Erosions on T1-Weighted Magnetic Resonance Imaging Versus Radiography of Sacroiliac Joints in Recent-Onset Axial Spondyloarthritis: 2-Year Data (EMBARK Trial and DESIR Cohort)

Walter P Maksymowych; Pascal Claudepierre; Manouk de Hooge; Robert G Lambert; Robert Landewé; Anna Molto; Désirée van der Heijde; Jack F Bukowski; Heather Jones; Ron Pedersen; Annette Szumski; Bonnie Vlahos; Maxime Dougados

doi:10.3899/jrheum.2023-0906

Erosions on T1-Weighted Magnetic Resonance Imaging Versus Radiography of Sacroiliac Joints in Recent-Onset Axial Spondyloarthritis: 2-Year Data (EMBARK Trial and DESIR Cohort)

J Rheumatol. 2024 May 1;51(5):462-471. doi: 10.3899/jrheum.2023-0906.

Authors

Affiliations

¹ W.P. Maksymowych, MD, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; walter.maksymowych@ualberta.ca.
² P. Claudepierre, MD, Department of Rheumatology, CHU Henri Mondor, Paris, France.
³ M. de Hooge, PhD, Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
⁴ R.G. Lambert, MB, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
⁵ R. Landewé, MD, Amsterdam University Medical Center, Amsterdam, and Zuyderland Medical Center, Heerlen, the Netherlands.
⁶ A. Molto, MD, Department of Rheumatology, CHU Cochin, Paris, INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne, Paris, France.
⁷ D. van der Heijde, MD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
⁸ J.F. Bukowski, MD, B. Vlahos, MBA, BSN, RN, Global Clinical Affairs, Pfizer, Collegeville, Pennsylvania, USA.
⁹ H. Jones, RN, Global Medical Affairs, Pfizer, Collegeville, Pennsylvania, USA.
¹⁰ R. Pedersen, MS, Department of Biostatistics, Pfizer, Collegeville, Pennsylvania, USA.
¹¹ A. Szumski, MA, Syneos Health, Princeton, New Jersey, USA.
¹² M. Dougados, MD, Department of Rheumatology, CHU Cochin, Paris, France.

PMID: 38359938
DOI: 10.3899/jrheum.2023-0906

Abstract

Objective: (1) To compare the capacity to detect sacroiliac joint (SIJ) erosions and baseline-to-week 104 change in erosions between magnetic resonance imaging (MRI) and radiographs in recent-onset axial spondyloarthritis (axSpA); and (2) to compare treatment-discriminatory capacities of MRI and radiographic scores for erosion detection in patients receiving etanercept in the Effect of Etanercept on Symptoms and Objective Inflammation in Nonradiographic axSpA (EMBARK) trial vs controls in the DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes) cohort.

Methods: Anonymized SIJ MRI and radiographs were assessed at patient and joint surface levels. Three readers evaluated MRI; 3 different readers evaluated radiographs. Final scores for comparison of radiographs and MRI for detection of erosions were assigned based on agreement of ≥ 2 of 3 readers' assessments.

Results: At baseline, discordance in erosion detection between imaging methods was more frequent for MRI erosions in the absence of radiographic erosions (48/224 [21.4%] patients) than for radiographic erosions in the absence of MRI erosions (14/224 [6.3%] patients; P < 0.001). After 104 weeks, a decrease in erosions was observed on MRI but not radiographs in 49/221 (22.2%) patients, and on radiographs but not MRI in 6/221 (2.7%) patients (P < 0.001). In the treatment-discriminant capacity analysis, the largest standardized differences between etanercept and control cohorts at week 104 were changes in Spondyloarthritis Research Consortium of Canada MRI erosion discrete score, changes in erosion average score, and meeting the modified New York criteria on radiographs, with unadjusted/adjusted Hedges G effect sizes of 0.40/0.50, 0.40/0.56, and 0.40/0.43, respectively.

Conclusion: In recent-onset axSpA, SIJ erosions and erosion change were observed more frequently on MRI than radiography. The significance of interval improvement of MRI erosions warrants further research. [ClinicalTrials.gov: NCT01258738, NCT01648907].

Keywords: erosions; etanercept; magnetic resonance imaging; radiograph; sacroiliac joint; spondyloarthritis.

Publication types

Research Support, Non-U.S. Gov't
Comparative Study

MeSH terms

Adult
Antirheumatic Agents / therapeutic use
Axial Spondyloarthritis* / diagnostic imaging
Axial Spondyloarthritis* / drug therapy
Etanercept* / therapeutic use
Female
Humans
Magnetic Resonance Imaging* / methods
Male
Middle Aged
Radiography*
Sacroiliac Joint* / diagnostic imaging
Sacroiliac Joint* / pathology
Severity of Illness Index
Treatment Outcome

Substances

Etanercept
Antirheumatic Agents

Associated data

ClinicalTrials.gov/NCT01258738
ClinicalTrials.gov/NCT01648907