 3 mg/l, p = 0.0002) and higher prevalence of radiographic sacroiliitis (84 versus 47%, p = 0.001) compared to patients without inflammatory posterior arch abnormalities.
Costotransverse arthritis, pedicle oedema and transverse process oedema are more frequent in axSpA patients than LBP patients, on lumbar spine MRI depicting TH9-S1.
• MRI pedicle oedema above L3, transverse process oedema, spinous process oedema or costotransverse arthritis is more frequently observed in axial spondyloarthritis (SpA).
• SpA patients with at least one MRI inflammatory lesion on the posterior arch had higher clinical activity scores and biological inflammation.
• Facet joint arthritis was more common in patients with chronic low back pain.
KeywordsSpondylitis Ankylosing Magnetic resonance imaging Diagnosis Differential
Assessment of Spondyloarthritis International Society
Ankylosing Spondylitis Disease Activity Score
Bath Ankylosing Spondylitis Disease Activity Index
Bath Ankylosing Spondylitis Functional Index
Biologic disease-modifying antirheumatic drugs
Vertebral corner inflammatory lesions
Costotransverse joint arthritis
Conventional synthetic disease-modifying antirheumatic drugs
Erythrocyte sedimentation rate
Facet joint arthropathy
Inflammatory anterior arch abnormalities
Inflammatory bowel disease
Inflammatory posterior arch abnormality
Low back pain
Magnetic resonance imaging
Non-steroidal anti-inflammatory drug
Spinous process oedema
Short-TI inversion recovery sequence
Tumour necrosis factor
Transverse process oedema
Visual analogue scale
Vertebral fat deposition
We are grateful to Dr. Helene Chiavassa and Dr. Lapègue for their useful advice on reading MRI scans and enrolling patients in the LBP group. We wish to thank all of the radiology technicians who adopted the standardised protocol for lumbar MRI scans and assisted with patient self-questionnaires.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Prof Adeline Ruyssen-Witrand.
Conflict of interest
The authors declare that they have no conflict of interest.
Statistics and biometry
One of the authors (Delphine Nigon) has significant statistical expertise.
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• Case–control study
• Cross-sectional study
• Diagnostic study
• Performed at one institution
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