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Advances in musculoskeletal imaging and their clinical utility in the early diagnosis of spondyloarthritis

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Abstract

Interest in imaging ankylosing spondylitis (AS) and related spondyloarthropathies has increased in recent years. MRI is regarded as the most sensitive imaging modality to detect early inflammatory lesions in the sacroiliac joints and in the spine. Standard radiography plays a major role in evaluating potential disease-modifying properties of the recently introduced, symptomatically effective anti-tumor necrosis factor-α agents. Various radiographic scoring methods have been developed to assess and monitor spinal structural damage in AS. The modified stoke ankylosing spondylitis spine score is the method of choice based on its sensitivity to change. MRI is emerging as a useful tool to detect AS early, but this remains a challenge. Recent progress in MR technology with the advent of whole body MRI has expanded the potential role of imaging in AS. Further data are needed before MRI can replace radiographs for earlier diagnosis of AS.

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References and Recommended Reading

  1. Braun J, Sieper J: Ankylosing spondylitis. Lancet 2007, 369:1379–1390.

    Article  PubMed  Google Scholar 

  2. Van der Heijde D, Landewé R: Imaging in spondylitis. Curr Opin Rheumatol 2005, 17:413–417.

    Article  PubMed  Google Scholar 

  3. Maksymowych W, Landewé R: Imaging in ankylosing spondylitis. Best Pract Res Clin Rheumatol 2006, 20:507–519.

    Article  PubMed  Google Scholar 

  4. Resnick D: Ankylosing spondylitis. In Diagnosis of Bone and Joint Disorders, 4th edn. Edited by Resnick D. Philadelphia: WR Saunders Company; 2002:1023–1081.

    Google Scholar 

  5. Rudwaleit M, Khan MA, Sieper J: The challenge of diagnosis and classification in early ankylosing spondylitis. Do we need new criteria? Commentary. Arthritis Rheum 2005, 52:1000–1008.

    Article  PubMed  Google Scholar 

  6. Van Tubergen A, Heuft-Dorenbosch L, Schulpen G, et al.: Radiographic assessment of sacroiliitis by radiologists and rheumatologists: Does training improve quality? Ann Rheum Dis 2003, 62:519–525.

    Article  PubMed  Google Scholar 

  7. Creemers MC, Franssen MJ, van’t Hof MA, et al.: Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis 2005, 64:127–129.

    Article  PubMed  CAS  Google Scholar 

  8. Wanders AJ, Landewé RB, Spoorenberg A, et al.: What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the Outcome Measures in Rheumatology Clinical Trials filter. Arthritis Rheum 2004, 50:2622–2632.

    Article  PubMed  Google Scholar 

  9. Baraliakos X, Listing J, Rudwaleit M, et al.: Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis 2007, 66:910–915.

    Article  PubMed  CAS  Google Scholar 

  10. Wanders A, Heijde D, Landewé R, et al.: Nonsteroidal anti-inflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: A randomized clinical trial. Arthritis Rheum 2005, 52:1756–1765.

    Article  PubMed  CAS  Google Scholar 

  11. Mau W, Zeidler H, Mau R, et al.: Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol 1988, 15:1109–1114.

    PubMed  CAS  Google Scholar 

  12. Huerta-Sil G, Casasola-Vargas JC, Londono JD, et al.: Low grade radiographic sacroiliitis as prognostic factor in patients with undifferentiated spondyloarthritis fulfilling diagnostic criteria for ankylosing spondylitis throughout follow up. Ann Rheum Dis 2006, 65:642–646.

    Article  PubMed  CAS  Google Scholar 

  13. Hermann KG, Landewé RB, Braun J, van der Heijde DM: Magnetic resonance imaging of inflammatory lesions in the spine in ankylosing spondylitis clinical trials: is paramagnetic contrast medium necessary? J Rheumatol 2005, 32:2056–2060.

    PubMed  Google Scholar 

  14. van der Heijde DM, Landewé RB, Hermann KG, et al.: Application of the OMERACT filter to scoring methods for magnetic resonance imaging of the sacroiliac joints and the spine. Recommendations for a research agenda at OMERACT 7. J Rheumatol 2005, 32:2042–2047.

    PubMed  Google Scholar 

  15. Appel H, Loddenkemper C, Grozdanovic Z, et al.: Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis. Arthritis Res Ther 2006, 8:R143.

    Article  PubMed  Google Scholar 

  16. Jee WH, McCauley TR, Lee SH, et al.: Sacroiliitis in patients with ankylosing spondylitis: Association of MR findings with disease activity. Magn Reson Imaging 2004, 22:245–250.

