Ten-year longitudinal relationship between spinal degenerative lesions in axial spondyloarthritis at MRI and radiography in the DESIR cohort

Vegas, L.P.; Gaalen, F. van; Lunteren, M. van; Loeuille, D.; Morizot, C.; Newsum, E.; ... ; Ramiro, S. (2026)

Article / Letter to editor

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 Indiff & eacute;renci & eacute;es R & eacute;centes [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]; P < .001), high-intensity zone (OR, 1.77 [95% CI: 1.49, 2.11]; P < .001), and Modic type 1 lesions (OR, 4.53 [95% CI: 3.53, 5.80]; P < .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]; P < .001). Herniations persisted over time (OR, 184.00 [95% CI: 154.00, 221.00]; P < .001). On radiographs, disk height loss was associated with osteophyte formation (OR, 4.33 [95% CI: 3.63, 5.17]; P < .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]; P < .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.

• All authors: Vegas, L.P.; Gaalen, F. van; Lunteren, M. van; Loeuille, D.; Morizot, C.; Newsum, E.; Claudepierre, P.; Saraux, A.; Feydy, A.; Reijnierse, M.; Heijde, D. van der; Ramiro, S.
• Date: 2026-06-01
• Journal: Radiology
• Volume: 319
• Issue: 3
• DOI: doi:10.1148/radiol.251715