Development and Validation of 3 Preliminary MRI Sacroiliac Joint Composite Structural Damage Scores in a 5-year Longitudinal Axial Spondyloarthritis Study

Marie Wetterslev; Mikkel Østergaard; Inge J Sørensen; Ulrich Weber; Anne G Loft; Gina Kollerup; Lars Juul; Gorm Thamsborg; Ole R Madsen; Jakob M Møller; Susanne J Pedersen

doi:10.3899/jrheum.201075

Development and Validation of 3 Preliminary MRI Sacroiliac Joint Composite Structural Damage Scores in a 5-year Longitudinal Axial Spondyloarthritis Study

J Rheumatol. 2021 Oct;48(10):1537-1546. doi: 10.3899/jrheum.201075. Epub 2021 Apr 15.

Authors

Affiliations

¹ M. Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; marie.wetterslev@regionh.dk.
² M. Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen.
³ I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen.
⁴ U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense.
⁵ A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus.
⁶ J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.

PMID: 33858979
DOI: 10.3899/jrheum.201075

Abstract

Objective: In axial spondyloarthritis (axSpA), sacroiliac joint (SIJ) erosion is often followed by fat metaplasia in an erosion cavity (backfill), and subsequently ankylosis. We aimed to combine the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ structural score for erosion, backfill, and ankylosis into 3 versions of a novel preliminary axSpA magnetic resonance imaging (MRI) SIJ Composite Structural Damage Score (CSDS) and to test these.

Methods: Thirty-three patients with axSpA, followed for 5 years after initiation of tumor necrosis factor inhibitor, had MRIs of the SIJs at baseline, and yearly thereafter. Three versions of CSDS were calculated based on different weightings of erosion, backfill, and ankylosis: (1) equal weighting: CSDS_equal = (erosion × 0.5) + backfill + ankylosis; (2) advanced stages weighting more: CSDS_stepwise = (erosion × 1) + (backfill × 4) + (ankylosis × 6); and (3) advanced stages overruling earlier stages ("hierarchical") with "<" meaning "overruled by": CSDS_hierarchical = (erosion × 1) < (backfill × 4) < (ankylosis × 6).

Results: At baseline, all CSDS correlated positively with SPARCC fat and ankylosis scores and modified New York radiography grading, and negatively with the Bath Ankylosing Spondylitis Disease Index and SPARCC SIJ inflammation scores. CSDS_stepwise and CSDS_hierarchical (not CSDS_equal) correlated positively with symptom duration and the Bath Ankylosing Spondylitis Metrology Index, and closer with SPARCC ankylosis score and modified New York radiography grading than CSDS_equal. The adjusted annual progression rate for CSDS_stepwise and CSDS_hierarchical (not CSDS_equal) was higher the first year compared with fourth year (P = 0.04 and P = 0.01). Standardized response mean (baseline to Week 46) was moderate for CSDS_hierarchical (0.64) and CSDS_stepwise (0.59) and small for CSDS_equal (0.25).

Conclusion: Particularly CSDS_stepwise and CSDS_hierarchical showed construct validity and responsiveness, encouraging further validation in larger clinical trials. The potential clinical implication is assessment of SIJ damage progression by 1 composite score.

Keywords: ankylosing spondylitis; magnetic resonance imaging; outcomes; prognosis; spondyloarthropathy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Magnetic Resonance Imaging
Sacroiliac Joint / diagnostic imaging
Sacroiliitis*
Spondylarthritis* / diagnostic imaging
Spondylitis, Ankylosing*