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The impact of MRI on the clinical management of inflammatory arthritides

  • Special Issue: Jubilee
  • Published:
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Abstract

In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.

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Funding sources

The Canadian Arthritis Society: National Research Initiative Award; Alberta Heritage Foundation for Medical Research; Walter L. and Johanna Wolf Foundation, Zurich, Switzerland; Foundation for Scientific Research at the University of Zurich, Switzerland

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The authors declare that they have no competing interests in relation to this article.

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Authors and Affiliations

  1. Department of Medicine, Division of Rheumatology, University of Alberta, 562 Heritage Medical Research Centre, Edmonton, AB, T6G 2S2, Canada

    Ulrich Weber & Walter P. Maksymowych

  2. Department of Rheumatology, Balgrist University Hospital, Zurich, Switzerland

    Ulrich Weber

  3. Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark

    Mikkel Østergaard

  4. Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada

    Robert G. W. Lambert

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  1. Ulrich Weber
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Correspondence to Ulrich Weber.

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Weber, U., Østergaard, M., Lambert, R.G.W. et al. The impact of MRI on the clinical management of inflammatory arthritides. Skeletal Radiol 40, 1153–1173 (2011). https://doi.org/10.1007/s00256-011-1204-5

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