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Current Rheumatology Reviews

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ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

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Research Article

Early Identification of Sacroiliitis in Patients with Suspected Spondyloarthritis: A Challenging Task

Author(s): Dorra Ben Nessib*, Mouna Chelli Bouaziz, Kaouther Maatallah, Mohamed Fethi Ladeb, Mohamed Montacer Kchir, Hend Riahi and Wafa Hamdi

Volume 19, Issue 4, 2023

Published on: 08 June, 2023

Page: [488 - 495] Pages: 8

DOI: 10.2174/1573397119666230529105122

Price: $65

Abstract

Objective: The purpose of this study was to assess the performance of computed tomography (CT) scan and magnetic resonance imaging (MRI) for detecting sacroiliitis in nonradiographic SpA (nr-SpA).

Methods: This cross-sectional monocentric double-blind study included 63 patients consulting for symptoms suggestive of SpA between February 2014 and February 2017. Patients with conventional radiographs showing a confirmed sacroiliitis (grade 3 or 4) were not included. Eligible patients underwent CT and MRI of sacroiliac joints (SIJ). CT and MR images were interpreted by 2 experienced musculoskeletal radiologists blinded to clinical and laboratory data. Two professors in rheumatology blinded to radiologists’ conclusions analyzed clinical data, laboratory tests, HLA typing, X-rays, CT and MRI images, and divided the patients into 2 groups: confirmed nr-SpA or no SpA. This classification was considered the gold standard when analyzing the results.

Results: 46 women and 17 men were included in this study. 47 patients were classified as confirmed nr-SpA (74.6%) and 16 patients as no SpA (25.4%). Sensitivity, specificity, and positive and negative predictive values of CT and MRI for detecting sacroiliitis were, respectively, estimated at 71.7%, 71.4%, 89.2%, 43.5%, and 51.2%, 100%, 100%, and 40%. CT and MRI findings were found to be statistically associated (p<0.001).

Conclusion: SIJ MRI is a highly specific method in the detection of sacroiliitis, but with a moderate sensitivity. SIJ CT scan, usually known as the third option after radiography and MRI, has much greater diagnostic utility than it has been documented previously.

