Peripheral Enthesitis Assessed by Whole-body MRI in Axial Spondyloarthritis: Distribution and Diagnostic Value

Overview

Journal Front Immunol

Specialty Allergy & Immunology

Date 2022 Sep 9

PMID 36081521

Authors

Zikang Guo

Boya Li

Yimeng Zhang

Chunyu Kong

Yang Liu

Jin Qu

Ying Zhan

Zhiwei Shen

Xinwei Lei

Affiliations

Soon will be listed here.

Abstract

Objective: To determine the distribution and diagnostic value of peripheral enthesitis detected by whole-body MRI (WBMRI) in axial spondyloarthritis (axSpA) diagnosis, and to determine the value of the peripheral enthesitis score in axSpA assessment.

Methods: Sixty axSpA patients [mean age of 33.2 (24.8-40.6) years] and 50 controls with chronic low back pain (LBP) [mean age of 34.7 (28.3-41.1) years] were enrolled. The gold standard was physician's comprehensive diagnosis based on current classification criteria and physical examination. All subjects underwent WBMRI, and 47 peripheral entheses were assessed for each patient with scores of 0-188.

Results: WBMRI identified 155 enthesitis sites in 78.3% (n = 47) patients with axSpA. Meanwhile, 23 enthesitis sites were identified in 32% (n = 16) controls. The pelvis had the maximum number of enthesitis sites (52, 33.5%) in axSpA patients. Pelvic and anterior chest wall enthesitis had the highest sensitivity (51.67%) and specificity (100%) in axSpA diagnosis, respectively. There were different manifestations of enthesitis subtypes between axSpA patients and the control group. Osteitis was more present than soft-tissue inflammation in axSpA patients. The AUC for the number of enthesitis sites was 0.819 (95% CI 0.739-0.899), and that for the enthesitis score was 0.833 (95% CI 0.755-0.910), indicating statistically significant differences (P = 0.025). Based on the Youden index and clinical need, three enthesitis sites (sensitivity of 53.33, specificity of 98, and Youden index of 0.51) and enthesitis score (sensitivity of 58.33, specificity of 98, and Youden index of 0.56) may have the greatest value for axSpA diagnosis.

Conclusion: The distribution of peripheral enthesitis can be adequately assessed by whole-body MRI, which could help diagnose axial spondyloarthritis. The enthesitis score may provide a more accurate assessment and diagnostic tool in axSpA compared with enthesitis site counting.

Citing Articles

Radiographic entheseal lesions of the pelvic region are more prevalent in radiographic axSpA than in age- and sex-matched controls and are associated with more severe spinal disease.

Wink F, Diemel T, Arends S, Spoorenberg A Clin Rheumatol. 2025; 44(3):1141-1150.

PMID: 39885099 PMC: 11865150. DOI: 10.1007/s10067-025-07345-8.

Identifying enthesitis in the sacroiliac joints in patients with axial spondyloarthritis by readers of varying experience: impact of the learning progress.

Liu D, Zhao J, Lin C, Liu B, Li J, Zhang Y BMC Rheumatol. 2024; 8(1):36.

PMID: 39164762 PMC: 11337647. DOI: 10.1186/s41927-024-00397-4.

References

Jans L, van Langenhove C, Van Praet L, Carron P, Elewaut D, Van den Bosch F . Diagnostic value of pelvic enthesitis on MRI of the sacroiliac joints in spondyloarthritis. Eur Radiol. 2013; 24(4):866-71. DOI: 10.1007/s00330-013-3074-9. View

Zhao S, Pittam B, Harrison N, Ahmed A, Goodson N, Hughes D . Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2021; 60(4):1620-1628. DOI: 10.1093/rheumatology/keaa807. View

Aggarwal R, Malaviya A . Diagnosis delay in patients with ankylosing spondylitis: factors and outcomes--an Indian perspective. Clin Rheumatol. 2008; 28(3):327-31. DOI: 10.1007/s10067-008-1049-z. View

Ez-Zaitouni Z, Bakker P, van Lunteren M, de Hooge M, van den Berg R, Reijnierse M . The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts. Ann Rheum Dis. 2017; 76(10):1731-1736. DOI: 10.1136/annrheumdis-2017-211486. View

Ball J . Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis. 1971; 30(3):213-23. PMC: 1005760. DOI: 10.1136/ard.30.3.213. View

