What level of inflammation leads to structural damage in the sacroiliac joints? A Four-Year Magnetic Resonance Imaging Follow-up Study of Low Back Pain Patients

Bodil Arnbak*, Tue S Jensen, Berit Schiøttz-Christensen, Susanne J Pedersen, Mikkel Østergaard, Ulrich Weber, Oliver Hendricks, Anna Zejden, Claus Manniche, Anne G Jurik

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: Sacroiliac (SI) joint bone marrow edema (BME) is considered to be pivotal in the detection of early spondyloarthritis. However, the link between BME and development of spondyloarthritis-related bone remodeling remains unclear. This study was undertaken to investigate the evolution of BME and structural lesions in the SI joints over time.

METHODS: Baseline and 4-year follow-up magnetic resonance imaging scans were conducted in 604 patients ages 18-40 years who were referred with low back pain to an outpatient spine clinic. Eight SI joint regions were scored for BME and categorized as absent, limited (<25% of subcortical bone region), intermediate (25-50%), or extensive (>50%). Structural lesions including erosions and fat lesions were scored as absent or present.

RESULTS: SI joint BME was seen at either time point (baseline or at 4 years) in 41% of participants but was persistent at both time points in only 16% of participants. Structural SI joint lesions developed according to the extent of BME at baseline: limited, intermediate, and extensive BME (as compared to absent BME) were independently associated with erosion at follow-up with odds ratios (ORs) of 3, 5, and 46, respectively, and with fat lesions (ORs 3, 7, and 33, respectively). In regions with limited and intermediate BME at baseline, 60% and 50% had resolved by follow-up, respectively, while only 2% and 7% had evolved into extensive BME by follow-up.

CONCLUSION: While extensive SI joint BME was a strong independent predictor of development of structural lesions, limited and intermediate BME were mostly transient and only rarely evolved into extensive BME or structural lesions. These findings enhance our understanding of the natural development of SI joint lesions and indicate different progression patterns for limited/intermediate versus extensive BME, possibly due to different etiologies.

Original languageEnglish
JournalArthritis & Rheumatology
Volume71
Issue number12
Pages (from-to)2027-2033
ISSN2326-5191
DOIs
Publication statusPublished - Dec 2019

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Sacroiliac Joint
Low Back Pain
Fats
Odds Ratio
Ambulatory Care Facilities

Keywords

  • Low Back Pain
  • MRI

Cite this

@article{37a45dc55880428eb747db688c42163d,
title = "What level of inflammation leads to structural damage in the sacroiliac joints?: A Four-Year Magnetic Resonance Imaging Follow-up Study of Low Back Pain Patients",
abstract = "OBJECTIVE: Sacroiliac (SI) joint bone marrow edema (BME) is considered to be pivotal in the detection of early spondyloarthritis. However, the link between BME and development of spondyloarthritis-related bone remodeling remains unclear. This study was undertaken to investigate the evolution of BME and structural lesions in the SI joints over time.METHODS: Baseline and 4-year follow-up magnetic resonance imaging scans were conducted in 604 patients ages 18-40 years who were referred with low back pain to an outpatient spine clinic. Eight SI joint regions were scored for BME and categorized as absent, limited (<25{\%} of subcortical bone region), intermediate (25-50{\%}), or extensive (>50{\%}). Structural lesions including erosions and fat lesions were scored as absent or present.RESULTS: SI joint BME was seen at either time point (baseline or at 4 years) in 41{\%} of participants but was persistent at both time points in only 16{\%} of participants. Structural SI joint lesions developed according to the extent of BME at baseline: limited, intermediate, and extensive BME (as compared to absent BME) were independently associated with erosion at follow-up with odds ratios (ORs) of 3, 5, and 46, respectively, and with fat lesions (ORs 3, 7, and 33, respectively). In regions with limited and intermediate BME at baseline, 60{\%} and 50{\%} had resolved by follow-up, respectively, while only 2{\%} and 7{\%} had evolved into extensive BME by follow-up.CONCLUSION: While extensive SI joint BME was a strong independent predictor of development of structural lesions, limited and intermediate BME were mostly transient and only rarely evolved into extensive BME or structural lesions. These findings enhance our understanding of the natural development of SI joint lesions and indicate different progression patterns for limited/intermediate versus extensive BME, possibly due to different etiologies.",
keywords = "Low Back Pain, MRI",
author = "Bodil Arnbak and Jensen, {Tue S} and Berit Schi{\o}ttz-Christensen and Pedersen, {Susanne J} and Mikkel {\O}stergaard and Ulrich Weber and Oliver Hendricks and Anna Zejden and Claus Manniche and Jurik, {Anne G}",
note = "This article is protected by copyright. All rights reserved.",
year = "2019",
month = "12",
doi = "10.1002/art.41040",
language = "English",
volume = "71",
pages = "2027--2033",
journal = "Arthritis & Rheumatology",
issn = "2326-5191",
publisher = "Heinemann",
number = "12",

}

What level of inflammation leads to structural damage in the sacroiliac joints? A Four-Year Magnetic Resonance Imaging Follow-up Study of Low Back Pain Patients. / Arnbak, Bodil; Jensen, Tue S; Schiøttz-Christensen, Berit; Pedersen, Susanne J; Østergaard, Mikkel; Weber, Ulrich; Hendricks, Oliver; Zejden, Anna; Manniche, Claus; Jurik, Anne G.

