Ten-year Longitudinal Relationship between Spinal Degenerative Lesions in Axial Spondyloarthritis at MRI and Radiography in the DESIR Cohort.

Abstract

Background Spinal degenerative lesions are prevalent on MRI scans and radiographs in the general population and axial spondyloarthritis (axSpA) cohorts. However, their interrelationships remain poorly understood. Purpose To investigate longitudinal relationships between spinal degenerative lesions in axSpA over 10 years. Materials and Methods This secondary analysis of a prospective cohort (Devenir des Spondylarthropathies Indifférenciées Récentes [DESIR]) included whole-spine MRI scans and cervical and lumbar radiographs from individuals with axSpA assessed for 10 MRI and six radiographic degenerative lesions by three readers at baseline, 5 years, and 10 years. Patients with two or more time points were included. Multilevel logistic regression analyses using a generalized estimating equations approach (logit link, binomial family) were developed to assess whether the presence of a lesion at one time point was associated with subsequent lesions at the same and adjacent vertebral units. Time-lagged and autoregressive models evaluated inter- and intralesion temporal relationships, accounting for within-patient, within-reader, and within-vertebral unit dependence, and were adjusted for age, sex, HLA-B27 status, body mass index, smoking, job type, and biologic agents during follow-up. Results Imaging was available for 329 patients (mean age, 35 years ± 9 [SD]; 175 women). At MRI, longitudinal associations were found between disk degeneration and subsequent herniation (odds ratio [OR], 3.97 [95% CI: 3.41, 4.62]; <i>P</i> < .001), high-intensity zone (OR, 1.77 [95% CI: 1.49, 2.11]; <i>P</i> < .001), and Modic type 1 lesions (OR, 4.53 [95% CI: 3.53, 5.80]; <i>P</i> < .001) within the same vertebral unit. Modic type 1 lesions were associated with subsequent Modic type 2 lesions within the same unit (OR, 49.36 [95% CI: 34.66, 70.28]; <i>P</i> < .001). Herniations persisted over time (OR, 184.00 [95% CI: 154.00, 221.00]; <i>P</i> < .001). On radiographs, disk height loss was associated with osteophyte formation (OR, 4.33 [95% CI: 3.63, 5.17]; <i>P</i> < .001). MRI lesions were associated with the appearance of corresponding degenerative lesions on subsequent radiographs at the same level (OR, 2.49 [95% CI: 2.18, 2.83]; <i>P</i> < .001). Conclusion Long-term imaging analyses in axial spondyloarthritis demonstrated temporal relationships between spinal degenerative lesions on MRI scans and radiographs, highlighting the progressive nature of spinal degeneration. © RSNA, 2026 <i>Supplemental material is available for this article.</i>