scholarly journals Role of Physical Evaluation in the Early Identification of Axial Spondyloarthritis: A Research Proposal

2015 ◽  
Vol 8 ◽  
pp. CMAMD.S28347 ◽  
Author(s):  
Marcelo P. Castro ◽  
Simon M. Stebbings ◽  
Stephan Milosavljevic ◽  
Melanie D. Bussey
Keyword(s):  
Axial Spondyloarthritis ◽  
Pelvic Girdle Pain ◽  
Functional Tests ◽  
Clinical Tests ◽  
Sacroiliac Joints ◽  
European Guidelines ◽  
Pain Provocation ◽  
Magnetic Resonance Imaging Mri ◽  
Active Inflammation

The aim of this study was to present a rationale to explore the use of clinical tests for the sacroiliac joints to detect early axial spondyloarthritis (SpA) and to suggest a protocol to validate these clinical tests. Based on the European Guidelines for Diagnosis and Treatments of Pelvic Girdle Pain, we propose a set of six clinical tests to identify the likely presence of inflammation in the sacroiliac joints associated with early axial SpA. As magnetic resonance imaging (MRI) is the current gold standard used to identify inflammation in the sacroiliac joints, the results of the proposed set of clinical tests are compared with those from the MRI examinations. We hypothesize that specific clinical tests, which combine pain provocation and functional tests, for assessing the sacroiliac joints will help to identify early active inflammation at the sacroiliac joints in axial SpA. If such tests prove to be sensitive and specific, they could add further value to the diagnostic classification criteria for axial SpA.

Sacroiliitis in Axial Spondyloarthritis: Assessing Morphology and Activity

2018 ◽  
Vol 22 (02) ◽  
pp. 180-188 ◽  
Author(s):  
Niels Egund ◽  
Iris Eshed ◽  
Iwona Sudoł-Szopińska ◽  
Anne Jurik ◽  
Lennart Jans
Keyword(s):  
Structural Changes ◽  
Bone Marrow Edema ◽  
Axial Spondyloarthritis ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Mri Features ◽  
Magnetic Resonance Imaging Mri ◽  
Active Inflammation ◽  
Marrow Edema

Objective To review the strengths, limitations, and new insights in the anatomy and magnetic resonance imaging (MRI) features of active and structural lesions of sacroiliitis in spondyloarthritis. Discussion MRI plays a key role in the diagnosis and follow-up of sacroiliitis in spondyloarthritis. MRI of the sacroiliac joints in affected patients may show active lesions such as bone marrow edema, capsulitis, enthesitis, or synovitis as well as structural changes such as erosion, fat infiltration, sclerosis, backfill, and ankylosis. Active lesions of sacroiliitis on MRI are particularly important for the diagnosis and assessment of ongoing active inflammation. Structural lesions increasingly gain importance for diagnosis and follow-up. Conclusion Active lesions remain the hallmark for assessment of inflammation in sacroiliitis. Structural lesions increasingly play a role in the diagnosis of spondyloarthritis.

Detection of Erosions in Sacroiliac Joints of Patients with Axial Spondyloarthritis Using the Magnetic Resonance Imaging Volumetric Interpolated Breath-hold Examination

2019 ◽  
Vol 46 (11) ◽  
pp. 1445-1449 ◽  
Author(s):  
Xenofon Baraliakos ◽  
Florian Hoffmann ◽  
Xiaohu Deng ◽  
Yan-Yan Wang ◽  
Feng Huang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Structural Changes ◽  
Axial Spondyloarthritis ◽  
Linear Regression Analysis ◽  
Cartilage Defects ◽  
Breath Hold ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Magnetic Resonance Imaging Mri

