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Clinical Rheumatology

, Volume 32, Issue 10, pp 1511–1517 | Cite as

Baseline sacroiliac joint magnetic resonance imaging abnormalities and male sex predict the development of radiographic sacroiliitis

  • Servet Akar
  • Sibel Isik
  • Bilge Birlik
  • Dilek Solmaz
  • Ismail Sari
  • Fatos Onen
  • Nurullah Akkoc
Original Article

Abstract

We evaluated the relationship between the baseline sacroiliac joint (SIJ) magnetic resonance imaging (MRI) findings and the development of radiographic sacroiliitis and tested their prognostic significance in cases of ankylosing spondylitis. Patients who had undergone an SIJ MRI at the rheumatology department were identified. Individuals for whom pelvic X-rays were available after at least 1 year of MRI were included in the analysis. All radiographs and MRI examinations were scored by two independent readers. Medical records of the patients were reviewed to obtain potentially relevant demographic and clinical data. We identified 1,069 SIJ MRIs, and 328 fulfilled our inclusion criteria. Reliability analysis revealed moderate to good inter- and intra-observer agreement. On presentation data, 14 cases were excluded because they had unequivocal radiographic sacroiliitis at baseline. After a mean of 34.8 months of follow-up, 24 patients developed radiographic sacroiliitis. The presence of active sacroiliitis (odds ratio (OR) 15.1) and structural lesions on MRI (OR 8.3), male sex (OR 4.7), fulfillment of Calin’s inflammatory back pain criteria (P = 0.001), and total MRI activity score (P < 0.001) were found to be related to the development of radiographic sacroiliitis. By regression modeling, the presence of both active inflammatory and structural damage lesions on MRI and male sex were found to be predictive factors for the development of radiographic sacroiliitis. Our present results suggest that the occurrence of both active inflammatory and structural lesions in SIJs revealed by MRI is a significant risk factor for radiographic sacroiliitis, especially in male patients with early inflammatory back pain.

Keywords

Ankylosing Magnetic resonance imaging Sacroiliitis Spondylitis 

Notes

Disclosures

None.

