Facet Joint Involvement in Early MRI Positive Axial Spondyloarthritis

Abstract

Background The disease course of non-radiographic axial spondyloarthritis (nr-axSpA), usually detected by magnetic resonance imaging (MRI), is often unclear at the time of diagnosis. We investigated which MRI findings in the sacroiliac joints (SIJs) and lumbar spine including the facet joints can be observed over a two-year period in patients with newly diagnosed active inflammatory lesions in the SIJs fufilling the Assessment of SpondyloArthritis International Society criteria (ASAS) for Axial Spondyloarthritis (axSpA).

Methods Patients (n=56, age<45 years, 30 female and 26 male, symptom duration 3–30 months) consecutively diagnosed with unilateral or bilateral sacroiliitis through MRI during an 18-month period and meeting the ASAS criteria for axial SpA were followed up for two years. Clinical examination, laboratory tests and an MRI of the sacroiliac joints (SIJs), lumbar spine and facet joints were performed at diagnosis (t0), after one year (t1) and after two years (t2).

Results At t0, 31 patients (55%) with a bone marrow edema (BME) in the SIJs already had detectable changes in the facet joints, including signs of inflammation or degenerative changes. At t2, patients with facet joint involvement in t0 not only had more significant changes in the SIJs but also significantly more changes in the vertebral bodies, including BME, fat lesions and vertebral body erosions than patients without changes in the facet joints at t0. All vertebral changes described might be potential indicators of progression to radiographic axSpA (r-axSpA). These MRI findings are seen more frequently over a short period of time than previously thought.

Conclusions MRI progression in the SIJs over a two-year period is associated with increasing damage to the facet joints and vertebral bodies. Involvement of the facet joints in the early stages of the disease may indicate increasing changes in the vertebral bodies and thus a less favourable course of axSpA.

Key words

facetjoints - non-radiographic spondyloarthritis - axial spondyloarthritis - magnetic resonance imaging

Schlüsselwörter

Facettengelenke - nicht-radiographische Spondyloarthritis - Magnetresonanztomographie - axiale Spondyloarthritis