    Article  PubMed  Google Scholar 

  17. Puhakka KB, Jurik AG, Schiottz-Christensen B, et al.: Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings. Rheumatology 2004, 43:234–237.

    Article  PubMed  CAS  Google Scholar 

  18. Bollow M, Hermann KG, Biedermann T, et al.: Very early spondyloarthritis: where the inflammation in the sacroiliac joints starts. Ann Rheum Dis 2005, 64:1644–1646.

    Article  PubMed  CAS  Google Scholar 

  19. Puhakka KB, Melsen F, Jurik AG, et al.: MR imaging of the normal sacroiliac joint with correlation to histology. Skeletal Radiol 2004, 33:15–28.

    Article  PubMed  CAS  Google Scholar 

  20. Baraliakos X, Landewé R, Hermann KG, et al.: Inflammation in ankylosing spondylitis: A systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging. Ann Rheum Dis 2005, 64:730–734.

    Article  PubMed  CAS  Google Scholar 

  21. Crowther SM, Lambert RG, Dhillon SS, et al.: High frequency of inflammatory lesions in the posterior structures of the spine in patients with ankylosing spondylitis: A systematic evaluation by MRI [abstract]. Arthritis Rheum 2006, 54(Suppl):S793.

    Google Scholar 

  22. Maksymowych WP, Rennie WJ, Dhillon SS, et al.: Is the costo-vertebral joint the primary site of inflammation in the thoracic spine of patients with ankylosing spondylitis? A systematic evaluation by MRI [abstract]. Arthritis Rheum 2006, 54(Suppl):S474.

    Google Scholar 

  23. Zochling J, van der Heijde D, Burgos-Vargas R, et al.: ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2006, 65:442–452.

    Article  PubMed  CAS  Google Scholar 

  24. Lukas C, Braun J, van der Heijde D, et al.: Scoring inflammatory activity of the spine by magnetic resonance imaging in ankylosing spondylitis: A multireader experiment. J Rheumatol 2007, 34:862–870.

    PubMed  Google Scholar 

  25. Maksymowych WP, Dhillon SS, Park R, et al.: Validation of the Spondyloarthritis Research Consortium of Canada magnetic resonance imaging spinal inflammation index: Is it necessary to score the entire spine? Arthritis Care Res 2007, 57:501–507.

    Article  Google Scholar 

  26. Rudwaleit M, van der Heijde D, Khan MA, et al.: How to diagnose axial spondyloarthritis early. Ann Rheum Dis 2004, 63:535–543.

    Article  PubMed  CAS  Google Scholar 

  27. Rudwaleit M, Vahldiek J, Wenz J, et al.: Sensitivity and specificity of magnetic resonance imaging of the sacroiliac joints in patients with suspected early ankylosing spondylitis [abstract]. Arthritis Rheum 2006, 54(Suppl):S793.

    Google Scholar 

  28. Heuft-Dorenbosch L, Landewé R, Weijers R, et al.: Combining information obtained from magnetic resonance imaging and conventional radiographs to detect sacroiliitis in patients with recent onset inflammatory back pain. Ann Rheum Dis 2006, 65:804–808.

    Article  PubMed  CAS  Google Scholar 

  29. Heuft-Dorenbosch L, Landewé R, Weijers R, et al.: Performance of various criteria sets in patients with inflammatory back pain of short duration; the Maastricht early spondyloarthritis clinic. Ann Rheum Dis 2007, 66:92–98.

    Article  PubMed  CAS  Google Scholar 

  30. Oostveen J, Prevo R, den Boer J, et al.: Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study. J Rheumatol 1999, 26:1953–1958.

    PubMed  CAS  Google Scholar 

  31. Braun J, Landewé R, Hermann KG, et al.: Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab: results of a multicenter, randomized, double-blind, placebo-controlled magnetic resonance imaging study. Arthritis Rheum 2006, 54:1646–1652.

    Article  PubMed  CAS  Google Scholar 

  32. Baraliakos X, Brandt J, Listing J, et al.: Outcome of patients with active ankylosing spondylitis after two years of therapy with etanercept: clinical and magnetic resonance imaging data. Arthritis Rheum 2005, 53:856–863.

    Article  PubMed  CAS  Google Scholar 

  33. Lambert RG, Salonen DC, Rahman P, et al.: Adalimumab reduces spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis (AS): 52-week magnetic resonance imaging (MRI) results from the Canadian AS study [abstract]. Arthritis Rheum 2006, 54:S799.

