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Background Axial spondyloarthritis (axSpA) is typically characterized by imaging (radiographs or MRI) abnormalities of the sacroiliac joints (SIJ). Also, inflammatory lesions of the SIJ have been observed in healthy women post-partum [1,2]. However, the impact of pregnancy on imaging abnormalities in women with axSpA is unknown.
Objectives The objective of this study was to evaluate impact of pregnancy on SIJ imaging in patients with early axSpA.
Methods Data of all women with early axSpA from the DESIR prospective cohort were included, with a follow-up of 5 years. Description of demographic disease characteristics, obstetric history, and SIJ imaging abnormalities (i.e. sacroiliitis on radiographs and on MRI, based on local and central reading) was performed in all women. SIJ abnormalities were compared depending on the history of past pregnancy (t-test and chi-square as appropriate). Furthermore, in nulligravidae females at baseline who presented an incident pregnancy during follow-up, SIJ abnormalities were compared before/after pregnancy, using paired-test.
Results 381 patients were included in the analysis. 142 (37%) were nulligravidae at baseline, and were younger (28 vs 39 years old) and had higher educational level (74 vs 52% university level).
Sacroiliitis on MRI and X-ray were more frequent in nulligravidae women (16.9% vs 9.9%, p = 0.05 and 33.8% vs 19.4%, p < 0.01, respectively).
Among them, 38 (10% of all patients) presented an incident pregnancy during follow-up and had an available imaging before and after pregnancy: overall no significant changes were observed with regard to both radiographic and MRI imaging abnormalities of the SIJ, except for an increase on the New York score of the left SIJ, and surprisingly, a trend towards a reduction on the proportion of MRI sacroiliitis and SPARCC score after pregnancy (table 1).
| Imaging criteria (mean (sd) or number (%)) | Before pregnancy (N = 38) | After delivery (N = 38) | Paired test (Mc Nemar or Student) |
|---|---|---|---|
| Radiographic criteria | |||
| X-ray sacroiliitis | 8 (21.1%) | 9 (23.7 %) | p = 0.37 |
| New York score on right sacroiliac joint | 0.66 (1.06) | 0.67 (0.86) | p = 1 |
| New York score on left sacroiliac joint | 0.67 (1.07) | 0.95 (0.95) | p = 0.037 |
| Any erosion in the sacroiliac joints | 9 (23.7%) | 9 (23.7%) | p = 0.48 |
| Any joint widening in the sacroiliac joints | 0 | 3 (7.9%) | NA |
| Any sclerosis in the sacroiliac joints | 6 (15.8%) | 9 (23.7%) | p = 0.13 |
| Any partial or total ankylosis in the sacroiliac joints | 1 (2.6%) | 2 (5.3%) | p = 0.48 |
| MRI criteria | |||
| Sacroiliitis on MRI | 18 (47.3%) | 2 (5.2%) | p = 0.074 |
| SPARCC score | 3.94 (7.63) | 0.39 (0.74) | p = 0.15 |
| ≥ 3 fatty lesions on MRI | 4 (10.5%) | 1 (2.6%) | p = 1 |
| ≥ 3 erosions on MRI | 1 (2.6%) | 0 | NA |
| ≥ 5 fatty lesions and/or erosions on MRI | 1 (2.6%) | 1 (2.6%) | p = 1 |
| Number of any lesions on sacroiliac joint (0 to 144) | 1.81 (3.36) | 1.8 (2.92) | p = 0.1 |
| Number of enthesitis (0 to 12) | 0 (0) | 0 (0) | NA |
| Number of erosions (0 to 40) | 0.84 (2.36) | 0.42 (0.7) | p = 1 |
| Number of fatty lesions (0 to 40) | 0.97 (2.01) | 1 (2.02) | p = 0.15 |
| Number of sclerosis (0 to 40) | 0 (0) | 0.26 (0.86) | p = 0.29 |
| Number of partial or total ankylosis (0 to 24) | 0 (0) | 0 (0) | NA |
Conclusion In an early SpA cohort, the occurrence of a first pregnancy did not seem to increase the number of imaging abnormalities of the SIJ.
References
Acknowledgements: NIL.
Disclosure of Interests None declared.
Keywords: Spondyloarthritis, Descriptive Studies, Imaging
DOI: 10.1136/annrheumdis-2023-eular.2679