NSAID Use May Affect Axial Spondyloarthritis Diagnosis via MRI

Patients with suspected axial spondyloarthropathy (AxSpA) not taking non-steroidal anti-inflammatory drugs (NSAIDs) are more likely to have MRI proven inflammation compared with those taking NSAIDs, according to study results presented at the Radiological Society of North America (RSNA) 2021 Annual Meeting.

“Undiagnosed AxSpA can have significant impact on patients’ physical and mental health but also their quality of life and livelihood,” the authors wrote. “It is possible that NSAID use at the time of scanning reduces the diagnostic yield of MRI scanning.”

The findings were presented by Prasanna Partha Sarathy, MBChB, BMedSc, of Singleton Hospital in Swansea, UK.

Early AxSpA diagnosis, which depends on HLA-B27 testing and MRI imaging, is essential. While NSAIDs can lead to improvement in MRI appearances, patients suspected of having AxSpA are often prescribed these drugs for symptomatic relief before imaging. In this study, the researchers assessed the use of MRI in patients with suspected AxSpA and the effect of NSAIDs on the diagnostic yield of MRI scanning.

The six-month, multicenter, retrospective cohort study included 74 patients referred for MRI of the spine for suspected AxSpA. At the time of MRI, the patients were asked about NSAID use. The MRI results were assessed for evidence of active inflammation. 

MRI showed signs of AxSpA in 22% of the patients. Those not using NSAIDs at the time of the scan were more likely to have MRI proven inflammation (P = .017). After adjusting for age and gender, the study found that patients not taking NSAIDs were more likely to have MRI proven inflammation compared with those taking NSAIDs (OR 8.3; 95% CI, 1.9-36; P = .005). This finding was mainly driven by the no NSAID versus regular NSAID use subgroups (OR 14; 95% CI, 2.1-97; P = .006). No difference was seen between patients not taking NSAIDs and those taking NSAIDs as required, or between patients taking NSAIDs as required versus those taking regular NSAIDs.

“This study suggests suspected AxSpA patients not taking NSAIDs were more likely to have MRI proven inflammation compared to patients taking NSAIDs especially those on regular NSAIDs,” the authors wrote.

They suggested that more prospective research is needed to explore this relationship further.

For more coverage of RSNA 2021, click here.