Page 117 - Recognizing axial spondyloarthritis - Janneke de Winter

None of the MRIs showed inflammatory lesions of the spine. Regarding MRIs of the SI joints, 8 of 8 negative control MRIs were scored negative for inflammatory lesions, and 4 of 10 MRIs of patients with active axial SpA were scored positive for inflammatory lesions. In the first reading, MRI showed inflammatory lesions of the SI joint (Figure 1) in 11 first-degree relatives (22%). In the second reading, 10 of the 11 MRIs that had scored positive were confirmed, 1 scored negative, and 3 of the 39 MRIs that had scored negative scored positive. Ten MRIs (20%) showed inflammatory lesions of the SI joint in both readings. The strength of agreement between the first and second readings was considered “good” (k 50.78 (95% confidence interval 0.58–0.99)).
Application of SpA classification criteria to first-degree relatives of HLA–B27– positive AS patients Seventeen first-degree relatives (33%) fulfilled any of the SpA classification criteria at baseline: 7 (14%) fulfilled both the ASAS axial SpA and ESSG criteria, 6 (12%) fulfilled only the ASAS axial SpA criteria, and 4 (8%) fulfilled only the ESSG criteria. Three (6%) also fulfilled the Amor criteria. None fulfilled the ASAS peripheral SpA criteria, the CASPAR Study Group criteria, or the modified New York criteria. When we compared first-degree relatives who did and those who did not fulfill the ASAS axial SpA and/or ESSG classification criteria (Table 1), back pain (17 (100%) versus 12 (35%); P<0.001) and IBP (11 (65%) versus 0 (0%); P<0.001) were more prevalent in the former group. Good response to nonsteroidal anti-inflammatory drugs was also more prevalent in the group of first-degree relatives who fulfilled the ASAS axial SpA and/or ESSG classification criteria (5 (29%) versus 0 (0%); P<0.001). Furthermore, first-degree relatives who fulfilled the ASAS axial SpA and/or ESSG classification criteria had a higher number of tender entheseal points (7 (41%) versus 3 (9%); P=0.007), showed a trend toward having more tender joints (5 (29%) versus 3 (9%); P=0.059), and had more psoriasis (2 (12%) versus 0 (0%); P=0.043) than those who did not. In contrast, there were no differences in peripheral and other extra-articular disease (past or present) between both groups.
The group that fulfilled the ASAS axial SpA and/or ESSG classification criteria had a higher mean±SD physician’s global assessment of disease activity on a VAS (12±3 mm versus 4±9 mm; P<0.001), a higher VAS score for patient’s nocturnal pain (13±22 mm versus 2±3 mm; P=0.003), a higher BASDAI score (2.04±1.42 versus 0.73±1.00; P<0.001), and a higher ASDAS-CRP (0.67±0.59 versus 0.27±0.38; P=0.007), with a trend toward a higher patient’s global assessment of disease activity on a VAS (15±18 mm versus 8±15 mm; P=0.065). The BASFI score was worse in the first-degree relatives who fulfilled the ASAS axial SpA and/or ESSG classification criteria (0.85±1.08 versus 0.22±0.46; P=0.001). First-degree relatives who fulfilled the ASAS axial SpA and/or ESSG classification criteria had low overall disease activity scores: only 3 first-degree relatives had a BASDAI score >4 and/ or an ASDAS-CRP≥1.3. Serum markers of inflammation were not increased in first-degree relatives who fulfilled the ASAS axial SpA and/or ESSG classification
THE PRE-SPA COHORT
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