Morphological characteristics of sacroiliac joint MRI lesions in axial spondyloarthritis and control subjects.

Objectives To investigate sacroiliac joint(SIJ) MRI inflammation, structural and degenerative lesion characteristics in patients with axial spondyloarthritis(axSpA) and various control groups. Methods Patients with axSpA(n = 41) and lumbar disc herniation(n = 25), women with(n = 46) and without(n = 14) post-partum(childbirth within 4-16 months) buttock/pelvic pain, cleaning assistants(n = 26), long-distance runners(n = 23) and healthy men(n = 29) had MRI of the SIJs prospectively performed. MRI lesions were assessed on 9 slices covering the cartilaginous compartment by two experienced readers according to the definitions of the Spondyloarthritis Research Consortium of Canada(SPARCC) SIJ inflammation and structural scores, and were evaluated according to depth and extent. Other morphological characteristics were also analysed. Results Total depth scores for bone marrow oedema(BME) and fat lesion(FAT) and total extent score for erosion were statistically significantly highest in axSpA, while scores for sclerosis were numerically highest in women with post-partum pain. Maximum BME depth > 10mm was frequently and exclusively found in axSpA and post-partum women(39% vs 14-17%) while FAT depth > 5mm was predominantly found in axSpA(76% vs 0-10%). Erosions were primarily seen in axSpA, especially when extensive(≥4 or confluent; 17% vs 0%). Capsulitis was absent in non-axSpA groups. BME and FAT in the ligamentous compartment were primarily found in axSpA(17/22% vs 0/2% in non-axSpA groups). In non-axSpA, osteophytes(axSpA vs non-axSpA: 0% vs 3-17%) and vacuum phenomenon(7% vs 30-66%) were more frequent, and the joint space was wider(mean(SD) 1.5(0.9)mm vs 2.2(0.5)mm). Conclusions FAT depth > 5mm, but not BME depth > 10mm, could almost differentiate axSpA patients from all other groups. When excluding post-partum women, BME >5mm and erosion were highly specific for axSpA.