References

  1. 1.
    Onen F, Akar S, Birlik M, Sari I, Khan MA, Gurler O et al (2008) Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey. J Rheumatol 35(2):305–309PubMedGoogle Scholar
  2. 2.
    Akar S, Birlik M, Gurler O, Sari I, Onen F, Manisali M et al (2004) The prevalence of rheumatoid arthritis in an urban population of Izmir-Turkey. Clin Exp Rheumatol 22(4):416–420PubMedGoogle Scholar
  3. 3.
    Akkoc N (2008) Are spondyloarthropathies as common as rheumatoid arthritis worldwide? A review. Curr Rheumatol Rep 10(5):371–378PubMedCrossRefGoogle Scholar
  4. 4.
    Aggarwal R, Malaviya AN (2009) Diagnosis delay in patients with ankylosing spondylitis: factors and outcomes—an Indian perspective. Clin Rheumatol 28(3):327–331PubMedCrossRefGoogle Scholar
  5. 5.
    Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J (2003) Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 23(2):61–66PubMedGoogle Scholar
  6. 6.
    Gerdan V, Akar S, Solmaz D, Pehlivan Y, Onat AM, Kisacik B et al (2012) Initial diagnosis of lumbar disc herniation is associated with a delay in diagnosis of ankylosing spondylitis. J Rheumatol 39(10):1996–1999PubMedCrossRefGoogle Scholar
  7. 7.
    Ibn Yacoub Y, Amine B, Laatiris A, Bensabbah R, Hajjaj-Hassouni N (2010) Relationship between diagnosis delay and disease features in Moroccan patients with ankylosing spondylitis. Rheumatol Int 32(2):357-60. doi: 10.1007/s00296-010-1635-7 Google Scholar
  8. 8.
    Ozgocmen S, Ardicoglu O, Kamanli A, Kaya A, Durmus B, Yildirim K et al (2009) Pattern of disease onset, diagnostic delay, and clinical features in juvenile onset and adult onset ankylosing spondylitis. J Rheumatol 36(12):2830–2833PubMedCrossRefGoogle Scholar
  9. 9.
    Rudwaleit M, Haibel H, Baraliakos X, Listing J, Marker-Hermann E, Zeidler H et al (2009) The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 60(3):717–727PubMedCrossRefGoogle Scholar
  10. 10.
    Rudwaleit M, Khan MA, Sieper J (2005) The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 52(4):1000–1008PubMedCrossRefGoogle Scholar
  11. 11.
    Mau W, Zeidler H, Mau R, Majewski A, Freyschmidt J, Stangel W et al (1988) Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year follow-up. J Rheumatol 15(7):1109–1114PubMedGoogle Scholar
  12. 12.
    Bennett AN, McGonagle D, O’Connor P, Hensor EM, Sivera F, Coates LC et al (2008) Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum 58(11):3413–3418PubMedCrossRefGoogle Scholar
  13. 13.
    Blum U, Buitrago-Tellez C, Mundinger A, Krause T, Laubenberger J, Vaith P et al (1996) Magnetic resonance imaging (MRI) for detection of active sacroiliitis—a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol 23(12):2107–2115PubMedGoogle Scholar
  14. 14.
    Puhakka KB, Jurik AG, Schiottz-Christensen B, Hansen GV, Egund N, Christiansen JV et al (2004) MRI abnormalities of sacroiliac joints in early spondylarthropathy: a 1-year follow-up study. Scand J Rheumatol 33(5):332–338PubMedCrossRefGoogle Scholar
  15. 15.
    Oostveen J, Prevo R, den Boer J, van de Laar M (1999) Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 26(9):1953–1958PubMedGoogle Scholar
  16. 16.
    Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J et al (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68(6):777–783PubMedCrossRefGoogle Scholar
  17. 17.
    Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N (2005) A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 25(4):280–284PubMedCrossRefGoogle Scholar
  18. 18.
    Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285PubMedGoogle Scholar
  19. 19.
    Karatepe AG, Akkoc Y, Akar S, Kirazli Y, Akkoc N (2005) The Turkish versions of the Bath Ankylosing Spondylitis and Dougados Functional Indices: reliability and validity. Rheumatol Int 25(8):612–618PubMedCrossRefGoogle Scholar
  20. 20.
    Calin A, Porta J, Fries JF, Schurman DJ (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237(24):2613–2614PubMedCrossRefGoogle Scholar
  21. 21.
    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368PubMedCrossRefGoogle Scholar
  22. 22.
    Rudwaleit M, Jurik AG, Hermann KG, Landewe R, van der Heijde D, Baraliakos X et al (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68(10):1520–1527PubMedCrossRefGoogle Scholar
  23. 23.
    Bennett AN, Marzo-Ortega H, Emery P, McGonagle D (2009) Diagnosing axial spondyloarthropathy. The new Assessment in SpondyloArthritis international Society criteria: MRI entering centre stage. Ann Rheum Dis 68(6):765–767PubMedCrossRefGoogle Scholar
  24. 24.
    van der Heijde D, Sieper J, Maksymowych WP, Dougados M, Burgos-Vargas R, Landewe R et al (2011) 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann Rheum Dis 70(6):905–908PubMedCrossRefGoogle Scholar
  25. 25.
    Madsen KB, Schiottz-Christensen B, Jurik AG (2010) Prognostic significance of magnetic resonance imaging changes of the sacroiliac joints in spondyloarthritis—a followup study. J Rheumatol 37(8):1718–1727PubMedCrossRefGoogle Scholar
  26. 26.
    Heuft-Dorenbosch L, Landewe R, Weijers R, Wanders A, Houben H, van der Linden S et al (2006) Combining information obtained from magnetic resonance imaging and conventional radiographs to detect sacroiliitis in patients with recent onset inflammatory back pain. Ann Rheum Dis 65(6):804–808PubMedCrossRefGoogle Scholar
  27. 27.
    Weber U, Lambert RG, Ostergaard M, Hodler J, Pedersen SJ, Maksymowych WP (2010) The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum 62(10):3048–3058PubMedCrossRefGoogle Scholar
  28. 28.
    Heuft-Dorenbosch L, Weijers R, Landewe R, van der Linden S, van der Heijde D (2006) Magnetic resonance imaging changes of sacroiliac joints in patients with recent-onset inflammatory back pain: inter-reader reliability and prevalence of abnormalities. Arthritis Res Ther 8(1):R11PubMedCrossRefGoogle Scholar
  29. 29.
    Burton PR, Clayton DG, Cardon LR, Craddock N, Deloukas P, Duncanson A et al (2007) Association scan of 14,500 nonsynonymous SNPs in four diseases identifies autoimmunity variants. Nat Genet 39(11):1329–1337PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2013

Authors and Affiliations

  • Servet Akar
    • 1
  • Sibel Isik
    • 2
  • Bilge Birlik
    • 3
  • Dilek Solmaz
    • 1
  • Ismail Sari
    • 1
  • Fatos Onen
    • 1
  • Nurullah Akkoc
    • 1
  1. 1.Department of Internal Medicine, Division of RheumatologyDokuz Eylul University School of MedicineIzmirTurkey
  2. 2.Department of Internal MedicineDokuz Eylul University School of MedicineIzmirTurkey
  3. 3.Department of RadiologyDokuz Eylul University School of MedicineIzmirTurkey

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