Naqvi J, Abdulla O, Shamshuddin S, Bukhari M, Proctor R . Do we need to perform MRI of the whole spine in addition to MRI of the sacroiliac joints in suspected spondyloarthropathy?. Clin Radiol. 2019; 74(5):409.e1-409.e6. DOI: 10.1016/j.crad.2019.01.008. View

Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J . The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009; 68(6):777-83. DOI: 10.1136/ard.2009.108233. View

Eshed I, Bollow M, McGonagle D, Tan A, Althoff C, Asbach P . MRI of enthesitis of the appendicular skeleton in spondyloarthritis. Ann Rheum Dis. 2007; 66(12):1553-9. PMC: 2095313. DOI: 10.1136/ard.2007.070243. View

de Winter J, de Hooge M, van de Sande M, de Jong H, van Hoeven L, de Koning A . Magnetic Resonance Imaging of the Sacroiliac Joints Indicating Sacroiliitis According to the Assessment of SpondyloArthritis international Society Definition in Healthy Individuals, Runners, and Women With Postpartum Back Pain. Arthritis Rheumatol. 2018; 70(7):1042-1048. PMC: 6032910. DOI: 10.1002/art.40475. View

10.

De Miguel E, Cobo T, Munoz-Fernandez S, Naredo E, Uson J, Acebes J . Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. 2008; 68(2):169-74. DOI: 10.1136/ard.2007.084251. View

11.

Mathew A, Ostergaard M . Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis-Status and Recent Advances. Front Med (Lausanne). 2020; 7:296. PMC: 7338655. DOI: 10.3389/fmed.2020.00296. View

12.

Krabbe S, Eshed I, Gandjbakhch F, Pedersen S, Bird P, Mathew A . Development and Validation of an OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses in Inflammatory Arthritis (MRI-WIPE). J Rheumatol. 2019; 46(9):1215-1221. DOI: 10.3899/jrheum.181084. View

13.

Poggenborg R, Pedersen S, Eshed I, Sorensen I, Moller J, Madsen O . Head-to-toe whole-body MRI in psoriatic arthritis, axial spondyloarthritis and healthy subjects: first steps towards global inflammation and damage scores of peripheral and axial joints. Rheumatology (Oxford). 2014; 54(6):1039-49. DOI: 10.1093/rheumatology/keu439. View

14.

Lukas C, Landewe R, Sieper J, Dougados M, Davis J, Braun J . Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2008; 68(1):18-24. DOI: 10.1136/ard.2008.094870. View

15.

Yasser R, Yasser E, Hanan D, Nashwa E, Rasker J . Enthesitis in seronegative spondyloarthropathies with special attention to the knee joint by MRI: a step forward toward understanding disease pathogenesis. Clin Rheumatol. 2011; 30(3):313-22. DOI: 10.1007/s10067-010-1655-4. View

16.

Weckbach S, Schewe S, Michaely H, Steffinger D, Reiser M, Glaser C . Whole-body MR imaging in psoriatic arthritis: additional value for therapeutic decision making. Eur J Radiol. 2009; 77(1):149-55. DOI: 10.1016/j.ejrad.2009.06.020. View

17.

Redmond J, Chen A, Domb B . Greater Trochanteric Pain Syndrome. J Am Acad Orthop Surg. 2016; 24(4):231-40. DOI: 10.5435/JAAOS-D-14-00406. View

18.

Althoff C, Sieper J, Song I, Weiss A, Diekhoff T, Haibel H . Comparison of Clinical Examination versus Whole-body Magnetic Resonance Imaging of Enthesitis in Patients with Early Axial Spondyloarthritis during 3 Years of Continuous Etanercept Treatment. J Rheumatol. 2016; 43(3):618-24. DOI: 10.3899/jrheum.150659. View

19.

van der Linden S, VALKENBURG H, Cats A . Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984; 27(4):361-8. DOI: 10.1002/art.1780270401. View

20.

Poulain C, DAgostino M, Thibault S, Daures J, Ferkal S, Le Corvoisier P . Can power Doppler ultrasound of the entheses help in classifying recent axial spondyloarthritis? Data from the DESIR cohort. RMD Open. 2018; 4(2):e000686. PMC: 6112385. DOI: 10.1136/rmdopen-2018-000686. View