Abstract
The advent of magnetic resonance imaging (MRI) and advanced sonographic techniques has led to a resurgence of interest in the role of imaging in the evaluation and management of spondyloarthritis. Radiography remains the cornerstone of diagnosis although MRI is more sensitive in early stages of the disease. Inflammatory changes in the sacroiliac joints and spine can now be reliably quantified and can also predict the subsequent development of radiographic changes in the corresponding locations. MRI-based scoring systems for inflammation are highly responsive, facilitating proof-of-concept studies of new therapies for spondyloarthritis. Assessment of chronic changes is much less reliable using MRI, while assessment using radiography lacks sensitivity to change. Assessment of disease modification therefore remains a principle challenge in the development of new therapies for ankylosing spondylitis. Ultrasound may be the preferred approach to the assessment of peripheral inflammation, especially enthesitis. Scintigraphy and computed tomography offer few advantages over MRI.
Highlights
Spondyloarthritis (SpA) is a group of inflammatory disorders that primarily affect the sacroiliac joint (SIJ) structures of the spine, large peripheral joints, and entheses, that are associated with the HLA-B27 gene
Scoring methods for lesions detected by magnetic resonance imaging (MRI) in the sacroiliac joints Several methods for quantifying disease activity on MRI in the SIJs have been proposed, only one approach has been clearly validated as having the ability to discriminate between treatment groups in a placebo-controlled randomized study that assessed adalimumab in nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis (AS) [36,37]
Plain radiography continues to be the primary approach for the evaluation of SpA in routine practice
Summary
Spondyloarthritis (SpA) is a group of inflammatory disorders that primarily affect the sacroiliac joint (SIJ) structures of the spine, large peripheral joints, and entheses, that are associated with the HLA-B27 gene. Since higher scores are assigned to new bone formation, this method is primarily useful for patients with longstanding disease and it may not be a sensitive approach in studies evaluating early disease.
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