Objective.The volumetric interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) technique can visualize erosive cartilage defects in peripheral joints. We evaluated the ability of VIBE to detect erosions in sacroiliac joints (SIJ) of patients with axial spondyloarthritis (axSpA) compared to the established T1-weighted MRI sequence and computed tomography (CT).Methods.MRI (T1-weighted and VIBE) and CT scans of SIJ of 109 patients with axSpA were evaluated by 2 blinded readers based on SIJ quadrants (SQ). Erosions were defined according to Assessment of Spondyloarthritis international Society (ASAS) definitions. Scores were recorded if readers were in agreement.Results.Erosions were less frequently detected by CT (153 SQ) than by T1-weighted MRI (182 SQ; p = 0.008) and VIBE-MRI (199 SQ; p < 0.001 vs CT and p = 0.031 vs T1-weighted MRI). Taking CT as the gold standard, the sensitivity of VIBE-MRI (71.2%) was higher than that for T1-weighted MRI (63.4%), with similar specificity (87.3% vs 88%, respectively). In linear regression analysis, younger age was significantly associated with occurrence of erosions independently in VIBE-MRI (β = 0.384, p < 0.001) and T1-weighted MRI (β = 0.369, p < 0.001) compared to CT.Conclusion.The VIBE-MRI sequence was more sensitive than T1-weighted MRI in identifying erosive damage in the SIJ, especially in younger patients. This might be due to the ability of VIBE-MRI to identify structural changes in the cartilage that have not yet extended to the underlying bone, where CT seems to be superior.

scholarly journals Disease activity and two-year sacroiliac joint changes according to instrumental study findings in a CoRSAr cohort of patients with early axial spondyloarthritis

2019 ◽  
Vol 57 (2) ◽  
pp. 186-190
Author(s):  
Sh. Erdes ◽  
D. G. Rumyantseva ◽  
A. V. Smirnov ◽  
T. V. Dubinina
Keyword(s):  
Disease Activity ◽  
Sacroiliac Joint ◽  
Disease Duration ◽  
Axial Spondyloarthritis ◽  
Hla B27 ◽  
Resonance Imaging ◽  
Instrumental Study ◽  
Pelvic Radiography ◽  
Magnetic Resonance Imaging Mri

The evolution of axial spondyloarthritis (axSpA) and the transition of its nonradiographic to radiographic stage, when ankylosing spondylitis (AS) can be diagnosed, concern many researchers. To clarify this issue, an active search for predictors of the progression of this disease is underway; special cohort studies are being conducted.Objective: to analyze two-year changes in the magnetic resonance imaging (MRI) signs of sacroiliac joint (SIJ) inflammation and disease activity in patients with axSpA who form a Moscow CoRSAr cohort (a Cohort of early SpondylArthritis) and the role of these indicators in the progression of sacroiliitis.Subjects and methods. The investigation enrolled 68 CoRSAr cohort patients followed up for two years. All the patients underwent pelvic radiography and SIJ MRI at inclusion in the cohort and then every year. At inclusion in the cohort, nonradiographic axSpA was present in 28 patients, and AS was in 40. Disease activity was determined by BASDAI and ASDAS-CRP. The progression of sacroiliitis was assessed by the total scores of radiographic sacroiliitis.Results and discussion. The patients' age at inclusion in the cohort averaged 28.5±5.8 years, with a mean disease duration of 24.1±15.4 months and a male proportion of 51.5%; the HLA-B27-positive patients were 92.6%. At two years, 39% of the patients with nonradiographic axSpA went to the AS group. 24-month sacroiliitis progression was observed in 40% of the patients. Disease activity had little impact on the progression of sacroiliitis.Conclusion. Over two years, almost 40% of patients with axSpA showed an increase in the radiographic stage of sacroiliitis in the CoRSar cohort; this progression was primarily associated with the foci of osteitis according to MRI and correlated little with the activity of the disease.

scholarly journals Metric Properties of the SPARCC Score of the Sacroiliac Joints — Data from Baseline, 3-month, and 12-month Followup in the SPACE Cohort

2015 ◽  
Vol 42 (7) ◽  
pp. 1186-1193 ◽  
Author(s):  
Rosaline van den Berg ◽  
Manouk de Hooge ◽  
Pauline A.C. Bakker ◽  
Floris van Gaalen ◽  
Victoria Navarro-Compán ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Axial Spondyloarthritis ◽  
Important Change ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Metric Properties ◽  
External Standard ◽  
Magnetic Resonance Imaging Mri ◽  
Research Consortium ◽  
Blinded Reader