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Graphical Abstract

[1]
Sieper J, Lenaerts J, Wollenhaupt J, et al. Efficacy and safety of infliximab plus naproxen versus naproxen alone in patients with early, active axial spondyloarthritis: results from the double-blind, placebo-controlled INFAST study, Part 1. Ann Rheum Dis 2014; 73(1): 101-7.
[http://dx.doi.org/10.1136/annrheumdis-2012-203201] [PMID: 23696633]
[2]
Çevik R, Nas K, Gür A, et al. Comparison of imaging techniques in the early diagnosis of sacroiliitis. Turk J Rheumatol 2000; 15: 99-104.
[3]
Mau W, Zeidler H, Mau R, et al. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol 1988; 15(7): 1109-14.
[PMID: 3262757]
[4]
Kozin F, Carrera GF, Ryan LM, Foley D, Lawson T. Computed tomography in the diagnosis of sacroiliitis. Arthritis Rheum 1981; 24(12): 1479-85.
[http://dx.doi.org/10.1002/art.1780241205] [PMID: 6976786]
[5]
Kucybała I, Urbanik A, Wojciechowski W. Radiologic approach to axial spondyloarthritis: Where are we now and where are we heading? Rheumatol Int 2018; 38(10): 1753-62.
[http://dx.doi.org/10.1007/s00296-018-4130-1] [PMID: 30132215]
[6]
Berthelot JM, Labat JJ, Le Goff B, Gouin F, Maugars Y. Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain. Joint Bone Spine 2006; 73(1): 17-23.
[http://dx.doi.org/10.1016/j.jbspin.2004.08.003] [PMID: 16461204]
[7]
Cottant E. Thirty sacroiliac joint pain provocation tests. Kinésithérapie Rev 2004; 1320: 1-47.
[8]
Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine 1996; 21(22): 2594-602.
[http://dx.doi.org/10.1097/00007632-199611150-00009] [PMID: 8961447]
[9]
Kok HK, Mumtaz A, O’Brien C, Kane D, Torreggiani WC, Delaney H. Imaging the patient with sacroiliac pain. Can Assoc Radiol J 2016; 67(1): 41-51.
[http://dx.doi.org/10.1016/j.carj.2015.08.001] [PMID: 26632100]
[10]
Mandl P, Navarro-Compán V, Terslev L, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015; 74(7): 1327-39.
[http://dx.doi.org/10.1136/annrheumdis-2014-206971] [PMID: 25837448]
[11]
van den Berg R, Lenczner G, Feydy A, et al. Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR cohort. Arthritis Rheumatol 2014; 66(9): 2403-11.
[http://dx.doi.org/10.1002/art.38738] [PMID: 24909765]
[12]
Devauchelle-Pensec V, D’Agostino MA, Marion J, et al. Computed tomography scanning facilitates the diagnosis of sacroiliitis in patients with suspected spondylarthritis: Results of a prospective multicenter French cohort study. Arthritis Rheum 2012; 64(5): 1412-9.
[http://dx.doi.org/10.1002/art.33466] [PMID: 22081446]
[13]
van Tubergen A, Heuft-Dorenbosch L, Schulpen G, et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: Does training improve quality? Ann Rheum Dis 2003; 62(6): 519-25.
[http://dx.doi.org/10.1136/ard.62.6.519] [PMID: 12759287]
[14]
Wei JCC, Chen HH, Hsieh TY, et al. Clinical practice recommendations for the use of imaging in the diagnosis and management of axial spondyloarthritis in Taiwan. Int J Rheum Dis 2020; 23(1): 24-36.
[http://dx.doi.org/10.1111/1756-185X.13679] [PMID: 31833212]
[15]
Carrera GF, Foley WD, Kozin F, Ryan L, Lawson TL. CT of sacroiliitis. AJR Am J Roentgenol 1981; 136(1): 41-6.
[http://dx.doi.org/10.2214/ajr.136.1.41] [PMID: 6779578]
[16]
Gao D, Li KP, Wen QF, Zhu J, Zhang JL, Huang F. A preliminary exploration of low-dose semicoronal CT of the sacroiliac joints in the diagnosis of ankylosing spondylitis. Zhonghua Nei Ke Za Zhi 2016; 55(5): 355-60.
[PMID: 27143184]
[17]
Li SG, Liu X, Zhou H, Zhang Q. Interrater reliability and radiation dosage of oblique coronal computed tomography for sacroiliitis in comparison with axial computed tomography. Br J Radiol 2018; 91(1081): 20150700.
[http://dx.doi.org/10.1259/bjr.20150700] [PMID: 29099615]
[18]
Zhang P, Yu KH, Guo RM, et al. Comparing the diagnostic utility of sacroiliac spectral CT and MRI in axial spondyloarthritis. Br J Radiol 2016; 89(1059): 20150196.
[http://dx.doi.org/10.1259/bjr.20150196] [PMID: 26670154]
[19]
Yu W, Feng F, Dion E, Yang H, Jiang M, Genant HK. Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis. Skeletal Radiol 1998; 27(6): 311-20.
[http://dx.doi.org/10.1007/s002560050388] [PMID: 9677647]
[20]
Puhakka KBO, Jurik AG, Egund N, et al. Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 2003; 44(2): 218-29.
[http://dx.doi.org/10.1034/j.1600-0455.2003.00034.x] [PMID: 12694111]
[21]
Bennett AN, McGonagle D, O’Connor P, et al. 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 2008; 58(11): 3413-8.
[http://dx.doi.org/10.1002/art.24024] [PMID: 18975311]
[22]
Lorenzin M, Ortolan A, Frallonardo P, et al. Spine and sacroiliac joints on magnetic resonance imaging in patients with early axial spondyloarthritis: Prevalence of lesions and association with clinical and disease activity indices from the Italian group of the SPACE study. Reumatismo 2016; 68(2): 72-82.
