Xenofon Baraliakos1,2, Frank Heldmann3,4, Johanna Callhoff3,4, Ravi Suppiah3,4, Fiona Marion McQueen3,4, Dietmar Krause3,4, Claudia Klink3,4, Elmar Schmitz-Bortz3,4, Manfred Igelmann3,4, Ludwig Kalthoff3,4, Uta Kiltz3,4, Anna Schmuedderich3,4, Juergen Braun3,4. 1. From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand. baraliakos@me.com. 2. X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet. baraliakos@me.com. 3. From the Rheumazentrum Ruhrgebiet, Herne; German Rheumatism Research Center, Berlin; Rheumatology Practice, Gladbeck; Rheumatology Practice, Hattingen; Rheumatology Practice, Bochum; Rheumatology Practice, Ruhr, Germany; Departments of Rheumatology, and Counties Manukau District Health Boards; Department of Rheumatology, University of Auckland, Auckland, New Zealand. 4. X. Baraliakos, MD, Rheumazentrum Ruhrgebiet; F. Heldmann, MD, Rheumazentrum Ruhrgebiet; J. Callhoff, MD, German Rheumatism Research Center; R. Suppiah, MD, Departments of Rheumatology, and Counties Manukau District Health Boards; F.M. McQueen, MD, Department of Rheumatology, University of Auckland; D. Krause, MD, Rheumatology Practice; C. Klink, MD, Rheumatology Practice; E. Schmitz-Bortz, MD, Rheumatology Practice; M. Igelmann, MD, Rheumatology Practice; L. Kalthoff, MD, Rheumatology Practice; U. Kiltz, MD, Rheumazentrum Ruhrgebiet; A. Schmuedderich, MD, Rheumazentrum Ruhrgebiet; J. Braun, MD, Rheumazentrum Ruhrgebiet.
Abstract
OBJECTIVE: Neck pain is common in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). We investigated the correlation of bone marrow edema (BME) on magnetic resonance imaging (MRI) in RA and AS and its association with clinical complaints of neck pain. METHODS: Cervical spine short-tau inversion recovery-MRI and T1w-MRI of 34 patients with RA and 6 patients with AS complaining about neck pain were obtained. Clinical and laboratory data were available. BME was scored by 2 blinded readers using a modification of a published score, including various cervical sites. Degenerative changes were also quantified. RESULTS: Patients were predominantly women (82.5%), and mean ± SD age was 57.5 ± 11.8 years, C-reactive protein (CRP) was 0.8 ± 1.3 mg/dl, and pain score was 46.0 ± 17.5. BME was detected in 24/40 patients (60%) involving the atlantoaxial region (21%), vertebral bodies (75%), facet joints (29%), and spinous processes (46%). Degenerative changes were identified in 21/40 patients (52.5%), 13 (62%) of whom also had BME in vertebral bodies. No differences were found between patients with versus without cervical BME for clinical assessments: numeric rating scale pain (median ± interquartile range) 5.5 ± 3.0 vs 6.0 ± 4.0 (p = 0.69), Funktionsfragebogen Hannover 68.2 ± 41.0 vs 42.0 ± 55.5 (p = 0.19), Northwick pain score 44.4 ± 21.8 vs 47.2 ± 27.0 (p = 0.83), or CRP 0.40 ± 0.80 vs 0.60 ± 0.66 (p = 0.94). For patients with degenerative changes, symptom duration was longer than for patients without (10 ± 12.5 vs 5.0 ± 18.0 yrs, p = 0.73). CONCLUSION: In this small study of patients with RA and AS complaining about neck pain, BME was found in many different cervical sites, including the facet joints and the spinous processes. However, the occurrence and severity of BME did not correlate with the severity of neck pain.
OBJECTIVE:Neck pain is common in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). We investigated the correlation of bone marrow edema (BME) on magnetic resonance imaging (MRI) in RA and AS and its association with clinical complaints of neck pain. METHODS: Cervical spine short-tau inversion recovery-MRI and T1w-MRI of 34 patients with RA and 6 patients with AS complaining about neck pain were obtained. Clinical and laboratory data were available. BME was scored by 2 blinded readers using a modification of a published score, including various cervical sites. Degenerative changes were also quantified. RESULTS:Patients were predominantly women (82.5%), and mean ± SD age was 57.5 ± 11.8 years, C-reactive protein (CRP) was 0.8 ± 1.3 mg/dl, and pain score was 46.0 ± 17.5. BME was detected in 24/40 patients (60%) involving the atlantoaxial region (21%), vertebral bodies (75%), facet joints (29%), and spinous processes (46%). Degenerative changes were identified in 21/40 patients (52.5%), 13 (62%) of whom also had BME in vertebral bodies. No differences were found between patients with versus without cervical BME for clinical assessments: numeric rating scale pain (median ± interquartile range) 5.5 ± 3.0 vs 6.0 ± 4.0 (p = 0.69), Funktionsfragebogen Hannover 68.2 ± 41.0 vs 42.0 ± 55.5 (p = 0.19), Northwick pain score 44.4 ± 21.8 vs 47.2 ± 27.0 (p = 0.83), or CRP 0.40 ± 0.80 vs 0.60 ± 0.66 (p = 0.94). For patients with degenerative changes, symptom duration was longer than for patients without (10 ± 12.5 vs 5.0 ± 18.0 yrs, p = 0.73). CONCLUSION: In this small study of patients with RA and AS complaining about neck pain, BME was found in many different cervical sites, including the facet joints and the spinous processes. However, the occurrence and severity of BME did not correlate with the severity of neck pain.
Authors: Katayoon Bidad; Eric Gracey; Kasey S Hemington; Josiane C S Mapplebeck; Karen D Davis; Robert D Inman Journal: Nat Rev Rheumatol Date: 2017-06-15 Impact factor: 20.543