CHICAGO — Analysis of bone marrow edema, including the anatomical location, may help differentiate axial spondyloarthritis from other conditions, according to data from the MASH study presented at the ACR/ARHP 2018 Annual Meeting.
“Clinically, it can be challenging to separate or differentiate patients with axial spondyloarthritis from patients with back and buttock pain from other reasons,” Sengül Heidi Seven, MD, a PhD student at Copenhagen Center for Arthritis Research, told attendees. “It is not unusual that there is a delay in the diagnosis of axial spondyloarthritis by several years. Ordinarily, MRI of the sacroiliac joints plays a key role in the Assessment of Spondyloarthritis International Society classification criteria for axial spondyloarthritis. However, bone marrow edema can also be seen in other conditions, and even in healthy persons.”
To analyze the relationship between MRI-detected bone marrow edema and other MRI sacroiliac lesions, and its ability to differentiate patients with axial SpA from those with other painful conditions, Seven and colleagues conducted a prospective, cross-sectional study of 204 patients aged 45 years or older.
Analysis of bone marrow edema, including the anatomical location, may help differentiate axial SpA from other conditions, according to data.
Participants included 41 patients with axial SpA, as well as 46 women with, and 14 without, pain related to pregnancy or postpartum within 12 months following delivery. In addition, there were 25 patients with lumbar disc herniation, 26 who endure hard physical labor, 23 long-distance runners who completed 30 km or more per week and 29 healthy men.
All study participants underwent clinical, laboratory and MRI examination, including semi-coronal short tau internal recovery sequence, and T1-weighted sequences of the sacroiliac joints. The researchers analyzed the MRI scans for bone marrow edema, erosions, fat, ankylosis and sclerosis. In addition, they separately assessed the left and right sacroiliac joints for bone marrow edema, in relation to the other structural lesions, in nine different images of each patient’s cartilaginous compartment.
According to Seven, the presence of bone marrow edema near the joint space, as well as adjacent to erosions and fat, were more often seen in patients with axial SpA, even as such lesions were also demonstrated across the other groups, notably among women with postpartum pain. In addition, as the researchers required increasing amounts of lesions, or higher cut-offs, in their analysis, it was the axial SpA group that most often met the requirements. Also, bone marrow edema located near sclerosis was most frequently seen in women with postpartum pain, while edema adjacent to ankylosis was only seen in patients with axial SpA.
“Bone marrow edema adjacent to joint space, to erosion and to fat were most frequently, but not exclusively, seen in patients with axial SpA,” Seven said. “Bone marrow edema adjacent to sclerosis was most frequent in women with postpartum pain. At higher cut-offs of 3 or more, bone marrow edema adjacent to erosion and to fat were almost exclusively seen in patients with axial SpA. Applying such cut-offs, and a detailed analysis of lesions and their anatomical location and relation to other pathologies, may help differentiate patients with axial SpA from other groups with sacroiliitis at MRI.” – by Jason Laday
Disclosure: Seven reports no relevant financial disclosures.
Seven S. Abstract 864. Presented at ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.