Differences in spinal structural lesions between patients with early axSpA and non-axSpA chronic back pain: 2-year SPACE cohort results

Lara D. Veeken, vol. 65

Abstract

OBJECTIVES: To compare spinal structural lesions on radiography and magnetic resonance imaging (MRI) over 2 years, between patients with early axial spondyloarthritis (axSpA) and non-axSpA chronic back pain. METHODS: Patients from the SPACE cohort with available radiography or MRI at both baseline and 2years were included. Spinal lesions on radiography were assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), corner MRI lesions by the modified Canada-Denmark scoring system. Baseline spinal structural lesions and 2-year changes were compared between axSpA and non-axSpA. Generalized estimating equations were used to assess the change over 2 years, adjusting for age, sex, non-steroidal anti-inflammatory drug use and diagnosis. RESULTS: Radiography data from 318 patients (67% axSpA), MRI data from 351 patients (69% axSpA) were included. At baseline, the mean (SD) mSASSS was 0.6 (1.1) for both axSpA and non-axSpA. Over 2 years, mSASSS progression was minimal (0.01 units/year) in both groups. On MRI, axSpA patients had a mean of 1.4 (2.9) total structural lesions compared with 0.7 (2) in non-axSpA at baseline (P = 0.12). Significant 2-year increase in structural lesions [0.5 (1.8)] was mainly due to fat lesions [0.5 (1.6)] in axSpA. On MRI, fat lesions changed at a rate of 0.16 units/year in axSpA (P = 0.002) and -0.02 units/year in non-axSpA (P = 0.70). CONCLUSION: Over 2 years, spinal structural damage typical for axSpA progressed minimally on radiography in axSpA and non-axSpA. On MRI, axSpA showed a significant increase in fat lesions, while non-axSpA had no progression. Fat lesions may be important to assess spinal changes from early disease onwards.

Authors 15

1. Gizem Ayan Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center · Ankara Eğitim ve Araştırma Hastanesi

   Affiliation as printed

   Department Rheumatology, Ankara Research and Training Hospital , Ankara, Türkiye

   Department of Rheumatology, Leiden University Medical Center , Leiden,

   Ankara Research and Training Hospital Ankara Department Rheumatology, , Türkiye

   Leiden University Medical Center Department of Rheumatology, , Leiden, the

2. Liese J. E. de Bruin Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center , Leiden,

   Leiden University Medical Center Department of Rheumatology, , Leiden, the

3. M. van Lunteren Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center , Leiden,

   Leiden University Medical Center Department of Rheumatology, , Leiden, the

4. Manouk de Hooge Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center · Ghent University Hospital

   Affiliation as printed

   Department of Rheumatology, Ghent University Hospital , Ghent,

   Department of Rheumatology, Leiden University Medical Center , Leiden,

   Ghent University Hospital Department of Rheumatology, , Ghent,

   Leiden University Medical Center Department of Rheumatology, , Leiden, the

5. Ana Bento da Silva Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center , Leiden,

   Leiden University Medical Center Department of Rheumatology, , Leiden, the

6. Mary Lucy Marques Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center · Unidade Local de Saúde de Coimbra

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center , Leiden,

   Rheumatology Department, Coimbra Local Health Unit , Coimbra,

   Coimbra Local Health Unit Rheumatology department, ,

   Leiden University Medical Center Department of Rheumatology, , Leiden, the

7. M. Reijnierse Aachen Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Center , Leiden,

   Leiden University Medical Center Department of Radiology, , Leiden, the

8. Victoria Navarro‐Compán

   Hospital Universitario La Paz

   Affiliation as printed

   Department of Rheumatology, Hospital Universitario La Paz, IdiPaz , Madrid,

   IdiPaz Hospital Universitario La Paz, , Madrid,

9. Marleen van de Sande

   Amsterdam University Medical Centers

   Affiliation as printed

   The Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center , Amsterdam,

   Amsterdam University Medical Center The Department of Rheumatology and Clinical Immunology, , Amsterdam, the

10. Inger Jorid Berg

    Diakonhjemmet Hospital

    Affiliation as printed

    Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital , Oslo,

    Diakonhjemmet Hospital Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), , Oslo,

11. Roberta Ramonda

    University of Padua

    Affiliation as printed

    Rheumatology Unit, Department of Medicine-DIMED, University of Padova , Padova,

    University of Padova Rheumatology Unit, Department of Medicine-DIMED, , Padova,

12. Sofia Exarchou corresponding

    Lund University

    Affiliation as printed

    Department of Clinical Sciences Malmö, Rheumatology, Lund University , Malmö,

    Lund University Department of Clinical Sciences Malmö, Rheumatology, , Malmö,

13. Désirée M F M van der Heijde Aachen Department of Rheumatology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Rheumatology, Leiden University Medical Center , Leiden,

    Leiden University Medical Center Department of Rheumatology, , Leiden, the

14. Floris A van Gaalen Aachen Department of Rheumatology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Rheumatology, Leiden University Medical Center , Leiden,

    Leiden University Medical Center Department of Rheumatology, , Leiden, the

15. Sofía Ramiro Aachen Department of Rheumatology, Leiden University Medical Center

    Leiden University Medical Center · Zuyderland Medisch Centrum

    Affiliation as printed

    Department of Rheumatology, Leiden University Medical Center , Leiden,

    Department of Rheumatology, Zuyderland Medical Center , Heerlen,

    Leiden University Medical Center Department of Rheumatology, , Leiden, the

    Zuyderland Medical Center, Heerlen , the