In: Arthritis & Rheumatology, Vol. 71, No. 12, 12.2019, p. 2027-2033.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - What level of inflammation leads to structural damage in the sacroiliac joints?

T2 - A Four-Year Magnetic Resonance Imaging Follow-up Study of Low Back Pain Patients

AU - Arnbak, Bodil

AU - Jensen, Tue S

AU - Schiøttz-Christensen, Berit

AU - Pedersen, Susanne J

AU - Østergaard, Mikkel

AU - Weber, Ulrich

AU - Hendricks, Oliver

AU - Zejden, Anna

AU - Manniche, Claus

AU - Jurik, Anne G

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/12

Y1 - 2019/12

N2 - OBJECTIVE: Sacroiliac (SI) joint bone marrow edema (BME) is considered to be pivotal in the detection of early spondyloarthritis. However, the link between BME and development of spondyloarthritis-related bone remodeling remains unclear. This study was undertaken to investigate the evolution of BME and structural lesions in the SI joints over time.METHODS: Baseline and 4-year follow-up magnetic resonance imaging scans were conducted in 604 patients ages 18-40 years who were referred with low back pain to an outpatient spine clinic. Eight SI joint regions were scored for BME and categorized as absent, limited (<25% of subcortical bone region), intermediate (25-50%), or extensive (>50%). Structural lesions including erosions and fat lesions were scored as absent or present.RESULTS: SI joint BME was seen at either time point (baseline or at 4 years) in 41% of participants but was persistent at both time points in only 16% of participants. Structural SI joint lesions developed according to the extent of BME at baseline: limited, intermediate, and extensive BME (as compared to absent BME) were independently associated with erosion at follow-up with odds ratios (ORs) of 3, 5, and 46, respectively, and with fat lesions (ORs 3, 7, and 33, respectively). In regions with limited and intermediate BME at baseline, 60% and 50% had resolved by follow-up, respectively, while only 2% and 7% had evolved into extensive BME by follow-up.CONCLUSION: While extensive SI joint BME was a strong independent predictor of development of structural lesions, limited and intermediate BME were mostly transient and only rarely evolved into extensive BME or structural lesions. These findings enhance our understanding of the natural development of SI joint lesions and indicate different progression patterns for limited/intermediate versus extensive BME, possibly due to different etiologies.

AB - OBJECTIVE: Sacroiliac (SI) joint bone marrow edema (BME) is considered to be pivotal in the detection of early spondyloarthritis. However, the link between BME and development of spondyloarthritis-related bone remodeling remains unclear. This study was undertaken to investigate the evolution of BME and structural lesions in the SI joints over time.METHODS: Baseline and 4-year follow-up magnetic resonance imaging scans were conducted in 604 patients ages 18-40 years who were referred with low back pain to an outpatient spine clinic. Eight SI joint regions were scored for BME and categorized as absent, limited (<25% of subcortical bone region), intermediate (25-50%), or extensive (>50%). Structural lesions including erosions and fat lesions were scored as absent or present.RESULTS: SI joint BME was seen at either time point (baseline or at 4 years) in 41% of participants but was persistent at both time points in only 16% of participants. Structural SI joint lesions developed according to the extent of BME at baseline: limited, intermediate, and extensive BME (as compared to absent BME) were independently associated with erosion at follow-up with odds ratios (ORs) of 3, 5, and 46, respectively, and with fat lesions (ORs 3, 7, and 33, respectively). In regions with limited and intermediate BME at baseline, 60% and 50% had resolved by follow-up, respectively, while only 2% and 7% had evolved into extensive BME by follow-up.CONCLUSION: While extensive SI joint BME was a strong independent predictor of development of structural lesions, limited and intermediate BME were mostly transient and only rarely evolved into extensive BME or structural lesions. These findings enhance our understanding of the natural development of SI joint lesions and indicate different progression patterns for limited/intermediate versus extensive BME, possibly due to different etiologies.

KW - Low Back Pain

KW - MRI

U2 - 10.1002/art.41040

DO - 10.1002/art.41040

M3 - Journal article

C2 - 31309715

VL - 71

SP - 2027

EP - 2033

JO - Arthritis & Rheumatology

JF - Arthritis & Rheumatology

SN - 2326-5191

IS - 12

ER -