title: Is the Site of Back Pain Related to the Location of Magnetic Resonance Imaging Lesions in Patients With Chronic Back Pain? Results From the Spondyloarthritis Caught Early Cohort.
abstract: To determine associations between magnetic resonance imaging (MRI) lesions originating from either axial spondyloarthritis (SpA) or from degeneration and pain in patients with chronic back pain of <2 years duration.
  
  
  
  Patients from the Spondyloarthritis Caught Early (SPACE) cohort identified the sites of pain (thoracic, lumbar, buttock). The average MRI scores from 2 readers for axial SpA lesions and from 2 different readers for degenerative lesions were used. Associations between sacroiliac (SI) joint lesions and buttock pain were investigated by logistic regression analysis, and associations between axial SpA or degenerative lesions and pain in the spine (thoracic and lumbar) were investigated using generalized estimating equations. Interactions with sex, age, HLA-B27, and fulfillment of Assessment of SpondyloArthritis international Society (ASAS) criteria were tested.
  
  
  
  In 348 patients (126 males, 127 fulfilling ASAS criteria, mean age 29.4 years), spinal MRI (and SI joint images in 342) were available. Pain was localized in the thoracic spine (35.9%), the lumbar spine (82.5%), or in the buttock(s) (57.8%). Inflammatory lesions of the SI joint (odds ratio [OR] 1.06; P = 0.04) and erosions of the SI joint in patients <25 years (OR 1.16; P = 0.04) were associated with buttock pain. Axial SpA spinal lesions were not associated with pain. Modic type 1 lesions in patients >35 years (OR 5.19; P = 0.001), high-intensity zone lesions in females not fulfilling ASAS criteria (OR 5.09; P = 0.001), and herniation in various subgroups (OR range 2.07-4.66) were associated with pain.
  
  
  
  Specific degenerative lesions, but not typical axial SpA lesions, of the spine are associated with pain at the same location in some subgroups. Inflammatory lesions in the SI joint are associated with buttock pain.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Manouk
authors.initials: M
authors.lastname: de Hooge
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Freek
authors.initials: F
authors.lastname: de Bruin
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Lieke
authors.initials: L
authors.lastname: de Beer
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Bakker
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rosaline
authors.initials: R
authors.lastname: van den Berg
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramiro
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Floris
authors.initials: F
authors.lastname: van Gaalen
authors.affiliation: Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Karen
authors.initials: K
authors.lastname: Fagerli
authors.affiliation: Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
authors.affiliation: Groene Hart Ziekenhuis, Gouda, The Netherlands.
authors.forename: Maikel
authors.initials: M
authors.lastname: van Oosterhout
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ramonda
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Huizinga
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Bloem
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Reijnierse
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
mesh_terms: D000328:Adult; D001416:Back Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D002081:Buttocks / Q000000981:diagnostic imaging / Q000473:pathology; D059350:Chronic Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D016017:Odds Ratio; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging / Q000473:pathology; D025241:Spondylarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology