Experimental Arthritis

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Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: Evidence of a relationship between inflammation and new bone formation

  1. Walter P. Maksymowych1,†,‡,*,
  2. Praveena Chiowchanwisawakit2,5,
  3. Tracey Clare1,
  4. Susanne J. Pedersen3,
  5. Mikkel Østergaard4,
  6. Robert G. W. Lambert1

Article first published online: 30 DEC 2008

DOI: 10.1002/art.24132

Issue

Arthritis & Rheumatism

Arthritis & Rheumatism

Volume 60, Issue 1, pages 93–102, January 2009

Additional Information

How to Cite

Maksymowych, W. P., Chiowchanwisawakit, P., Clare, T., Pedersen, S. J., Østergaard, M. and Lambert, R. G. W. (2009), Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: Evidence of a relationship between inflammation and new bone formation. Arthritis & Rheumatism, 60: 93–102. doi: 10.1002/art.24132

Author Information

  1. 1

    University of Alberta, Edmonton, Alberta, Canada

  2. 2

    University of Alberta, Edmonton, Alberta, Canada

  3. 3

    Copenhagen University Hospital at Herlev, Copenhagen, Denmark

  4. 4

    Copenhagen University Hospital at Herlev, Copenhagen, and Copenhagen University Hospital at Hvidovre, Hvidovre, Denmark

  5. 5

    Siriraj Hospital, Mahidol University, Bangkok, Thailand

  1. †

    Dr. Maksymowych is a Scientist of the Alberta Heritage Foundation for Medical Research.

  2. ‡

    Dr. Maksymowych has received consulting fees, speaking fees, and/or honoraria from Schering-Plough, Amgen/Wyeth, and Abbott (less than $10,000 each).

*Department of Medicine, University of Alberta, 562 Heritage Medical Research Building, Edmonton, Alberta T6G 2S2, Canada

Publication History

  1. Issue published online: 30 DEC 2008
  2. Article first published online: 30 DEC 2008
  3. Manuscript Accepted: 5 SEP 2008
  4. Manuscript Received: 23 MAY 2008

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Abstract

Objective

To determine whether a vertebral corner that demonstrates an active corner inflammatory lesion (CIL) on magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) is more likely to evolve into a de novo syndesmophyte visible on plain radiography than is a vertebral corner that demonstrates no active inflammation on MRI.

Methods

MRI scans and plain radiographs were obtained for 29 patients recruited into randomized placebo-controlled trials of anti–tumor necrosis factor α (anti-TNFα) therapy. MRI was conducted at baseline, 12 or 24 weeks (n = 29), and 2 years (n = 22), while radiography was conducted at baseline and 2 years. A persistent CIL was defined as a CIL that was found on all available scans. A resolved CIL was defined as having completely disappeared on either the second or third scan. A validation cohort consisted of 41 AS patients followed up prospectively. Anonymized MRIs were assessed independently by 3 readers who were blinded with regard to radiographic findings.

Results

New syndesmophytes developed significantly more frequently in vertebral corners with inflammation (20%) than in those without inflammation (5.1%) seen on baseline MRI (P ≤ 0.008 for all reader pairs). They also developed more frequently in vertebral corners where inflammation had resolved than in those where inflammation persisted after anti-TNF treatment. This was confirmed in the analysis of the prospective cohort, in which significantly more vertebral corners with inflammation (14.3%) compared with those without inflammation (2.9%) seen on baseline MRI developed new syndesmophytes (P ≤ 0.003 for all reader pairs).

Conclusion

Our findings indicate that a syndesmophyte is more likely to develop from a prior inflammatory lesion, supporting a relationship between inflammation and ankylosis.

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