Objective.To evaluate metric properties of the SpondyloArthritis Research Consortium of Canada (SPARCC) score of the sacroiliac (SI) joints.Methods.Patients with back pain (≥ 3 months, ≤ 2 years, onset < 45 years) were included in the SPACE cohort (SpondyloArthritis Caught Early). Patients with (possible) axial spondyloarthritis had followup visits after 3 and 12 months and were treated according to clinical practice. Magnetic resonance imaging (MRI) of the SI joints (MRI-SI) was scored in 2 independent campaigns (campaign 1: at baseline and 3 months; campaign 2: at baseline, 3 months, and 12 months) by 2 different blinded reader pairs, applying the Assessment of Spondyloarthritis International Society (ASAS) definition (MRI-SI+ vs MRI-SI−; discordant cases were adjudicated by a third reader) and SPARCC score (mean of 2 agreeing readers). Calculations were made for agreement between SPARCC score cutoff values and a consensus judgment of MRI-SI+ (ASAS definition) as external standard, change in SPARCC score, and smallest detectable changes (SDC) over 3 and 12 months.Results.SPARCC score ≥ 2 showed best agreement with MRI-SI+ in both campaigns. Regarding observed changes in relation to SDC, SPARCC score changed in 70/151 patients; 26/70 patients changed > SDC (3.4), of whom 20 patients received stable treatment over 3 months in campaign 1. Over 3 months, 20/68 patients showed changes in SPARCC score; 11/20 > SDC (2.1), of whom 8 patients received stable treatment. Over 1 year, 23/74 patients changed their SPARCC score; 14/23 changed > SDC (2.4), of whom 7 received stable treatment in campaign 2.Conclusion.SPARCC score ≥ 2 can be used as surrogate for a consensus judgment of MRI-SI+ (ASAS definition) in clinical trials. The SDC ranged from 2.1–3.4 dependent on reader pair and were close to the proposed minimum important change of 2.5.

Significance of structural changes in the sacroiliac joints of patients with axial spondyloarthritis detected by MRI related to patients symptoms and functioning

2021 ◽  
pp. annrheumdis-2021-221406
Author(s):  
Juergen Braun ◽  
Uta Kiltz ◽  
Xenofon Baraliakos
Keyword(s):  
Bone Formation ◽  
Structural Damage ◽  
Structural Changes ◽  
Axial Spondyloarthritis ◽  
Conventional Radiography ◽  
Axial Skeleton ◽  
Interleukin 17 ◽  
New Bone Formation ◽  
Sacroiliac Joints ◽  
Magnetic Resonance Imaging Mri

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that manifests primarily in the axial skeleton, initially mostly in the sacroiliac joints (SIJ), usually later spreading to the spine. The disease is characterised by inflammation and new bone formation which are mainly assessed by conventional radiography (CR) and magnetic resonance imaging (MRI). Tumour necrosis factor inhibitors (TNFi) and interleukin-17 antagonists have been shown to be efficacious and efficient in patients with axSpA. This treatment seems to also inhibit structural damage, for example, retard radiographic progression. Indeed, a reduction of new bone formation in the spine, as assessed by CR, has been reported to occur after at least 2 years of therapy with TNFi. Recently, a reduction of erosions and ankylosis in the SIJ has also been observed in axSpA patients treated with etanercept and filgotinib. In this narrative review, we discuss the limited significance of such findings.

scholarly journals Axial Spondyloarthritis: Clinical Characteristics, Epidemiology, and General Approaches to Management

2021 ◽  
pp. 105-114
Author(s):  
Conall MacGearailt ◽  
Gillian E. Fitzgerald
Keyword(s):  
Patient Education ◽  
Clinical Characteristics ◽  
Axial Spondyloarthritis ◽  
Age Of Onset ◽  
Clinical Manifestations ◽  
Inflammatory Condition ◽  
Sacroiliac Joints ◽  
Chronic Inflammatory Condition ◽  
Principles Of Treatment

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition, with an age of onset almost exclusively under 45 years. Although symptoms are initially centred on the sacroiliac joints and spine, extraspinal manifestations are common and add considerably to the burden of disease. In this narrative review, the authors provide an update on the epidemiology of the disease and briefly summarise the pathophysiology. The authors detail the clinical manifestations of axSpA, including an overview of axial features, peripheral manifestations, and associated comorbidities. The authors outline the current outcome measures used in the assessment of patients. Finally, the authors provide a summary of the general principles of treatment and briefly outline the role of patient education in the management of individuals with axSpA.

scholarly journals Comparison between STIR and T2-weighted SPAIR sequences in the evaluation of inflammatory sacroiliitis: diagnostic performance and signal-to-noise ratio

