Disease activity and two-year sacroiliac joint changes according to instrumental study findings in a CoRSAr cohort of patients with early axial spondyloarthritis

The evolution of axial spondyloarthritis (axSpA) and the transition of its nonradiographic to radiographic stage, when ankylosing spondylitis (AS) can be diagnosed, concern many researchers. To clarify this issue, an active search for predictors of the progression of this disease is underway; special cohort studies are being conducted.

Objective: to analyze two-year changes in the magnetic resonance imaging (MRI) signs of sacroiliac joint (SIJ) inflammation and disease activity in patients with axSpA who form a Moscow CoRSAr cohort (a Cohort of early SpondylArthritis) and the role of these indicators in the progression of sacroiliitis.

Subjects and methods. The investigation enrolled 68 CoRSAr cohort patients followed up for two years. All the patients underwent pelvic radiography and SIJ MRI at inclusion in the cohort and then every year. At inclusion in the cohort, nonradiographic axSpA was present in 28 patients, and AS was in 40. Disease activity was determined by BASDAI and ASDAS-CRP. The progression of sacroiliitis was assessed by the total scores of radiographic sacroiliitis.

Results and discussion. The patients' age at inclusion in the cohort averaged 28.5±5.8 years, with a mean disease duration of 24.1±15.4 months and a male proportion of 51.5%; the HLA-B27-positive patients were 92.6%. At two years, 39% of the patients with nonradiographic axSpA went to the AS group. 24-month sacroiliitis progression was observed in 40% of the patients. Disease activity had little impact on the progression of sacroiliitis.

Conclusion. Over two years, almost 40% of patients with axSpA showed an increase in the radiographic stage of sacroiliitis in the CoRSar cohort; this progression was primarily associated with the foci of osteitis according to MRI and correlated little with the activity of the disease.

1. Smirnov AV, Erdes ShF. Optimization of X-ray diagnosis of ankylosing spondylitis in clinical practice: Importance of a plain X-ray film of the pelvis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2015;53(2):175-81 (In Russ.). doi: 10.14412/1995-4484-2015-175-181

2. Smirnov AV, Erdes ShF. Magnetic resonance imaging diagnosis of inflammatory changes of the axial skeleton in ankylosing spondylitis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2016;54(1):53-9 (In Russ.). doi: 10.14412/1995-4484-2016-53-59

3. Bollow M, Braun J, Hamm B, et al. Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadoliniumenhanced MR imaging. Radiology. 1995;194(2):529-36. doi: 10.1148/radiology.194.2.7824736

4. Rudwaleit M, van der Heijde D, Khan MA, et al. How to diagnose axial spondyloarthritis early. Ann Rheum Dis. 2004;63:535-43. doi: 10.1136/ard.2003.011247

5. Appel H, Sipper J. Spondyloarthritis at the crossroads of imaging, pathology, and structural damage in the era of biologics. Curr Rheumatol Rep. 2008;10(5):356-63. doi: 10.1007/s11926-008-0058-x

6. Song IH, Hermann KG, Haibel H, et al. Relationship between active inflammatory lesions in the spine and sacroiliac joints and new development of chronic lesions on whole-body MRI in early axial spondyloarthritis: results of the ESTHER trial at week 48. Ann Rheum Dis. 2011;70:1257-63. doi: 10.1136/ard.2010.147033

7. Maksymowych WP, Wichuk S, Chiowchanwisawakit P, et al. Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis. Arthritis Res Ther. 2014;66:2958-67. doi: 10.1002/art.38792

8. Maksymowych WP, Wichuk S, Chiowchanwisawakit P, et al. Fat metaplasia on MRI of the sacroiliac joints increases the propensity for disease progression in the spine of patients with spondyloarthritis. RMD Open. 2017;3:e000399. doi: 10.1136/rmdopen-2016-000399

9. Dougados M, Demattei C, van den Berg R, et al. Rate and Predisposing Factors for Sacroiliac Joint Radiographic Progression After a Two-Year Follow-up Period in Recent-Onset Spondyloarthritis. Arthritis Rheum. 2016;68(8):1904-13. doi: 10.1002/art.39666

10. Dougados M, Sepriano A, Molto A, et al. Sacroiliac radiographic progression in recent onset axial spondyloarthritis: the 5-year data of the DESIR cohort. Ann Rheum Dis. 2017;76:1823-8. doi: 10.1136/annrheumdis-2017-211596

11. Poddubnyy D, Haibel H, Listing J, et al. Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum. 2012;64:1388-98. doi: 10.1002/art.33465

12. Ramiro S, van der Heijde D, van Tubergen A, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis. 2014;73:1455-61. doi: 10.1136/annrheumdis-2014-205178

13. Rumyantseva DG, Dubinina TV, Demina AB, et al. Ankylosing spondylitis and nonx-ray axial spondylitis: two stages of the same disease? Terapevticheskii Arkhiv.2017;89(5):33-7 (In Russ.).

14. Erdes ShF, Rumyantseva DG, Smirnov AV. Evaluation of the progression of axial spondyloarthritis in the early stages of the disease in real clinical practice: the possibilities of using the summary score of radiographic sacroiliitis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2018;56(4):461-5 (In Russ.). doi: 10.14412/1995-4484-2018-461-465

15. Rumyantseva DG, Dubinina TV, Erdes ShF. Impact of the frequency of using nonsteroidal anti-inflammatory drugs on the radiographic progression of sacroiliitis in patients with early axial spondyloarthritis. NauchnoPrakticheskaya Revmatologiya = Rheumatology Science and Practice.2018;56(3):346-50 (In Russ.). doi: 10.14412/1995-4484-2018-346-350

16. Dougados M, Maksymowych WP, Landewe RBM, et al. Evaluation of the change in structural radiographic sacroiliac joint damage after 2 years of etanercept therapy (EMBARK trial) in comparison to a contemporary control cohort (DESIR cohort) in recent onset axial spondyloarthritis. Ann Rheum Dis. 2018;77:221-7. doi: 10.1136/annrheumdis-2017-212008

17. Sieper J, Srinivasan S, Zamani O, et al. Comparison of two referral strategies for diagnosis of axial spondyloarthritis: the Recognising and Diagnosing Ankylosing Spondylitis Reliably (RADAR) study. Ann Rheum Dis. 2013;72:1621-7. doi: 10.1136/annrheumdis-2012-201777

18. Chiowchanwisawakit R, Lambert RGW, Conner-Spady B, Maksymowych WP. Focal Fat Lesions at Vertebral Corners on Magnetic Resonance Imaging Predict the Development of New Syndesmophytes in Ankylosing Spondylitis. Arthritis Rheum. 2011;63(8):2215-25. doi: 10.1002/art.30393