FRI0317 CONSENSUS DEFINITIONS FOR MRI LESIONS IN THE SPINE OF PATIENTS WITH AXIAL SPONDYLOARTHRITIS: FIRST ANALYSIS FROM THE ASSESSMENTS IN SPONDYLOARTHRITIS INTERNATIONAL SOCIETY CLASSIFICATION COHORT
Authors: W. P. Maksymowych, I. Eshed, P. M. Machado, S. Juhl Pedersen, U. Weber, M. De Hooge, J. Sieper, S. Wichuk, D. Poddubnyy, M. Rudwaleit, D. Van der Heijde, R. B. M. Landewé, R. G. Lambert, M. Ǿstergaard, X. Baraliakos
Journal: Annals of the Rheumatic Diseases (2020)

Background: A recent consensus from the ASAS MRI group has culminated in updated spine lesion definitions for axial spondyloarthritis (ASAS_MRI_def n ) 1 . There has been no central reader evaluation of MRI scans from the ASAS Classification Cohort (ASAS-CC) 2 to determine the spectrum of MRI lesions in the spine in this cohort. Objectives: To determine the spectrum of active and structural lesions on MRI images of the spine from the ASAS-CC according to the consensus ASAS_MRI_def n update. Methods: ASAS_MRI_def n were recorded by 9 central readers in an eCRF for global assessment and detailed scoring of each discovertebral unit and postero-lateral structures. Vertebral corner bone marrow edema (VCBME) and corner fat (VCFAT) lesions were recorded if present on 2 slices; facet joint, lateral, and posterior inflammatory lesions were recorded if present on a single slice. Vertebral corner erosion, bone spurs, and ankylosis were each scored on a single slice. Comparison of active and structural lesion frequencies by local rheumatologist diagnosis of axSpA was assessed descriptively according to ≥2 and majority reader (≥5/9) concordant data. Results: MRI scans of the spine were available from 69 cases with axSpA diagnosed in 44/64 (68.8%). VCBME was most frequent with ≥1 lesion in 32(46.4%) and 19 (27.5%) by ≥2 and ≥5/9 readers, respectively. VCFAT was the most frequent structural lesion with ≥1 lesion in 24 (34.8%) and 14 (20.3%) by ≥2 and ≥5/9 readers, respectively. There were significantly more VCBME lesions in axSpA patients than non-axSpA (mean(SD):1.8(2.7) vs 0.3 (0.5)) (p&lt;0.001) while differences in VCFAT were not significant (Table). The presence of ≥2 VCBME had 90-95% specificity for axSpA. Significantly more VCBME and VCFAT were observed in the setting of radiographic sacroiliitis (modified New York criteria (mNY)). Conclusion: Spine lesions on MRI are relatively frequent in patients with undiagnosed back pain presenting to the rheumatologist. The presence of ≥2 VCBME, but not VCFAT, may have some diagnostic utility. References: [1]Maksymowych WP, et al. Arthritis Rheumatol 70 (suppl 10): 654, 2018 [2]Rudwaleit et al. Ann Rheum Dis 2009;68: 777-83 Vertebral Corner MRI lesions majority of readers (&gt;=5) ≥2 readers axSpA=Yes (n=44) axSpA=No (n=20) p-value axSpA=Yes (n=44) axSpA=No (n=20) p-value Corner Fat ≥1 12 (27.3%) 2 (10%) 0.19 17 (38.6%) 7 (35%) 0.78 Corner Fat ≥2 10 (22.7%) 2 (10%) 0.31 13 (29.5%) 4 (20%) 0.64 Corner Fat ≥3 8 (18.2%) 1 (5%) 0.25 10 (22.7%) 3 (15%) 0.74 Corner Fat ≥4 7 (15.9%) 1 (5%) 0.42 9 (20.5%) 2 (10%) 0.48 Corner BME ≥1 17 (38.6%) 1 (5%) 0.006 25 (54.5%) 6 (30%) 0.047 Corner BME ≥2 15 (34.1%) 1 (5%) 0.013 19 (43.2%) 2 (10%) 0.009 Corner BME ≥3 11 (25%) 0 (0%) 0.013 16 (36.4%) 1 (5%) 0.008 Corner BME ≥4 8 (18.2%) 0 (0%) 0.094 12 (27.3%) 1 (5%) 0.048 mNY=Yes (n=10) mNY=No (n=49) p-value mNY=Yes (n=10) mNY=No (n=49) p-value Corner Fat ≥1 5 (50%) 9 (18.4%) 0.047 5 (50%) 17 (34.7%) 0.48 Corner Fat ≥2 5 (50%) 7 (14.3%) 0.022 5 (50%) 11 (22.4%) 0.12 Corner Fat ≥3 4 (40%) 5 (10.2%) 0.036 4 (40%) 9 (18.4%) 0.20 Corner Fat ≥4 4 (40%) 4 (8.2%) 0.022 4 (40%) 7 (14.3%) 0.079 Corner BME ≥1 5 (50%) 11 (22.4%) 0.116 7 (70%) 22 (44.9%) 0.18 Corner BME ≥2 5 (50%) 9 (18.4%) 0.047 5 (50%) 14 (28.6%) 0.27 Corner BME ≥3 5 (50%) 6 (12.2%) 0.014 5 (50%) 11 (22.4%) 0.12 Corner BME ≥4 5 (50%) 3 (6.1%) 0.002 5 (50%) 7 (14.3%) 0.022 Disclosure of Interests: Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB, Iris Eshed: None declared, Pedro M Machado Consultant of: PMM: Abbvie, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Speakers bureau: PMM: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Susanne Juhl Pedersen Grant/research support from: Novartis, Ulrich Weber: None declared, Manouk de Hooge: None declared, Joachim Sieper Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Stephanie Wichuk: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Martin Rudwaleit Consultant of: AbbVie, BMS, Celgene, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly &amp; Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Robert G Lambert: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen