Prognostic value of the clinical and imaging arm of the ASAS criteria for progression of structural sacroiliac joint lesions

Objective To investigate the prognostic value of the two arms of the Assessment of SpondyloArthritis international Society (ASAS) criteria regarding the progression of structural lesions in the sacroiliac joints (SIJs). Methods Information on baseline fulfilment of the ASAS criteria and baseline and follow-up magnetic resonance imaging of the SIJ in 603 patients aged 18-40 years referred with low back pain to an outpatient spine were collected. Magnetic resonance imaging positivity was defined as bone marrow oedema (BMO) in two or more consecutive slices or two or more lesions in one slice, as described in the ASAS definition of sacroiliitis. Results Of 71 participants fulfilling the ASAS criteria at baseline, 66 (93%) fulfilled the 'imaging arm' and 14 (20%) fulfilled the 'clinical arm'. The 'clinical arm' predicted the progression of erosions with an odds ratio of 55 (compared with not fulfilling the ASAS criteria), while the 'imaging arm' predicted the progression of erosions with an odds ratio of 8. Moreover, in 24% of the patients in the 'imaging arm', all having BMO at the SIJ at baseline, the BMO disappeared without neither erosions nor ankylosis emerging. Conclusion We found that the 'clinical arm' was a strong predictor for the progression of SIJ erosion, while the 'imaging arm' had a more modest prognostic value for structural progression.