Magnetic Resonance Imaging in Axial Spondyloarthritis

Background

Axial spondyloarthritis (axSpA) is a chronic inflammatory arthritis affecting predominantly the spine and / or sacroiliac joints (the joints where the spine meets the pelvis). Magnetic resonance imaging (MRI) is a standard imaging technique for patients with axial axSpA, and a key factor in early diagnosis is sacroiliitis (inflammation in the sacroiliac joints) as observed with MRI. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in patients with axSpA – and indeed many patients are already using NSAIDs (either bought over the counter, or prescribed by their general practitioner) when they first see a rheumatologist … and therefore before they even get a diagnosis.

Because of their anti-inflammatory properties, it is plausible that the use of NSAIDs may reduce the appearance of inflammation on MRI. This may not only hinder diagnosis, but might also lead to inappropriate management. The extent to which NSAIDs ‘mask’ sacroiliitis is currently unknown. The University of Aberdeen is currently conducting a large clinical study to answer this question; the DyNAMISM study (https://w3.abdn.ac.uk/hsru/DyNAMISM/Public/Public/index.cshtml).

In brief, patients with axSpA, or suspected axSpA are recruited from rheumatology clinics are asked to undergo a one-week NSAID-free wash-out period after which they receive an MRI scan (baseline) of their sacroiliac joints using a standardised protocol. All participants then re-start their NSAIDs. However, those whose first scan shows evidence of sacroiliitis receive a second MRI scan after six weeks. The primary analysis will determine the proportion of participants with sacroiliitis (scan 1; NSAID-free) in whom it has resolved in scan 2 (with NSAIDs).

Project

An opportunity exists for a PhD student to analyse some of the study’s secondary outcomes, and to conduct some methodological work alongside the project. The precise research questions will be decided by the candidate, in collaboration with the supervisors but may include:
(a) Assessment of inter- and intra-reliability between MRI readers;
(b) Examination of secondary outcomes – i.e. looking at the extent of sacroiliitis, rather than just whether it is present / absent.
(c) Agreement between subjective and objective measures of inflammation; and
(d) Sub-group analysis of the main study analysis – for example: are there sub-groups of patients in whom NSAIDs did / did not have an effect?

Research group

The Epidemiology Group at the University of Aberdeen is one of the major research groups in the Institute of Applied Health Sciences. The Group’s programme of applied epidemiological research is focused on arthritis and musculoskeletal health. Our epidemiological work seeks to understand mechanisms of disease onset and outcome, this then informs our programme of observational studies and randomised controlled trials on disease management, which in turn feeds into our work on designing, implementing and evaluating health services for patients with these conditions.

We provide a vibrant research and training environment and information for prospective students is available at: www.abdn.ac.uk/iahs/research/epidemiology/phd-students-page-165.php

APPLICATION PROCEDURE:
This project is advertised in relation to the research areas of the APPLIED HEALTH SCIENCE. Formal applications can be completed online: https://www.abdn.ac.uk/pgap/login.php; You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.

NOTE CLEARLY THE NAME OF THE SUPERVISOR and EXACT PROJECT TITLE ON THE APPLICATION FORM. IF YOU DO NOT MENTION IAHS STUDENTSHIP ON YOUR APPLICATION THEN IT WILL NOT BE CONSIDERED FOR THE STUDENTSHIP. Applicants are limited to applying for a maximum of 3 applications for funded projects. Any further applications received will be automatically withdrawn.

Informal inquiries can be made to Dr Gareth Jones ([Email Address Removed]) with a copy of your curriculum vitae and cover letter indicating your interest in the project and why you wish to undertake it. All general enquiries should be directed to the Postgraduate Research School ([Email Address Removed]).