[http://dx.doi.org/10.4081/reumatismo.2016.885] [PMID: 27608795]
[23]
Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis 2009; 68(6): 777-83.
[http://dx.doi.org/10.1136/ard.2009.108233] [PMID: 19297344]
[24]
Baraliakos X. van der HEIJDE DESIRÉE, Braun J, Landewé RBM. OMERACT magnetic resonance imaging initiative on structural and inflammatory lesions in ankylosing spondylitis-report of a special interest group at OMERACT 10 on sacroiliac joint and spine lesions. J Rheumatol 2011; 38(9): 2051-4.
[http://dx.doi.org/10.3899/jrheum.110423] [PMID: 21885516]
[25]
Weber U, Østergaard M, Lambert RGW, et al. Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis. Ann Rheum Dis 2015; 74(11): 1976-82.
[http://dx.doi.org/10.1136/annrheumdis-2014-205408] [PMID: 24925836]
[26]
Herrada I, Devilliers H, Fayolle C, et al. Diagnostic performance of sacroiliac and spinal MRI for the diagnosis of non-radiographic axial spondyloarthritis in patients with inflammatory back pain. Joint Bone Spine 2021; 88(2): 105106.
[http://dx.doi.org/10.1016/j.jbspin.2020.105106] [PMID: 33186734]
[27]
Weber U, Lambert RGW, Østergaard M, Hodler J, Pedersen SJ, Maksymowych WP. The diagnostic utility of magnetic resonance imaging in spondylarthritis: An international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum 2010; 62(10): 3048-58.
[http://dx.doi.org/10.1002/art.27571] [PMID: 20496416]
[28]
Weber U, Jurik AG, Lambert RGW, Maksymowych WP. Imaging in spondyloarthritis: Controversies in recognition of early disease. Curr Rheumatol Rep 2016; 18(9): 58.
[http://dx.doi.org/10.1007/s11926-016-0607-7] [PMID: 27435070]
[29]
Tarantino A, Jablonska JP, D’Aprile P. All that glitters is not gold: Sacroiliitis. Reumatologia 2018; 56(5): 289-93.
[http://dx.doi.org/10.5114/reum.2018.79499] [PMID: 30505010]
[30]
Omoumi P, Larbi A, Zufferey P, et al. MRI of axial spondyloarthritis: Diagnostic role and pitfalls. Rev Med Suisse 2016; 12(509): 495-496, 498-502.
[PMID: 27089638]
[31]
Jans L, Coeman L, Van Praet L, et al. How sensitive and specific are MRI features of sacroiliitis for diagnosis of spondyloarthritis in patients with inflammatory back pain? JBR-BTR 2014; 97(4): 202-5.
[32]
Arnbak B, Grethe Jurik A, Hørslev-Petersen K, et al. Associations between spondyloarthritis features and magnetic resonance imaging findings: A cross-sectional analysis of 1,020 patients with persistent low back pain. Arthritis Rheumatol 2016; 68(4): 892-900.
[http://dx.doi.org/10.1002/art.39551] [PMID: 26681230]
[33]
Varkas G, de Hooge M, Renson T, et al. Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: Assessment of military recruits by magnetic resonance imaging study. Rheumatology 2018; 57(3): 508-13.
[http://dx.doi.org/10.1093/rheumatology/kex491] [PMID: 29253272]
[34]
Arnbak B, Hendricks O, Hørslev-Petersen K, et al. The discriminative value of inflammatory back pain in patients with persistent low back pain. Scand J Rheumatol 2016; 45(4): 321-8.
[http://dx.doi.org/10.3109/03009742.2015.1105289] [PMID: 26982485]
[35]
Campos-Correia D. Sudoł-Szopińska I, Diana Afonso P. Are we overcalling sacroiliitis on MRI? Differential diagnosis that every rheumatologist should know - Part I. Acta Reumatol Port 2019; 44(1): 29-41.
[PMID: 31249274]
[36]
Çalisir C, Korkmaz C, Kaya T. Comparison of MRI and CT in the diagnosis of early sacroiliitis. Med J Kocatepe 2006; 6: 49-56.
[37]
Ranga A, Agarwal Y, Meena V, Chopra RK. Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis in ankylosing spondylitis. Astrocyte 2016; 2(4): 179-84.
[http://dx.doi.org/10.4103/2349-0977.191042]
[38]
Ahlström H, Feltelius N, Nyman R, Hällgren R. Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990; 33(12): 1763-9.
[http://dx.doi.org/10.1002/art.1780331202] [PMID: 2260998]
[39]
Wittram C, Whitehouse GH, Williams JW, Bucknall RC. A comparison of MR and CT in suspected sacroiliitis. J Comput Assist Tomogr 1996; 20(1): 68-72.
[http://dx.doi.org/10.1097/00004728-199601000-00013] [PMID: 8576484]
[40]
Murphey MD, Wetzel LH, Bramble JM, Levine E, Simpson KM, Lindsley HB. Sacroiliitis: MR imaging findings. Radiology 1991; 180(1): 239-44.
[http://dx.doi.org/10.1148/radiology.180.1.2052702] [PMID: 2052702]
[41]
Rémy M, Bouillet P, Bertin P, et al. Evaluation of magnetic resonance imaging for the detection of sacroiliitis in patients with early seronegative spondylarthropathy. Rev Rhum Engl Ed 1996; 63(9): 577-83.
[PMID: 8938866]
[42]
Ye L, Liu Y, Xiao Q, et al. MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis. Clin Rheumatol 2020; 39(4): 1295-303.
[http://dx.doi.org/10.1007/s10067-019-04824-7] [PMID: 31797168]

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