Prevalence of degenerative changes of the spine on magnetic resonance images and radiographs in patients aged 16-45 years with chronic back pain of short duration in the Spondyloarthritis Caught Early (SPACE) cohort.
OBJECTIVE
To determine the prevalence of degenerative changes (DCs) in the spine of young patients with back pain without axial spondyloarthritis (no-axSpA), with possible axSpA (poss-axSpA) and with definite axSpA (axSpA), as shown on MRI and radiographs.


METHODS
Whole-spine MRI and cervical and lumbar radiography were performed in patients ≥16 years of age with chronic back pain (≥3 months, ≤2 years, onset <45 years) and potential axSpA (Spondyloarthritis Caught Early cohort). Patients were classified as no-axSpA, poss-axSpA [not fulfilling the Assessment of Spondyloarthritis International Society (ASAS) axSpA criteria] or axSpA (fulfilling ASAS axSpA criteria). Images (MRI and X-rays) were evaluated on the presence of DCs by two independent readers, blinded to clinical and laboratory information as well as to the results of the other imaging modality. In cases of disagreement, a third reader served as adjudicator. A Chi-square test was used to analyse differences between patient groups according to various selected cut-off points (1-3) of individual DCs.


RESULTS
Of 274 patients (38% male, mean age: 29 years), 25 (9%) were classified as no-axSpA, 134 (48.9%) as poss-axSpA and 115 (42.0%) as axSpA. Two hundred and forty-five (89%) patients had DCs on MRI [21/25 (84%) no-axSpA, 121/134 (90%) poss-axSpA, 103/115 (90%) axSpA, P = 0.792], range 1-29 (median 5.5), and 121 (44%) patients had DCs on radiographs [13/25 (52%) no-axSpA, 62/134 (46%) poss-axSpA, 48/115 (42%) axSpA, P = 0.261], range 1-11 (median 2). Prevalence of DCs was similar between patient groups. DCs were predominantly found in the lumbar spine.


CONCLUSIONS
Prevalence of DCs was high in this cohort of young patients with short-term chronic back pain, in accordance with the literature. Prevalence of DCs in no-axSpA patients, poss-axSpA patients and axSpA patients was found to be similar.
Department of Radiology, f.de_bruin@lumc.nl.
Freek
F
de Bruin
Department of Radiology.
Simone
S
ter Horst
Department of Radiology.
Hans L
HL
Bloem
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Rosaline
R
van den Berg
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Manouk
M
de Hooge
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Floris
F
van Gaalen
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Karen M
KM
Fagerli
Department of Rheumatology, Amsterdam Medical Center, Amsterdam and.
Robert
R
Landewé
Department of Rheumatology, Groene Hartziekenhuis, Gouda, The Netherlands.
Maikel
M
van Oosterhout
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Désirée
D
van der Heijde
Department of Radiology.
Monique
M
Reijnierse
D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011859:Radiography; D025241:Spondylarthritis / Q000150:complications* / Q000175:diagnosis; D013997:Time Factors; D055815:Young Adult
MRI; axial spondyloarthritis; degenerative changes; radiograph; short-term chronic back pain; whole spine; young population