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Research ArticleArticle

Consensus-Driven Definition for Unequivocal Sacroiliitis on Radiographs in Juvenile Spondyloarthritis

Pamela F. Weiss, Timothy G. Brandon, Robert G. Lambert, David M. Biko, Nancy A. Chauvin, Michael L. Francavilla, Nele Herregods, Alison M. Hendry and Walter P. Maksymowych
The Journal of Rheumatology April 2023, jrheum.2022-0890; DOI: https://doi.org/10.3899/jrheum.2022-0890
Pamela F. Weiss
P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Timothy G. Brandon
T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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Robert G. Lambert
R.G. Lambert, MB BCh, Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
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David M. Biko
D.M. Biko, MD, Department of Radiology, Children's Hospital of Philadelphia, and Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Nancy A. Chauvin
N.A. Chauvin, MD, Department of Radiology, Penn State Health Milton S. Hershey Children's Hospital, Hershey, Pennsylvania, USA.
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Michael L. Francavilla
M.L. Francavilla, MD, Department of Radiology, Whiddon College of Medicine, University of South Alabama, Mobile, Alabama USA.
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Nele Herregods
N. Herregods, MD, Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
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Alison M. Hendry
A.M. Hendry, PGDipHealMgt, PGDipHSc, General Medicine and Rheumatology, Division of Medicine, Emergency and Integrated Care, Counties Manukau District Health Board, Auckland, New Zealand.
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Walter P. Maksymowych
W.P. Maksymowych, MD, Department of Medicine, University of Alberta and CARE Arthritis, Edmonton, Alberta, Canada.
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Abstract

Objective Radiography is still used worldwide for the detection of sacroiliitis in juvenile spondyloarthritis (JSpA), despite its low sensitivity and reliability. We aimed to define unequivocal evidence of sacroiliitis on pelvic radiography in skeletally immature youth for use in classification criteria when magnetic resonance imaging (MRI) is unavailable.

Methods Subjects were a retrospective cohort of juvenile patients with spondyloarthritis with a radiograph and MRI as part of a diagnostic evaluation for axial disease. Six musculoskeletal imaging experts underwent an iterative consensus process to define unequivocal sacroiliitis on radiography in skeletally immature youth. Radiographs were graded using the modified New York (mNY) criteria and the unequivocal sacroiliitis criteria. Interrater agreement was assessed with the Fleiss κ statistic. Specificity, area under the receiver operator characteristic curve (AUROC), and sensitivity of the 2 measures were tested using 2 MRI reference standards.

Results A total of 112 subjects, with a median age of 14.9 (range 6.7-20.1) years, were included. The Fleiss κ was fair for the mNY criteria (0.54, 95% CI 0.42-0.67) and the unequivocal sacroiliitis criteria (0.58, 95% CI 0.46-0.69). The unequivocal sacroiliitis criteria achieved > 90% specificity using both MRI reference standards. Sensitivity (59.26 and 57.14 vs 44.83 and 43.33) and AUROC (0.76 and 0.76 vs 0.71 and 0.71) were higher, for both reference standards, for the unequivocal sacroiliitis in youth definition than for the mNY criteria, respectively.

Conclusion In this study, we propose the first consensus-derived definition to our knowledge of unequivocal sacroiliitis by radiography in skeletally immature youth. This definition achieved excellent specificity and had higher AUROC and sensitivity values than the mNY criteria using both MRI reference standards. This definition has applicability to the JSpA axial disease classification imaging criterion when MRI is unavailable.

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The Journal of Rheumatology
Vol. 50, Issue 9
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Consensus-Driven Definition for Unequivocal Sacroiliitis on Radiographs in Juvenile Spondyloarthritis
Pamela F. Weiss, Timothy G. Brandon, Robert G. Lambert, David M. Biko, Nancy A. Chauvin, Michael L. Francavilla, Nele Herregods, Alison M. Hendry, Walter P. Maksymowych
The Journal of Rheumatology Apr 2023, jrheum.2022-0890; DOI: 10.3899/jrheum.2022-0890

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Consensus-Driven Definition for Unequivocal Sacroiliitis on Radiographs in Juvenile Spondyloarthritis
Pamela F. Weiss, Timothy G. Brandon, Robert G. Lambert, David M. Biko, Nancy A. Chauvin, Michael L. Francavilla, Nele Herregods, Alison M. Hendry, Walter P. Maksymowych
The Journal of Rheumatology Apr 2023, jrheum.2022-0890; DOI: 10.3899/jrheum.2022-0890
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