TY - JOUR T1 - Magnetic Resonance Imaging — Key to Understanding and Monitoring Disease Progression in Spondyloarthritis? JF - The Journal of Rheumatology JO - J Rheumatol SP - 1 LP - 4 DO - 10.3899/jrheum.141402 VL - 42 IS - 1 AU - MIKKEL ØSTERGAARD AU - INGE J. SØRENSEN Y1 - 2015/01/01 UR - http://www.jrheum.org/content/42/1/1.abstract N2 - Understanding the process of structural progression in axial spondyloarthritis (axSpA) and elucidating the link/dissociation between inflammation and damage have attracted much attention, as has the question of whether avoiding structural progression is therapeutically possible. The impressive effect of tumor necrosis factor (TNF) inhibitors on disease activity without any apparent effect on structural damage progression as assessed by the standard measure (radiography) has fueled this interest1,2. Is the link between inflammation and damage nonexistent? Is it time-dependent (only occurring at a specific timepoint, e.g., early in the disease or only after long-lasting therapy)? Or is the apparent lack of a link the result of inadequate methods for measuring progression?A sufficiently sensitive and reliable method for demonstrating change is a prerequisite to study structural progression. Preferably, different aspects of progression should be measurable, particularly if there is an interest in understanding details of the disease process. In this issue of The Journal, Maksymowych, et al describe the development and validation of a magnetic resonance imaging (MRI) scoring method for several aspects of structural damage in the sacroiliac joints (SIJ)3. This is an important step in clarification of the development of these structural changes. Building on definitions of individual SIJ pathologies (erosion, backfill, fat infiltration, ankylosis) described in the MORPHO study by Weber, et al4,5, Maksymowych, et al describe and apply a newly developed scoring system by which the presence/absence of lesions is systematically scored in SIJ quadrants (fat, erosion) or halves (backfill, ankylosis) separately in each of 5 consecutive semicoronal slices through the cartilaginous part of the joint3. The quadratic per-slice scoring system follows the same principles as the Spondyloarthritis Research Consortium of Canada (SPARCC) scoring method for SIJ inflammation6. The structural damage scoring system is … Address correspondence to Prof. M. Østergaard, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Nordre Ringvej 57, DK-2600 Glostrup, Denmark; E-mail: mo{at}dadlnet.dk ER -