2020 ◽  
Vol 53 (4) ◽  
pp. 223-228
Author(s):  
Vitor Faeda Dalto ◽  
Rodrigo Luppino Assad ◽  
Mario Müller Lorenzato ◽  
Michel Daoud Crema ◽  
Paulo Louzada-Junior ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Recent Literature ◽  
Signal To Noise Ratio ◽  
Sacroiliac Joints ◽  
Signal To Noise ◽  
Asas Criteria ◽  
The Mean ◽  
Noise Ratio ◽  
Magnetic Resonance Imaging Mri ◽  
Active Inflammation

Abstract Objective: To compare two different fat-saturated magnetic resonance imaging (MRI) techniques-STIR and T2 SPAIR-in terms of image quality, as well as in terms of their diagnostic performance in detecting sacroiliac joints (SIJ) active inflammation. Materials and Methods: We included 69 consecutive patients with suspected spondyloarthritis undergoing MRI between 2012 and 2014. The signal-to-noise ratio (SNR) was calculated with the method recommended by the American College of Radiology. Two readers evaluated SIJ MRI following ASAS criteria to assess diagnostic performance regarding the detection of active SIJ inflammation. T1 SPIR Gd+ sequence was used as the reference standard. Results: The mean SNR was 72.8 for the T1 SPIR Gd+ sequence, compared with 14.1 and 37.6 for the STIR and T2 SPAIR sequences, respectively. The sensitivity and specificity of STIR and SPAIR T2 sequences did not show any statistically significant differences, for the diagnosis of sacroiliitis with active inflammation. Conclusion: Our results corroborate those in the recent literature suggesting that STIR sequences are not superior to T2 SPAIR sequences for SIJ evaluation in patients with suspected spondyloarthritis. On 1.5-T MRI, T2-weighted SPAIR sequences provide better SNRs than do STIR sequences, which reinforces that T2 SPAIR sequences may be an advantageous option for the evaluation of sacroiliitis.

Prognostic Significance of Magnetic Resonance Imaging Changes of the Sacroiliac Joints in Spondyloarthritis – A Followup Study

2010 ◽  
Vol 37 (8) ◽  
pp. 1718-1727 ◽  
Author(s):  
KAREN BERENTH MADSEN ◽  
BERIT SCHIØTTZ-CHRISTENSEN ◽  
ANNE GRETHE JURIK
Keyword(s):  
Magnetic Resonance Imaging ◽  
New York ◽  
Magnetic Resonance ◽  
Axial Spondyloarthritis ◽  
Prognostic Significance ◽  
Activity Score ◽  
Resonance Imaging ◽  
Sacroiliac Joints ◽  
Scoring Method ◽  
Magnetic Resonance Imaging Mri

Objective.To evaluate the prognostic significance of sacroiliac joint (SIJ) changes by magnetic resonance imaging (MRI) based on 2–7 years of followup of patients with axial spondyloarthritis (SpA).Methods.Ninety-four patients (50 women, 44 men) with axial SpA obtained MRI of the SIJ from 1998–2004. They were examined at followup after 25–95 months (mean 51), including MRI and radiography of the SIJ and the spine. The Danish scoring method was used to quantify the activity and chronic SIJ changes by MRI. The activity score included subchondral edema and/or enhancement, while chronic changes encompassed erosions and subchondral fatty marrow deposition (FMD).Results.The MR score values for chronic SIJ changes increased significantly during followup, and were most pronounced in HLA-B27-positive patients and patients fulfilling the modified New York criteria for ankylosing spondylitis (AS) at followup. SIJ activity scores ≥ 2, total chronic scores ≥ 1, erosion scores ≥ 1, and FMD scores ≥ 4 at baseline were significantly related to progression of chronic SIJ changes. Activity score values ≥ 3 at baseline had a sensitivity of 0.83, specificity of 0.75, and accuracy of 0.80 in relation to the presence of AS at followup. The similar values for total chronic SIJ scores ≥ 4 at baseline were 0.86, 0.75, and 0.82, respectively, and for erosion scores ≥ 2 they were 0.88, 0.75, and 0.83.Conclusion.The occurrence of manifest SIJ activity by MRI or chronic changes at baseline was related to progression of chronic changes and the presence of AS at followup.

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