Publication History

Article published online:
21 December 2022

• References

• 1 Redeker I, Callhoff J, Hoffmann F. et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford) 2019; 1634-1638
• 2 Rudwaleit M, van der Heijde D. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777-783
• 3 Sieper J, Baraliakos X, Listing J. et al. Persistent reduction of spinal inflammation as assessed by magnetic resonance imaging in patients with ankylosing spondylitis after 2 yrs of treatment with the anti-tumour necrosis factor agent infliximab. Rheumatology (Oxford) 2005; 44: 1525-1530
• 4 Deodhar A, Strand V, Kay J. et al. The term ‘non-radiographic axial spondyloarthritis’ is much more important to classify than to diagnose patients with axial spondyloarthritis. Ann Rheum Dis 2016; 75: 791-794
• 5 Protopopov M, Poddubnyy D. Radiographic progression in non-radiographic axial spondyloarthritis. Expert Rev Clin Immunol 2018; 14: 525-533
• 6 Yu T, Zhang J, Zhu W. et al. Chondrogenesis mediates progression of ankylosing spondylitis through heterotopic ossification. Bone Res 2021; 9-19
• 7 Poddubnyy D, Rudwaleit M, Haibel H. et al. Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis 2012; 71: 1616-1622
• 8 Wang R, Gabriel SE, Ward MM. Progression of Nonradiographic Axial Spondyloarthritis to Ankylosing Spondylitis: A Population-Based Cohort Study. Arthritis Rheumatol 2016; 68: 21
• 9 Heijde DV, Østergaard M, Reveille JD. et al. Spinal Radiographic Progression and Predictors of Progression in Patients With Radiographic Axial Spondyloarthritis Receiving Ixekizumab Over 2 Years. J Rheumatol 2022; 49: 265-273
• 10 Faure M, Huyskens J, Van Goethem JWM. et al. Medical imaging of the lumbar facet joint. In van de Kelft E, (eds) Surgery of the Spine and Spinal Cord. Springer; Cham:
• 11 Di Meglio N, Gentili F, Guerrini S. et al. POS1005 Active Inflammatory Lesions Of The Spine In Sacroiliacal Joints MRI (SIJs-MRI): An Overlooked Finding By Radiologists. Annals of the Rheumatic Diseases 2022; 81: 810-811
• 12 de Winter J, de Hooge M, van de Sande M. et al. 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: 1042-1048
• 13 Carmona L, Sellas A, Rodríguez-Lozano C. et al. Scoring with the Berlin MRI method for assessment of spinal inflammatory activity in patients with ankylosing spondylitis: a calibration exercise among rheumatologists. Clin Exp Rheumatol. 2013-31:883;8
• 14 Arnbak B, Grethe Jurik A, Hørslev-Petersen K. et al. Associations Between Spondyloarthritis features and magnetic resonance imaging findings: a cross-sectional analysis of 1,020 patients with persistent low back pain. Arthritis Rheumatol 2016; 68: 892-900
• 15 Deodhar A. Sacroiliac joint magnetic resonance imaging in the diagnosis of axial spondyloarthritis: “A tiny bit of white on two consecutive slices” may be objective, but not specific. Arthritis Rheumatol 2016; 68: 775-778
• 16 Weishaupt D, Zanetti M, Boos N. et al. MR Imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 1999; 28: 215-219
• 17 Anaya JEC, Coelho SRN, Taneja AK. et al. Differential Diagnosis of Facet Joint Disorders. Radiographics. 2021; 41: 543-558
• 18 O’Leary SA, Paschos NK, Link JM. et al. Facet Joints of the Spine: Structure-Function Relationships, Problems and Treatments, and the Potential for Regeneration. Annu Rev Biomed Eng 2018; 20: 145-170 5/2022/2486745. PMID: 35242295; PMCID: PMC8888088.
• 19 Eubanks JD, Lee MJ, Cassinelli E. et al. Prevalence of lumbar facet arthrosis and its relationship to age, sex, and race: an anatomic study of cadaveric specimens. Spine 2007; 32: 2058-2062 PMID: 17762805
• 20 Zheng Z, Wang Y, Wang T. et al. A Systematic Review and Meta-Analysis of the Facet Joint Orientation and Its Effect on the Lumbar. J Healthc Eng 2022; 2022: 2486745 10.115
• 21 Czervionke LF, Fenton DS. Fat-saturated MR imaging in the detection of inflammatory facet arthropathy (facet synovitis) in the lumbar spine. Pain Med 2008; 9: 6
• 22 Lee S, Lee JY, Hwang JH. et al. Clinical importance of inflammatory facet joints of the spine in ankylosing spondylitis: a magnetic resonance imaging study. Scand J Rheumatol 2016; 45: 491-498
• 23 Chiowchanwisawakit P, Lambert RG, Conner-Spady B. et al. Focal fat lesions at vertebral corners on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis. Arthritis Rheum 2011; 63: 2215-2225
• 24 Poddubnyy D, Protopopov M, Haibel H. et al. High disease activity according to the ankylosing spondylitis Disease Activity Score is associated with accelerated radiographic spinal progression in patients with early axial spondyloarthritis: results from the German spondyloarthritis Inception Cohort. Ann Rheum Dis 2016; 75: 2114-2118
• 25 Tan S, Yao J, Flynn JA. et al. Zygapophyseal joint fusion in ankylosing spondylitis assessed by computed tomography: associations with syndesmophytes and spinal motion. J Rheumatol 2017; 44: 1004-1010
• 26 Ball J. Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis 1971; 30: 213-223
• 27 Geiler G. [Spondylarthritis ankylopoietica from the viewpoint of pathologic anatomy]. [article in German]. Dtsch Med Wochenschr 1969; 94: 1185-1188
• 28 Maksymowych WP, Wichuk S, Chiowchanwisawakit P. et al. Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis. Arthritis Rheumatol 2014; 66: 2958-2967
• 29 Song IH, Hermann KG, Haibel H. et al. Relationship between active inflammatory lesions in the spine and sacroiliac joints and new development of chronic lesions on whole-body MRI in early axial spondyloarthritis: results of the ESTHER trial at week 48. Ann Rheum Dis 2011; 70: 1257-1263
• 30 Karmacharya P, Duarte-Garcia A, Dubreuil M. et al. Effect of Therapy on Radiographic Progression in Axial Spondyloarthritis: A Systematic Review and Meta-Analysis. Arthritis Rheumatol 2020; 72: 733-749
• 31 Tseng HW, Glant TT, Brown MA. et al. Early anti-inflammatory intervention ameliorates axial disease in the proteoglycan-induced spondylitis mouse model of ankylosing spondylitis. BMC Musculoskelet Disord 2017; 18-228
• 32 Friedrich KM, Nemec S, Peloschek P. et al. The prevalence of lumbar facet joint edema in patients with low back pain. Skeletal Radiol 2007; 36: 755-760
• 33 Madani A, Katz R, Muylem AV. et al. Prevalence and frequency of subchondral bone marrow edema in the lumbar facet joints of asymptomatic and symptomatic individuals. Skeletal Radiol 2020; 49: 1141-1147
• 34 Proft F, Spiller L, Redeker I. et al. Comparison of an online self-referral tool with a physician-based referral strategy for early recognition of patients with a high probability of axial spa. Semin Arthritis Rheum 2020; 50: 1015-1021