A review of mri indications and outcomes to identify a clinical predictor for joint inflammation

Abstract Background/Aims Due to the nature of symptoms there is often a delay in diagnosing axial spondyloarthritis (AxSpA), the median delay from initial symptoms is over 8 years. A Rheumatology IBP (inflammatory back pain) service can reduce this to 3 years. MRI is highly sensitive for recognising early spine and sacroiliac joint (SIJ) changes. The objective of this project was to evaluate the value of spinal and SIJ MRI requests in a rheumatology department to try and identify a clinical predictor of MRI inflammation. Methods A retrospective review of 107 patients who underwent a spinal and SIJ MRI. An assessment of the clinical indications, MRI findings, and the management impact. Numerous parameters were assessed for each patient, including appointment type (face-to-face vs telephone), referrer grade, AxSpA ASAS criteria, CRP, HLA-B27 status, MRI result and management impact. Results 41.25% of patients who had ≥2 AxSpA features had inflammation on MRI. However, only 11.54% of patients with ≤1 AxSpA feature had inflammation on MRI. ≥2 AxSpA features was a significant predictor for MRI inflammation, with a p-value of 0.00545 and sensitivity 91.67%. Additionally, just 33% of patients had HLA-B27 status documented, providing scope for improvement when using AxSpA features as a predictor. An active BASDAI score was not found to be a predictor of MRI inflammation. Additionally, there was no statistical difference in the MRI findings following face-to-face or telephone consultations; 35.53% had inflammation on MRI compared to 32.26%, respectively. Conclusion ≥2 AxSpA features is a statistically significant predictor of active MRI inflammation. This could be used to support a new triage assessment pathway for inflammatory back pain referrals to rheumatology. Disclosure L. Barry: None. A. Roberts: None. B. Menon: None. S. Subesinghe: None.