Sponyloarthritis features forecasting the presence of HLA-B27 or sacroiliitis on magnetic resonance imaging in patients with suspected axial spondyloarthritis: Results from a cross-sectional study in the ESPeranza Cohort
Entity
UAM. Departamento de Medicina; Instituto de Investigación Sanitaria Hospital Universitario de La Paz (IdiPAZ)Publisher
BioMed CentralDate
2015-09-23Citation
10.1186/s13075-015-0779-y
Arthritis Research and Therapy 17.1 (2015): 265
ISSN
1478-6354 (print); 1478-6362] (online)DOI
10.1186/s13075-015-0779-yFunded by
VNC received one of the ASAS research grants on call 2013 to perform this study. The Spanish Foundation of Rheumatology received funding from Pfizer to develop the Esperanza Programme. Nowadays, the programme is supported by a restricted grant of the Institute Carlos III (FIS PI13/02034).Editor's Version
http://dx.doi.org/10.1186/s13075-015-0779-ySubjects
Spondyloarthritis; Sacroiliitis; HLA-B27; MRI-SI increases; MedicinaRights
© 2015 Navarro-Compán et al.Abstract
Introduction: Chronic back pain (CBP) is frequently the presenting symptom in patients with suspected axial
spondyloarthritis (axSpA). Presence of sacroiliitis on magnetic-resonance-imaging (MRI) or HLA-B27 adds to
diagnostic certainty. However, these costly tests cannot be applied in all patients with CBP. This study aims to
investigate which SpA features increase the likelihood of a positive HLA-B27 or positive MRI of the sacroiliac-joints
(MRI-SI) in patients with suspected axSpA.
Methods: Data from 665 patients with CBP within the ESPeranza Programme were analysed. Diagnostic utility
measures (LR+, LR−) for a positive MRI-SI or HLA-B27 were calculated for various definitions of inflammatory back
pain (IBP), their separate items and for other SpA features.
Results: Pretest probabilityies of a positive result was 41 % for MRI-SI and 40 % for HLA-B27. For a positive MRI-SI
result the most useful IBP characteristic was alternating buttock pain (LR + =2.6). Among the IBP-criteria, fulfillment
of the ‘ASAS criteria’ (LR + =2.1) was most contributory. Interestingly, the addition of alternating buttock pain to the
Calin/ASAS-IBP criteria (LR + =6.0 and 5.5, respectively) or the addition of awakening at second half of night to the
Calin-IBP criteria (LR + =5.5) increased the pre-test probability of MRI-sacroiliitis from 41 % to 79–80 %. Dactylitis
(LR + =4.1) and inflammatory bowel disease (IBD) (LR + =6.4) increased this probability to 73 % and 81 %, respectively.
To forecast HLA-B27 positivity, awakening at the second half of the night, fulfillment of the ASAS-IBP definition and
uveitis were the most useful, but only marginally predictive (LR + = 1.3, 1,6 and 2.6, respectively).
Conclusions: If patients with suspected axial SpA have either 1) IBP according to Calin/ASAS definition plus alternating
buttock pain, or 2) IBP according to Calin definition plus awakening at night, or 3) dactylitis or 4) IBD, the probability of
finding a positive MRI-SI increases significantly
Files in this item
Google Scholar:Navarro-Compán, Victoria
-
Miguel, Eugenio de
-
van der Heijde, Désirée
-
Landewé, Robert
-
Almodóvar, Raquel
-
Montilla, Carlos
-
Beltrán, Emma
-
Zarco, Pedro
This item appears in the following Collection(s)
Related items
Showing items related by title, author, creator and subject.
-
Non-inferiority of dose reduction versus standard dosing of TNF-inhibitors in axial spondyloarthritis 11 Medical and Health Sciences 1117 Public Health and Health Services 11 Medical and Health Sciences 1103 Clinical Sciences
Gratacós, Jordi; Pontes, Caridad; Juanola, Xavier; Sanz, Jesús; Torres, Ferran; Avendaño Solá, Cristina; Vallano, Antoni; Calvo, Gonzalo; De Miguel, Eugenio; Sanmartí, Raimon; Almirall, Miriam; Aparicio, Maria; Sellas, Agustí; Vives, Roser; Albiñana, Nestor; Moreno, Mireia; Clavaguera, Teresa; Torre-Alonso, Juan Carlos; Veroz, Raúl; Rodríguez-Lozano, Carlos; Linares, Luís Francisco; Urruticoechea, Ana; Collantes, Eduardo; Morlà, Rosa María; Reina, Dèlia; Cuende, Eduardo; Zarco, Pedro; Fernández-Espartero, Maria Cruz; García de Vicuña Pinedo, María del Rosario; Montilla, Carlos Alberto; Villalba, Alejandro; Pascual, Dora; Campos, Cristina; Juan, Antonio; Ariza, Rafael; Díaz-Miguel, Consuelo; Maqueda, Manuel; Fernández-Dapica, Maria Pilar; Fernández-Prada, Manuel; Batlle, Enrique; González-Fernández, Carlos; Queiro, Rubén
2019-01-08