Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy.

Feb 2013

Albert HB, Sorensen JS, Christensen BS, Manniche C.

Source

Research Department, Spine Centre of Southern Denmark, Institute of Regional Health Services Research, Lillebaelt Hospital, University of Southern Denmark, Middelfart, Denmark, hanne.birgit.albert@slb.regionsyddanmark.dk.

Abstract

PURPOSE:

Modic type 1 changes/bone edema in the vertebrae are present in 6 % of the general population and 35-40 % of the low back pain population. It is strongly associated with low back pain. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain (>6 months) and Modic type 1 changes (bone edema).

METHODS:

The study was a double-blind RCT with 162 patients whose only known illness was chronic LBP of greater than 6 months duration occurring after a previous disc herniation and who also had bone edema demonstrated as Modic type 1 changes in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment (Bioclavid) or placebo and were blindly evaluated at baseline, end of treatment and at 1-year follow-up.

OUTCOME MEASURES:

Primary outcome, disease-specific disability, lumbar pain. Secondary outcome leg pain, number of hours with pain last 4 weeks, global perceived health, EQ-5D thermometer, days with sick leave, bothersomeness, constant pain, magnetic resonance image (MRI).

RESULTS:

144 of the 162 original patients were evaluated at 1-year follow-up. The two groups were similar at baseline. The antibiotic group improved highly statistically significantly on all outcome measures and improvement continued from 100 days follow-up until 1-year follow-up. At baseline, 100 days follow-up, 1-year follow-up the disease-specific disability-RMDQ changed: antibiotic 15, 11, 5.7; placebo 15, 14, 14. Leg pain: antibiotics 5.3, 3.0, 1.4; placebo 4.0, 4.3, 4.3. Lumbar pain: antibiotics 6.7, 5.0, 3.7; placebo 6.3, 6.3, 6.3. For the outcome measures, where a clinically important effect size was defined, improvements exceeded the thresholds, and a trend towards a dose-response relationship with double dose antibiotics being more efficacious.

CONCLUSIONS:

The antibiotic protocol in this study was significantly more effective for this group of patients (CLBP associated with Modic I) than placebo in all the primary and secondary outcomes.

Springerlink

Bone edema on MRI is highly associated with low bone mineral density in patients with early inflammatory back pain: results from the DESIR cohort.

Bone oedema on MRI is highly associated with low bone mineral density in patients with early inflammatory back pain: results from the DESIR cohort.

Nov 2012

Briot K, Durnez A, Paternotte S, Miceli-Richard C, Dougados M, Roux C.

Source

1Department of Rheumatology, Cochin Hospital, Paris Descartes University, Paris, France.

Abstract

OBJECTIVES:

 To assess bone mineral density (BMD) at lumbar spine and hip in a large cohort of patients with early inflammatory back pain (IBP) suggestive of axial spondyloarthritis (SpA), and to assess systemic and bone inflammation (according to MRI) as risk factors of low BMD.

PATIENTS AND METHODS:

 332 (52.4% male) patients with IBP suggestive of axial SpA defined by Calin or Berlin criteria were recruited; they had lumbar spine and hip BMD and body composition measurements. Low BMD was defined by Z≤-2 (at least one site). Clinical, biological (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and imaging (x-rays, spine and sacroiliac joint MRI) parameters were compared in patients with and without low BMD (Z≤-2). Significant parameters in univariate analysis were tested in multivariate models.

RESULTS:

 Patients (mean age 33.8 years) had a short duration of axial symptoms (mean 1.6 years); 71.4% fulfilled the Assessment of Spondyloarthritis International Society criteria for axial SpA and HLA-B27 was present in 62.1%. 43 (13.0%) had low BMD (88% male). Multivariate logistic regression showed that parameters significantly associated with low BMD (any site) were the presence of bone marrow oedema (inflammatory lesions) on MRI (OR 4.63, p=0.001), either ESR or CRP (OR 2.60, p=0.037) and male gender (OR 9.60, p=0.0004).

CONCLUSIONS:

This study conducted in a large cohort of young adults with early IBP suggestive of SpA shows that 13.0% of patients have a low BMD and that the main risk factor associated with low BMD was inflammation on MRI.

PubMed

Nail Disease in Psoriatic Arthritis: Distal Phalangeal Bone Edema Detected by Magnetic Resonance Imaging Predicts Development of Onycholysis and Hyper

Nail Disease in Psoriatic Arthritis: Distal Phalangeal Bone Edema Detected by Magnetic Resonance Imaging Predicts Development of Onycholysis and Hyperkeratosis.

Dalbeth N, Pui K, Lobo M, Doyle A, Jones PB, Taylor WJ, McQueen FM.

Source

From the Department of Medicine, University of Auckland, Auckland; Department of Rheumatology, Auckland District Health Board, Auckland; Department of Anatomy with Radiology, University of Auckland, Auckland; Department of Medicine, University of Otago, Wellington; and Department of Molecular Medicine, University of Auckland, Auckland, New Zealand.

Abstract

OBJECTIVE:

To examine the association between magnetic resonance imaging (MRI) features of distal phalanx (DP) disease and the progression of nail pathology in psoriatic arthritis (PsA).

METHODS:

Clinical nail assessment and hand MRI scans were done on 34 patients with PsA. Twenty patients had repeat nail assessments after 1 year.

RESULTS:

Nails with onycholysis and hyperkeratosis at baseline were more likely to have corresponding DP bone erosion and proliferation on MRI. DP bone edema on baseline MRI was associated with development of onycholysis and hyperkeratosis in corresponding nails.

CONCLUSION:

Our data suggest that DP inflammation is central in the development of psoriatic nail disease.

PubMed

High grade MRI bone edema in rheumatoid arthritis patients undergoing joint replacement

High grade MRI bone edema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone.

Ann Rheum Dis. 2007 May 9
McQueen FM,
Gao A,
Ostergaard M,
King A,
Shalley G,
Robinson E,
Doyle A,
Clark B,
Dalbeth N.
Auckland University, New Zealand.

OBJECTIVES: /B> MRI bone oedema has been observed in early and advanced RA and may represent a cellular infiltrate (osteitis) in subchondral bone. We studied MRI scans from RA patients undergoing surgery, seeking to identify regions of bone oedema and examine its histopathological equivalent in resected bone.

METHODS: /B> Pre-operative contrast-enhanced MRI scans were obtained in 11 RA patients scheduled for orthopaedic surgery to the hands/wrists or feet. In 9, MRI scans were scored by 2 readers for bone oedema (RAMRIS system). Its distribution with respect to surgical site was investigated. In 4 patients, 7 bone samples were examined for a cellular infiltrate and this was compared with MRI bone oedema, scored for spatial extent and intensity.

RESULTS: /B> Inter-reader ICCs for bone oedema were 0.51 (all sites) and 0.98 (bone samples for histology). Bone oedema was observed at 60% of surgical sites vs 38% of non-surgical sites. High grade bone oedema (score = or >50% maximum) was strongly associated with the surgical field (OR 9.3 [3.5-24.2], P<0.0001). r="0.67," p="0.048)" r="0.86," p="0.01).">

CONCLUSION: High grade MRI bone oedema was common within the field of intended surgery and associated with pain. There was concordance between the presence and severity of MRI bone oedema and osteitis on histology, with an MRI threshold effect due to differences in image resolution.

PMID: 17491098 [PubMed - as supplied by publisher]