Inflammatory Features of Low Back Pain with Modic Changes on MRI

Sina  Owlia; Mahdieh  Bahri; Amirpasha  Amelshahbaz; Mohammad Bagher  Owlia

doi:10.18502/jimc.v8i2.17708

Sina Owlia Clinical Research Development Center of Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Mahdieh Bahri Division of Rheumatology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Amirpasha Amelshahbaz Department of Radiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Mohammad Bagher Owlia Division of Rheumatology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

DOI: https://doi.org/10.18502/jimc.v8i2.17708

Keywords: flammation, Low back pain, Magnetic resonance imaging, Seronegative rheumatoid arthritis

Abstract

Background: Recent evidence suggests a potential association between Modic Changes (MC) and inflammation in nonspecific low back pain patients. Inflammation, characterized by the activation of immune cells and the release of pro-inflammatory molecules, is known to play. This research aims to investigate the clinical and laboratory features suggestive of inflammation in patients with MC on lumbar MRI.

Methods: A retrospective analysis was conducted on 169 patients with MC identified on lumbar Magnetic Resonance Imaging (MRI). Laboratory investigations were also obtained, including Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) levels. The MC were categorized based on their MRI signal patterns. The presence of inflammatory markers and their association with clinical features was assessed using appropriate statistical methods.

Results: The majority of patients exhibited type 2 MC (n=139, 82.4%), followed by type 1 MC (n=28, 16.5%) and type 3 MC (n=2, 1.1%). Among the clinical features, patients with type 1 MC had a significantly higher prevalence of nocturnal low back pain (OR=6.76 [95%CI: 2.25-20.24], p<0.001) and morning low back stiffness (OR= 4.27 [95%CI: 1.42-12.85], p=0.006). Additionally, patients with type 1 MC were more likely to have elevated CRP levels (OR=2.61 [95%CI: 1.18-5.78]).

Conclusion: Although the majority of patients had type 2 MC (82.4%), type 1 MC was strongly associated with higher CRP levels, morning stiffness, and nocturnal pain. These associations suggest that type 1 MC may represent a more inflammatory and clinically severe form of the condition, emphasizing the importance of recognizing it in clinical practice.