Clinical Scorecard: Long-term Assessment of Degenerative Spinal Lesions via Radiography and MRI in Axial Spondyloarthritis: Findings from the DESIR Cohort Study

At a Glance

Key Highlights

• High prevalence of spinal degenerative lesions in axSpA patients: ~30% on radiographs and >70% on MRI at baseline in DESIR cohort
• Long-term evolution of DLs over 10 years remains poorly documented; study aims to assess occurrence and progression of DLs and associated factors
• Radiographic and MRI parameters include disc height loss, osteophytes, sclerosis, facet joint osteoarthritis, Schmorl’s nodes, spondylolisthesis, Pfirrmann disc degeneration, Modic changes, and spinal stenosis

Guideline-Based Recommendations

Diagnosis

• Use lateral cervical and lumbar radiographs and sagittal T1-weighted and STIR MRI to assess inflammatory and degenerative spinal lesions
• Apply standardized scoring systems: Pfirrmann classification for disc degeneration, Modic classification for vertebral endplate changes, and grading for spondylolisthesis
• Interpret imaging findings in context of clinical presentation to differentiate between axSpA-related lesions and degenerative changes

Management

• Consider the presence and progression of degenerative lesions when diagnosing axSpA to avoid diagnostic delay and inappropriate treatment
• Monitor structural changes including syndesmophytes and facet joint fusion that may influence spinal biomechanics and DL progression
• Tailor treatment strategies to balance inflammation control and management of degenerative spinal changes

Monitoring & Follow-up

• Perform longitudinal imaging assessments at baseline, 2, 5, and 10 years to evaluate lesion progression
• Use blinded, trained readers to ensure consistent and unbiased lesion scoring over time
• Monitor clinical symptoms alongside imaging to guide management adjustments

Risks

• Diagnostic delay of axSpA by almost 3 years due to presence of degenerative lesions
• Risk of under- or over-treatment if degenerative lesions are misinterpreted as inflammatory lesions
• Potential loss of spinal range of motion and altered biomechanics contributing to degenerative progression

Patient & Prescribing Data

Young adults with clinical diagnosis of axial spondyloarthritis enrolled in the DESIR cohort

Imaging findings of degenerative lesions should inform clinical decision-making to avoid misdiagnosis and inappropriate treatment; longitudinal imaging helps track lesion progression and guide therapy

Clinical Best Practices

• Incorporate both radiographic and MRI assessments for comprehensive evaluation of spinal lesions in axSpA
• Use validated scoring systems and trained readers blinded to clinical data to improve reliability of lesion detection and monitoring
• Recognize the high prevalence of degenerative lesions in axSpA and their potential impact on diagnosis and management
• Consider biomechanical changes due to ankylosis and degenerative lesions when planning patient care
• Ensure informed consent and ethical approval for longitudinal imaging studies in clinical cohorts

References

• DESIR Cohort Study ClinicalTrials.gov
• DESIR Cohort Website