Lara Barnsley1, Joseph Paiva2, Leslie Barnsley3. 1. Western Health, 160 Gordon Street, Footscray, Victoria, 3011, Australia. larabarnsley@gmail.com. 2. Western Health, 160 Gordon Street, Footscray, Victoria, 3011, Australia. 3. Department of Rheumatology, Department of Medicine University of Sydney, Concord Hospital, Hospital Rd, Concord, NSW, 2139, Australia.
Abstract
INTRODUCTION: MRI criteria are central to the diagnosis of non-radiographic axial spondyloarthropathy (nr-axSpA). The cardinal feature of nr-axSpa is inflammatory low back pain, which may be difficult to distinguish from highly prevalent non-specific low back pain. This study aims to determine the frequency of relevant MRI findings in the sacroiliac joints (SIJ) of patients without Spondyloarthropathy (SpA), and therefore estimate the specificity of MRI scans for SpA. METHODS: EMBASE and Medline were searched and limited to English. Titles were screened for relevance, with studies that included primary MRI findings in patients without SpA triggering retrieval. Retrieved papers were reviewed, data extracted by two authors and quality criteria (QUADAS 2) were applied. Findings were considered for asymptomatic and symptomatic individuals. RESULTS: The search recovered 2172 articles. Abstracts of 117 were reviewed for full text retrieval, 11 papers met eligibility criteria. These papers described MRI findings of 1180 asymptomatic patients and 1318 with low back symptoms but without SpA. In relevant populations, bone marrow oedema was found in 22% (95% CI 19-25) of asymptomatic and 20% (95% CI 18-22) of asymptomatic individuals. In all non-Spa patients, sclerosis was found in 13.4% and erosions in 6.5%. CONCLUSIONS: There is a significant frequency of diagnostically pertinent MRI abnormalities in the SIJ of patients without SpA. These are present in both asymptomatic and symptomatic individuals. Findings, such as oedema and sclerosis, lack specificity and should be interpreted with caution. Erosions are less frequent and are likely more specific for SpA.
INTRODUCTION: MRI criteria are central to the diagnosis of non-radiographic axial spondyloarthropathy (nr-axSpA). The cardinal feature of nr-axSpa is inflammatory low back pain, which may be difficult to distinguish from highly prevalent non-specific low back pain. This study aims to determine the frequency of relevant MRI findings in the sacroiliac joints (SIJ) of patients without Spondyloarthropathy (SpA), and therefore estimate the specificity of MRI scans for SpA. METHODS: EMBASE and Medline were searched and limited to English. Titles were screened for relevance, with studies that included primary MRI findings in patients without SpA triggering retrieval. Retrieved papers were reviewed, data extracted by two authors and quality criteria (QUADAS 2) were applied. Findings were considered for asymptomatic and symptomatic individuals. RESULTS: The search recovered 2172 articles. Abstracts of 117 were reviewed for full text retrieval, 11 papers met eligibility criteria. These papers described MRI findings of 1180 asymptomatic patients and 1318 with low back symptoms but without SpA. In relevant populations, bone marrow oedema was found in 22% (95% CI 19-25) of asymptomatic and 20% (95% CI 18-22) of asymptomatic individuals. In all non-Spa patients, sclerosis was found in 13.4% and erosions in 6.5%. CONCLUSIONS: There is a significant frequency of diagnostically pertinent MRI abnormalities in the SIJ of patients without SpA. These are present in both asymptomatic and symptomatic individuals. Findings, such as oedema and sclerosis, lack specificity and should be interpreted with caution. Erosions are less frequent and are likely more specific for SpA.