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Special Theme Article: Clinical Imaging and the Rheumatic Diseases
Inflammatory Changes of the Lumbar Spine in Children and Adolescents With Enthesitis-Related Arthritis: Magnetic Resonance Imaging Findings†
Article first published online: 24 DEC 2013
© 2014 The Authors. Arthritis Care & Research is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Arthritis Care & Research
Volume 66, Issue 1, pages 40–46, January 2014
How to Cite
Vendhan, K., Sen, D., Fisher, C., Ioannou, Y. and Hall-Craggs, M. A. (2014), Inflammatory Changes of the Lumbar Spine in Children and Adolescents With Enthesitis-Related Arthritis: Magnetic Resonance Imaging Findings. Arthritis Care Res, 66: 40–46. doi: 10.1002/acr.22201
- Issue published online: 24 DEC 2013
- Article first published online: 24 DEC 2013
- Accepted manuscript online: 14 OCT 2013 11:31AM EST
- Manuscript Accepted: 4 OCT 2013
- Manuscript Received: 20 MAR 2013
- Department of Health's NIHR Biomedical Research Centre funding scheme
- Arthritis Research UK. Grant Number: 20164
To describe and profile abnormalities of the lumbar spine in a cohort of patients with enthesitis-related arthritis (ERA) as compared to a control group of adolescents with mechanical back pain.
We performed a retrospective review of magnetic resonance imaging (MRI) lumbar spine scans of 79 patients (58 cases, 21 controls). The study was covered by institutional review board approval and informed consent was obtained for review of all clinical investigations. Images were reviewed by an expert MRI reader who was blinded to clinical details. The presence or absence of morphologic features of enthesitis, apophyseal joint synovitis, and inflammation of posterior elements was assessed at each lumbar vertebral level. The apophyseal joint inflammation was graded from 0 to 3 using a grading system that was adapted from one used in adults with inflammatory facet osteoarthropathy. STATA software was used for data analysis.
One or more abnormalities of the lumbar spine were found in 39 (67%) of 58 cases and sacroiliitis was present in 45 (78%) of the cases. Apophyseal joint synovitis was seen in 22 (38%) cases and in 1 (5%) control patient. This difference was highly significant (P = 0.004). Inflammatory changes in the interspinous ligaments were seen in a higher percentage of cases than controls and this observation was of statistical significance (P = 0.04).
Statistically significant inflammation of the lumbar apophyseal joints and interspinous ligaments was seen in our cohort of ERA patients, most of whom have concurrent sacroiliitis. This could be contributing to back pain in these patients.