Do NSAIDs mask bone marrow oedema on MRI in spondyloarthritis?
Research type
Research Study
Full title
Do non-steroidal anti-inflammatory drugs (NSAIDs) reduce the appearance of sacroiliac joint bone marrow oedema on MRI, in spondyloarthritis?
IRAS ID
221223
Contact name
Gareth Jones
Contact email
Duration of Study in the UK
3 years, 6 months, 31 days
Research summary
Research Summary
Magnetic resonance imaging (MRI) is a standard imaging technique for patients with axial spondyloarthritis, (axSpA), an inflammatory joint disease of the spine and sacroiliac joints (SIJs), and a key factor in early diagnosis is MRI-evidence of inflammation in the SIJs. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in patients with axSpA, indeed many patients are already using NSAIDs when they first see a rheumatologist. However, it is plausible that the use of NSAIDs reduces the appearance of inflammation on MRI, although this is currently unknown. This potentially limits the ability of the clinician to make an accurate diagnosis. The aim of this study is to investigate whether NSAIDs have an effect on the presence of inflammation on MRI scans in axSpA patients. We propose an observational study using MR imaging of patients SIJs. Male HLA-B27+ patients with axSpA on regular full dose NSAIDs, recruited from rheumatology clinics, will be asked to undergo a one-week NSAIDs-free wash-out period, after which they will receive an MRI scan (baseline) of their SIJs. Those participants with MRI evidence of inflammation after one week NSAID free will be asked to re-start and take regular full dose NSAIDs for six weeks. Then, participants will receive another MRI scan (follow-up). Participants who at scan 1 have no evidence of inflammation of the SIJs at baseline will not continue with the study. We will determine the proportion of participants with MRI-observable sacroiliitis (scan 1) that resolves with NSAIDs use (scan 2). The results of the proposed study will inform recommendations regarding medication use prior to MR imaging in axSpA, a clinical area that currently has no evidence based guidance.
Summary of Results
A key feature of spondyloarthritis (an arthritis of the spine) is inflammation in the sacroiliac joints – the joints where the spine meets the pelvis. This can be imaged using MRI. However, many patients regularly take non-steroidal anti-inflammatory drugs (NSAIDs), either prescribed by their GP or available over-the-counter. We aimed to see whether the use of NSAIDs hides the appearance of inflammation in the sacroiliac joints when patients undergo an MRI scan.
We recruited 311 patients from 34 hospitals across the UK and asked them to stop their NSAIDs for 1-2 weeks before an MRI scan. Those whose first scan showed evidence of inflammation (when not taking NSAIDs) were invited back for a second scan six weeks later, after restarting their medication. At the second scan we found that 1 in 5 now showed no evidence of inflammation.
These findings suggest that patients should wash-out of their medication – if possible – prior to MRI scan, to allow correct monitoring of inflammation. It may be, for example, that some patients have received an incorrect diagnosis, or a delayed diagnosis, because their inflammation was previously hidden by the medication they were already taking.REC name
West of Scotland REC 3
REC reference
17/WS/0041
Date of REC Opinion
30 Mar 2017
REC opinion
Further Information Favourable Opinion