Learning objectives
1) To describe typical MRI findings of active sacroiliitis in axial spondyloarthritis (axSpA),
with emphasis on ancillary findings supporting the diagnosis.
2) To review the spectrum of abnormalities mimicking active sacroiliitis in axSpA,
with clues for proper differential diagnosis.
Background
Spondyloarthritis (SpA) describes a group of interrelateddisabling chronic inflammatory diseases,
includingankylosing spondylitis,psoriatic arthritis,
arthritis associated with inflammatory bowel disease (IBD) and reactive arthritis.The clinical presentation may be very heterogeneous,
but patients with SpA can be distinguished according to their presentation as axial (axSpA) or peripheral SpA [1].AxSpA predominantlyaffects the spine and the sacroiliac joints (SIJs).The main diagnostic imaging feature to diagnose axSpA is sacroiliitis.The old modified New York criteria for ankylosing spondylitis took into account the presence of radiographic changes in the SIJs to assess...
Findings and procedure details
In this poster: i) we illustrate MRI typical features of axSpA in the SIJs,
withemphasis on the ancillary findings supporting the diagnosis; ii) we review the spectrum of main pathologies and mimickers of SIJ BMO; iii) we analyze the role for MRI within a multidisciplinary approach to axSpA.
i)SIJ MRI typical features of axSpA and ancillary findings
The presence of periarticular/subchondral BMO in the SIJs represents the main feature of active sacroiliitis.
According to ASAS criteria,
sacroiliitis is defined as BMO that is present on...
Conclusion
Though clinical assessment remains of paramount importance for diagnostic workup,
MRI of SIJ is a useful imaging biomarker of active sacroiliitis in axSpA.
A reliable MRI assessment of the SIJs should account for BMO but also for structural changes,
such as articular erosions,
and other ancillary findings to help differentiate active inflammatory sacroiliitisfrom mimickers.
References
Van Gaalen,
F.
A.,
van der Heijde,
D.,
Dougados,
M.
inOxford Textbook of Axial Spondyloarthritis(eds.
Inman,
R.
D.
& Sieper,
J.) 19–20 (Oxford University Press,
2016).
Van der Linden,
S.,
Valkenburg,
H.,
Cats,
A.
Evaluation of diagnostic criteria for ankylosing spondylitis.
A proposal for modification of the New York criteria.Arthritis Rheum.27,361–68 (1984).
Sieper,
J.,
Rudwaleit M.,
Baraliakos X.,
et al.The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis.Ann.
Rheum.
Dis.68,1-44 (2009).
Lambert,
RG.,
Salonen D.,
Rahman P.,
et al.Adalimumab Significantly Reduces...