MRI lesions match site of recent-onset inflammatory back pain

By Andrew Czyzewski, medwireNews Reporter

Patients with recent inflammatory back pain (IBP) who undergo examination with magnetic resonance imaging (MRI) typically show inflammation at the site of their pain, a study confirms.

The Assessment of SpondyloArthritis international Society recently included MRI inflammation of the sacroiliac joint (SIJ) among the classification criteria for axial spondyloarthritis, which is often preceded by IBP.

"The greater probability of finding MRI inflammation at the site of pain indicates a need for obtaining details on the pain site from the patient and on paying particular attention to that site when reading the MRI scans," say study co-author Pascal Claudepierre (Hôpital Henri Mondor, Paris, France) and colleagues.

The researchers conducted a cross-sectional study of 648 patients with recent IBP from DESIR - a French prospective longitudinal cohort of adults aged 18-50 years from 25 regional centres. The researchers found that the average duration of axial symptoms was 1.6 years and that past and/or current pain was located at the thoracic spine in 61% of patients, lumbar spine in 91%, and buttock(s) in 79%.

Baseline radiographs of the SIJs were abnormal in 173 (26.7%) patients, while MRI showed at least one inflammatory lesion in 357 (55%) patients.

More specifically, MRI inflammation was found at the thoracic spine in 125 (19%) patients, lumbar spine in 140 (21%) patients, and SIJ(s) in 303 (46%) patients.

Past or current pain in the thoracic spine was associated with thoracic MRI inflammation (odds ratio [OR]=1.71), past or current lumbar pain was associated with lumbar MRI inflammation (OR=2.53), and past or current buttock pain was associated with SIJ MRI inflammation (OR=2.86).

By contrast, MRI inflammation at one site was not associated with past or current pain at any other site.

Notably MRI inflammation of the SIJ(s) was found in about 34% of the patients with normal SIJ radiographs.

"This greater sensitivity of MRI compared to radiography can decrease the time to diagnosis in patients with recent IBP," Claudepierre et al comment in the Annals of the Rheumatic Diseases.

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