Vendhan, K; (2015) Inflammatory changes of the lumbar spine and sacroiliac joints in patients with enthesitis-related arthritis; MRI findings and quantification of inflammation using DWI. Doctoral thesis , UCL (University College London).

Abstract

Enthesitis-related arthritis (ERA) is a paediatric/adolescent inflammatory arthritis characterised by peripheral arthritis, spinal involvement, sacroiliitis and enthesitis. The natural history and aetiology of the disease are poorly understood. A quantitative method of measuring disease activity would be helpful for the detection of early disease, disease monitoring and assessment of treatment. Currently there is no available gold standard for quantifying disease activity nor is there a validated radiological method for quantifying inflammation in children. Three areas are addressed in this thesis: 1. The first part of this thesis focuses on the development and validation of a methodology to quantify inflammation of the sacroiliac joints (SIJs) in ERA patients, using diffusion weighted MRI. Diffusion in inflamed bone is less restricted than in normal bone, increasing numerical values of diffusion. A custom written Matlab program was used to obtain profiles of apparent diffusion coefficient (ADC) values in regions of inflammation in the SIJs in ERA patients and these were compared with normal SIJs in controls. A highly significant difference was seen in ADC values between ERA cases and controls. This novel technique shows promise as a method of simply and quickly assessing SIJ inflammation. 2. A further study was performed to investigate the effects of skeletal maturity on ADC values in subchondral bone of sacroiliac joints. The results showed that normalised ADC values of immature SIJs were significantly higher than that of mature SIJs. This has implications when assessing young adolescents for axial inflammation. 3. The spinal features of inflammation in ERA have been studied and described in this thesis. Statistically significant inflammation of the facet joints and the interspinous ligaments were seen in a cohort of ERA patients. This is a previously undescribed finding and it is possible that spinal inflammatory changes could be contributing to back pain in these patients.

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