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

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 w...

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Autores: Navarro-Compán, Victoria, Miguel Mendieta, Eugenio de, van der Heijde, Désirée, Landewé, Robert, Almodóvar, Raquel, Montilla, Carlos, Beltrán, Emma, Zarco, Pedro
Tipo de recurso: artículo
Fecha de publicación:2015
País:España
Institución:Universidad Autónoma de Madrid
Repositorio:Biblos-e Archivo. Repositorio Institucional de la UAM
Idioma:inglés
OAI Identifier:oai:repositorio.uam.es:10486/672354
Acceso en línea:http://hdl.handle.net/10486/672354
https://dx.doi.org/10.1186/s13075-015-0779-y
Access Level:acceso abierto
Palabra clave:Spondyloarthritis
Sacroiliitis
HLA-B27
MRI-SI increases
Medicina
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spelling 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 CohortNavarro-Compán, VictoriaMiguel Mendieta, Eugenio devan der Heijde, DésiréeLandewé, RobertAlmodóvar, RaquelMontilla, CarlosBeltrán, EmmaZarco, PedroSpondyloarthritisSacroiliitisHLA-B27MRI-SI increasesMedicinaIntroduction: 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 significantlyVNC 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).BioMed CentralDepartamento de MedicinaFacultad de MedicinaInstituto de Investigación Sanitaria del Hospital Universitario de La Paz (IdiPAZ)20152015-09-23research articlehttp://purl.org/coar/resource_type/c_2df8fbb1VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10486/672354https://dx.doi.org/10.1186/s13075-015-0779-yreponame:Biblos-e Archivo. Repositorio Institucional de la UAMinstname:Universidad Autónoma de MadridInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:repositorio.uam.es:10486/6723542026-06-23T12:46:27Z
dc.title.none.fl_str_mv 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
title 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
spellingShingle 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
Navarro-Compán, Victoria
Spondyloarthritis
Sacroiliitis
HLA-B27
MRI-SI increases
Medicina
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
dc.creator.none.fl_str_mv Navarro-Compán, Victoria
Miguel Mendieta, Eugenio de
van der Heijde, Désirée
Landewé, Robert
Almodóvar, Raquel
Montilla, Carlos
Beltrán, Emma
Zarco, Pedro
author Navarro-Compán, Victoria
author_facet Navarro-Compán, Victoria
Miguel Mendieta, Eugenio de
van der Heijde, Désirée
Landewé, Robert
Almodóvar, Raquel
Montilla, Carlos
Beltrán, Emma
Zarco, Pedro
author_role author
author2 Miguel Mendieta, Eugenio de
van der Heijde, Désirée
Landewé, Robert
Almodóvar, Raquel
Montilla, Carlos
Beltrán, Emma
Zarco, Pedro
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Departamento de Medicina
Facultad de Medicina
Instituto de Investigación Sanitaria del Hospital Universitario de La Paz (IdiPAZ)
dc.subject.none.fl_str_mv Spondyloarthritis
Sacroiliitis
HLA-B27
MRI-SI increases
Medicina
topic Spondyloarthritis
Sacroiliitis
HLA-B27
MRI-SI increases
Medicina
description 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
publishDate 2015
dc.date.none.fl_str_mv 2015
2015-09-23
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/10486/672354
https://dx.doi.org/10.1186/s13075-015-0779-y
url http://hdl.handle.net/10486/672354
https://dx.doi.org/10.1186/s13075-015-0779-y
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
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eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv reponame:Biblos-e Archivo. Repositorio Institucional de la UAM
instname:Universidad Autónoma de Madrid
instname_str Universidad Autónoma de Madrid
reponame_str Biblos-e Archivo. Repositorio Institucional de la UAM
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