Learning objectives
- To review the evolution of the diagnostic criteria of spondyloarthropathy (SpA)
- Describe the spinal MRI manifestationsthat orient towards Spa.
-To learn how to differentiate from other diseases
Background
The term spondyloarthritis is used for a family of disorders,
such as ankylosing spondylitis (AS),
axial non-radiographic spondyloarthritis (nr-axSpA),
forms of arthritis associated with psoriasis and inflammatory bowel diseases and other conditions.
Spondyloarthritis is classified as axial or peripheral,
depending on whether patients suffer mainly symptoms in the spine,
sacroiliac joints,
hips and rib cage (the axial skeleton),
as seen in patients with ankylosing spondylitis or peripheral joints,
as patients present with psoriatic arthritis.
The different forms of SpA share a group of clinical characteristics;...
Imaging findings OR Procedure Details
PATHOPHYSIOLOGY
Thecharacteristichistopathological feature of SpA is enthesitis,
which is given by the pathological inflammation of the involved entheses,
which are the sites of insertion of tendons,
ligaments,
fascias and capsules to the bone; as well as theattachmentof cartilage to the subchondral bone.
Three processes are observed at the entheses: inflammation,
bone erosion and syndesmophyte (spur) formation (Fig.1).
Each porcess is controlled by diferent mediatorsincluding CD4and CD8 T lymphocytes,
macrophages,cytokines,
particularly tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β) leading to fibrosis and ossification at...
Conclusion
Spondyloarthropathies follow a caudocranial evolution starting from the sacroiliac joints extending to the spine.
Occasionally there may be exclusive spine involvement or simply spine is first studied,
thereforeknowing typical spinal lesions in MRImay be useful for early diagnosis and treatment.
For this purpose,
MRI study protocols must necessary include water sensitive sequences and covercostovertebral and costotransverse joints and posterior elements.
References
1.
Benjamin M,
McGonagle D.
The anatomical basis for diseaselocalisation in seronegative spondyloarthropathy at entheses andrelated sites.
J Anat 2001;199(Pt 5):503–26
2.
Hermann KG,
Baraliakos X,Van der Heijdedm DM et al.; Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group.Ann Rheum Dis2012; 71: 1278- 88.
3.
Bennett AN,
Rehman A,
Hensor EM,
et al.
Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondylarthritis.
Arthritis...