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- Volume 83,Issue Suppl 1
- AB0420 PERFORMANCE OF THE 2021/2022 ASAS CRITERIA FOR DEFINING SACROILIITIS/SPONDYLITIS IN PATIENTS WITH PSORIATIC ARTHRITIS
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Psoriatic arthritis
AB0420 PERFORMANCE OF THE 2021/2022 ASAS CRITERIA FOR DEFINING SACROILIITIS/SPONDYLITIS IN PATIENTS WITH PSORIATIC ARTHRITIS
- X. Yan1,
- I. T. Cheng2,
- J. So2,
- H. So3,
- R. K. L. Lee4,
- J. F. Griffith5,
- L. S. Tam6
- 1The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong (SAR)
- 2The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong (SAR)
- 3The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong (SAR)
- 4The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, Hong Kong (SAR)
- 5The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, Hong Kong (SAR)
- 6The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong (SAR)
Abstract
Background: Unlike axial spondyloarthritis (axSpA), there are currently no classification criteria available for axial psoriatic arthritis (axPsA).1-2 MRI is better than radiography for detecting and quantifying inflammatory and structural SI joint disease and spine involvement in axSpA.3 The 2021 ASAS criteria for positive SI joint MRI have shown exemplary performance in identifying axSpA.4-5 Data regarding their performance in differentiating axial involvement in PsA patients is lacking.
Objectives: This study aimed to evaluate the performance of the 2021 Assessment of Spondyloarthritis International Society (ASAS) criteria for magnetic resonance imaging (MRI) lesions of sacroiliac joints (SIJs) and the 2022 ASAS criteria for positive spine MRI in distinguishing axial involvement in psoriatic arthritis (PsA) patients.
Methods: Sixty-seven consecutive PsA patients (66% male, age 47±12 years) meeting the CASPAR classification criteria, regardless of back pain, were included. All patients had radiography of the pelvis and spine as well as SIJ MRI while 47 (70%) of the 67 patients also had whole-spine MRI. Axial PsA (axPsA) diagnosis was based on clinical and imaging findings. Two trained readers evaluated the MRI images.
Results: AxPsA was diagnosed in 23/67 (34%) patients, with non-radiographic sacroiliitis identified in 12/23 (52%) axPsA patients. The 2021 ASAS criteria for active sacroiliitis demonstrated relatively low sensitivity (52.2%) though high (97.7%) specificity in distinguishing patients with and without axPsA. When structural lesions of the SIJs were included as well as active lesions, sensitivity significantly improved (95.7% vs. 52.2%), with a modest decrease in specificity (84.1% vs. 97.7%). Incorporating spinal lesions alongside SIJ lesions did not change sensitivity or specificity compared to assessing only the SIJ.
Conclusion: The 2021 ASAS criteria for active and structural lesions in the SIJs demonstrated satisfactory performance in discriminating axial involvement in PsA patients. The addition of spinal MRI alongside SIJ lesions did not provide additional value in this cohort of PsA patients.
REFERENCES: [1] Diaz P, et al. RMD Open. 2022 Jan; 8(1).
[2] Giovannini I, et al. J Clin Med. 2021 Jun 27; 10(13).
[3] Maksymowych WP, et al. Ann Rheum Dis. 2019 Nov; 78(11):1550-1558.
[4] Maksymowych WP, et al. Rheumatology (Oxford). 2021 Oct 2; 60(10):4778-4789.
[5] Baraliakos X, et al. Ann Rheum Dis. 2022 May 24.
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Figure 1.
A-B. Performance of 2021 ASAS criteria for positive MRI in discriminating axPsA (n=67). (A) Active lesions on MRI by 2021 ASAS criteria; (B) Active ± structural SIJ lesions on MRI by 2021 ASAS criteria. Figure. B vs. A: including structural lesions of SIJ, in addition to active lesions of SIJ, leads to a marked increase in sensitivity with a modest decrease in specificity. AxPsA, axial psoriatic arthritis; SE, sensitivity; SP, specificity; LR+, positive likelihood ratio; LR-, negative likelihood ratio.
Figure 1C-F. Performance of 2021/2022 ASAS criteria for positive MRI in discriminating axPsA in subgroup with spine MRI (n=47). (C) Active SIJ lesions on MRI by 2021 ASAS criteria; (D) Active ± structural SIJ lesions on MRI by 2021 ASAS criteria; (E) Active sacroiliitis ± spondylitis by 2021/2022 ASAS criteria; (F) (Active ± structural) SIJ lesions ± (active ± structural) spinal lesions by 2021/2022 ASAS criteria. Figure. D vs. C: including structural lesions of SIJ, in addition to active lesions of SIJ, leads to a marked increase in sensitivity with a modest decrease in specificity. Figure. F vs. D: no significant change in sensitivity or specificity occurred with adding spine MRI to SIJ MRI. AxPsA, axial psoriatic arthritis; SE, sensitivity; SP, specificity; LR+, positive likelihood ratio; LR-, negative likelihood ratio.
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Acknowledgements: NIL.
Disclosure of Interests: None declared.
- Imaging
- Validation
- Diagnostic test
- Clinical Trial
- Magnetic Resonance Imaging
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- Imaging
- Validation
- Diagnostic test
- Clinical Trial
- Magnetic Resonance Imaging
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