Quantification of bone marrow edema by MRI of the sacroiliac joints in patients diagnosed with axial spondyloarthritis: results from the ESPeranza cohort.

OBJECTIVE: To evaluate whether the quantification of bone marrow edema (BMO) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison with the assessment of sacroiliitis by Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHOD: This prospective study from the ESPeranza cohort involved 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n = 28), peripheral spondyloarthritis (n = 10), and other diagnoses that were not spondyloarthritis (n = 28). Measures of diagnostic usefulness [area under the curve (AUC), sensitivity, specificity, Youden's J statistic, positive and negative likelihood ratios (LR+ and LR-)] were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were human leucocyte antigen (HLA)-B27 positive and negative. RESULTS: The AUC value with BMO quantification was 0.919 [95% confidence interval (CI) 0.799-1] for HLA-B27-positive patients and 0.884 (95% CI 0.764-1) for HLA-B27-negative patients. A SCAISS cut-off point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4. CONCLUSION: For patients with suspected axSpA, quantification of BMO improves the predictive capacity of MRI of the SI joints, for both HLA-B27-positive and HLA-B27-negative patients. Axial spondyloarthritis (axSpA) has a dramatic impact on physical function and quality of life (1). Despite its significant impact, patients with axSpA are normally diagnosed several years after presenting symptoms (2). In this respect, magnetic resonance imaging (MRI) of the sacroiliac (SI) joints has gained significance over the past decade, particularly in the early stages of the disease. Nowadays, imaging tests and human leucocyte antigen (HLA)-B27 testing are among the most important diagnostic procedures for patients with suspected axSpA.

Multiple strokes after initiation of steroid therapy in giant cell arteritis.

We report the case of a 66 year old woman with clinical manifestations of giant-cell arteritis, positive temporal artery biopsy and excellent response to prednisone, who developed massive cerebral infarcts after 5 days of treatment. Computed tomographic and magnetic resonance imaging scans revealed multiple infarcts in areas irrigated by both the carotid and vertebrobasilar systems bilaterally. A four-vessel angiography performed 19 days later revealed only mild atheromatous disease. Anticardiolipin antibodies were negative and a transoesophageal echocardiogram was normal. Stroke during the first 2 weeks of therapy in giant-cell arteritis, especially in the vertebrobasilar territory, has been previously reported. Anticoagulation during the first weeks of steroid treatment in these patients might be advisable.

Cyclosporine neurotoxicity in heart transplantation.

The neurotoxic potential of cyclosporine in previous clinical experience has not been considered a significant problem. Recently a significant incidence of severe neurotoxicity has been related to cyclosporine therapy in liver transplant recipients. In our heart transplant program we have observed an unexpectedly high incidence of serious neurologic toxicity, presumably caused by use of cyclosporine. Coma, cerebral hemorrhage, hemiparesis and dysphasia, confusion, and visual hallucinations were reported in four patients. Cyclosporine discontinuation or dose reduction eliminated the neurologic effects in all but one patient. Cyclosporine neurotoxic effects should be suspected in heart transplant recipients with central nervous system syndromes.