THU0373 ACTIVE SACROILIITIS ON MAGNETIC RESONANCE IMAGING IN PATIENTS WITH ANTERIOR UVEITIS
Authors: Kristýna Bubová, Monika Gregová, Kateřina Zegzulková, Karel Pavelka, Jarmila Heissigerová, Ladislav Šenolt
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Anterior uveitis (AU) is a common extraarticular manifestation in spondyloarthritis (SpA). The disease can precede the typical axial and peripheral features. Additionally, some studies had described positive bone marrow edema in patients with AU lacking chronic back pain. <h3>Objectives</h3> The aim of this study was to examine patients with AU, to determine whether the patients already fulfil criteria for axial and/or peripheral SpA and compare the findings to healthy controls (HC). <h3>Methods</h3> We recruited 65 patients without prior rheumatologic diagnosis who developed at least one episode of AU and 33 age and sex matched HC. The clinical data were collected and rheumatology examinations were performed by trained rheumatologists. Magnetic resonance imaging (MRI) of sacroiliac joints (SIJ) was read by trained rheumatologist who was blinded to the patient's data. Patients were divided into SpA subsets (axial: imaging and clinical arm and peripheral SpA) fulfilling The Assessment of SpondyloArthritis international Society (ASAS) classification criteria and non-SpA subset. The ASAS modified Berlin algorithm for diagnosis of axial SpA (axSpA) was also applied. <h3>Results</h3> Altogether, 72% (n=47) patients referred back pain including 22.0% (n=14) patients referring inflammatory back pain, 28% (n=18) did not refer back pain. Similar results were found in HC subset. Bone marrow edema (BME) was found in 51% (n=33) of all patients with AU, however 35% (n=23) had highly suggestive BME (hsBME) corresponding to typical findings in sacroiliitis compared to HC where 30% (n=10) had BME, however none had hsBME (p=0.08, p&lt; 0.0001, respectively). Furthermore, patients with AU had higher serum CRP levels compared to HC (p=0.001), no other significant differences were observed. The diagnosis of SpA was confirmed in 46% (n=30) of all patients with AU, 34% (n=22) patients fulfilled the imaging arm and 12% (n=7) fulfilled the clinical arm of ASAS classification criteria for axSpA, 3% (n=2) patients fulfilled ASAS classification criteria for peripheral SpA. Two patients lacking back pain developed hsBME on SIJ. The diagnosis of axSpA according to the ASAS modified Berlin algorithm was confirmed in 42% (n=27) patients. Analysis of clinical characteristics showed significant difference between BASDAI in SpA vs. non-SpA (1.6±1.5 vs 0.8±1.0, p=0.007, respectively), and remained significant in those fulfilling imaging arm of axial SpA (p=0.04). The levels of CRP were significantly higher in SpA compared to non-SpA subsets (8.6±9.7 vs 2.6±2.7 mg/L, p=0.003). Presence of back pain and inflammatory back pain were more often in SpA compared to non-SpA subsets (97% and 43% vs. 51% and 3%, p=0.001 and p=0.001 respectively). Patients with hsBME had significantly higher serum CRP levels compared to patients lacking hsBME (9.0±10.4 vs 3.3±4.2 mg/L, p=0.005), no other significant differences were observed. <h3>Conclusion</h3> More than one third of patients with AU fulfilled the criteria for axial or peripheral SpA. Furthermore, the prevalence of back pain, increased BASDAI and serum CRP levels was significantly higher in AU patients with SpA compared to non-SpA subjects and HC. Inflammatory back pain was significantly more often in patients with AU classified as axSpA. Patients with hsBME had significantly higher serum CRP levels compared to the rest of the patients. <h3>Acknowledgement</h3> Supported by MH CR 023728, SVV 260373, AZV - 17-33127A <h3>Disclosure of Interests</h3> Kristýna Bubová: None declared, Monika Gregová: None declared, Kateřina Zegzulková: None declared, Karel Pavelka: None declared, Jarmila Heissigerová: None declared, Ladislav Šenolt Grant/research support from: AbbVie, Consultant for: AbbVie, Bristol-Myers Squibb, Celgene Corporation, Merck Sharp and Dohme, Novartis, Pfizer, Roche, UCB, Amgen, Takeda, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Merck Sharp and Dohme, Novartis, Pfizer, Roche, UCB