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    Manejo clínico de pacientes com espondilite anquilosante: o papel da ressonância magnética de coluna vertebral total para a tomada de decisão
    (Universidade Federal de São Paulo (UNIFESP), 2021) Bendahan, Louise Tandaya [UNIFESP]; Pinheiro, Marcelo De Medeiros [UNIFESP]; Universidade Federal de São Paulo
    The lack of specific biomarkers to evaluate disease activity in patients with ankylosing spondylitis (AS) is a relevant challenge in clinical practice. Some conditions, including fibromyalgia, chronic spine damage and other causes of non-inflammatory back pain, need to be considered as differential diagnosis before making clinical decision, such as biological therapy, rehabilitation or global pain management. Aim: To assess the role of total spine magnetic resonance imaging (MRI) in AS patients with clinical doubt between activity or chronicity in short and in long-term. Patients and Methods: A total of 57 AS patients, according to New York criteria, were included in this 2-year prospective study. The main inclusion criterion was the clinical doubt between disease activity or not disease activity, considering standard tools, such as mechanical or inflammatory back pain, peripheral arthritis or enthesitis, extra-articular manifestations and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The patients were divided in 2 groups (A: patients with pain and low CRP and ESR serum levels; B: patients no symptoms but with high CRP and ESR serum levels). All patients performed total spine MRI, including cervical, thoracic and lumbar spine. The reading was performed by a blind radiologist, considering the SPARCC (Spondyloarthritis Research Consortium of Canada) methodology, and the rheumatologist used it to make the major clinical decision. A positive spine MRI was defined when 3 or more bone marrow edema (BME) signals were found, according to the OMERACT proposal. Results: Positive MRI was observed in 40% and 30% of group A and B, respectively. Using the global evaluation (clinical, lab and imaging information) performed by expert rheumatologist as gold-standard, the concordance between positive MRI and overall disease activity was observed in almost 70% of AS patients (r=0.36, p=0.01), especially in group A. On the other hand, higher inflammation severity and area score was more found in group B than group A (15.7±7.5 and 9.9±6.7; p=0.048; respectively). After 12 and 24 months of follow-up, all patients were re-evaluated and the most of them still remained with the same medical decision, suggesting good assertiveness of whole spine MRI over time. Conclusions: Our data showed whole spine MRI could be used as an important tool for making the diagnosis differential and more adequate clinical decision between disease activity and other non-inflammatory causes of pain in patients with AS.