    Google Scholar 

  34. Weber U, Pfirrmann CW, Kissling RO, et al.: Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis. BMC Musculoskelet Disord 2007, 8:20.

    Article  PubMed  Google Scholar 

  35. Lambert RG, Dhillon SS, Jhangri GS, et al.: High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease. Arthritis Care Res 2004, 51:681–690.

    Article  Google Scholar 

  36. Jurik AG, Hansen J, Puhakka KB: Effective radiation dose from semicoronal CT of the sacroiliac joints in comparison with axial CT and conventional radiography. Eur Radiol 2002, 12:2820–2825.

    PubMed  Google Scholar 

  37. Koivikko MP, Kiuru MJ, Koskinen SK: Multidetector computed tomography of cervical spine fractures in ankylosing spondylitis. Acta Radiol 2004, 7:751–759.

    Article  Google Scholar 

  38. Wang YF, Teng MM, Chang CY, et al.: Imaging manifestations of spinal fractures in ankylosing spondylitis. AJNR Am J Neuroradiol 2005, 26:2067–2076.

    PubMed  Google Scholar 

  39. Inanc N, Atagunduz P, Sen F, et al.: The investigation of sacroiliitis with different imaging techniques in spondyloarthropathies. Rheumatol Int 2005, 25:591–594.

    Article  PubMed  CAS  Google Scholar 

  40. Grigoryan M, Roemer FW, Mohr A, Genant HK: Imaging in spondyloarthropathies. Curr Rheumatol Rep 2004, 6:102–109.

    Article  PubMed  Google Scholar 

  41. Wendling D, Blagosklonov O, Streit G, et al.: FDG-PET/CT scan of inflammatory spondylodiscitis lesions in ankylosing spondylitis, and short term evolution during anti-tumor necrosis factor treatment. Ann Rheum Dis 2005, 64:1663–1665.

    Article  PubMed  CAS  Google Scholar 

  42. Ozgocmen S, Kiris A, Ardicoglu O, et al.: Glucocorticoid iontophoresis for Achilles tendon enthesitis in ankylosing spondylitis: significant response documented by power Doppler ultrasound. Rheumatol Int 2005, 25:158–160.

    Article  PubMed  Google Scholar 

  43. Ory PA, Gladman DD, Mease PJ: Psoriatic arthritis and imaging. Ann Rheum Dis 2005, 64(Suppl II):ii55–ii57.

    Article  PubMed  Google Scholar 

  44. Kane D: The role of ultrasound in the diagnosis and management of psoriatic arthritis. Curr Rheumatol Rep 2005, 7:319–324.

    Article  PubMed  Google Scholar 

  45. Kiris A, Kaya A, Ozgocmen S, et al.: Assessment of enthesitis in ankylosing spondylitis by power Doppler ultrasonography. Skeletal Radiol 2006, 35:522–528.

    Article  PubMed  Google Scholar 

  46. Unlu E, Pamuk ON, Cakir N: Color and duplex Doppler sonography to detect sacroiliitis and spinal inflammation in ankylosing spondylitis. Can this method reveal response to anti-tumor necrosis factor therapy? J Rheumatol 2007, 34:110–116.

    PubMed  Google Scholar 

  47. Klauser A, Halpern EJ, Frauscher F, et al.: Inflammatory low back pain: high negative predictive value of contrast-enhanced color Doppler ultrasound in the detection of inflamed sacroiliac joints. Arthritis Care Res 2005, 53:440–444.

    Article  Google Scholar 

  48. Baek HJ, Kang SW, Lee YJ, et al.: Osteopenia in men with mild and severe ankylosing spondylitis. Rheumatol Int 2005, 26:30–34.

    Article  PubMed  CAS  Google Scholar 

  49. Marzo-Ortega H, McGonagle D, Jarret S, et al.: Infliximab in combination with methotrexate in active ankylosing spondylitis: A clinical and imaging study. Ann Rheum Dis 2005, 64:1568–1575.

    Article  PubMed  CAS  Google Scholar 

  50. Jun JB, Joo KB, Her MY, et al.: Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitis: A cross-sectional study. J Rheumatol 2006, 33:1637–1641.

    PubMed  Google Scholar 

  51. Rudwaleit M, Metter A, Listing J, et al.: Inflammatory back pain in ankylosing spondylitis. A reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 2006, 54:569–578.

    Article  PubMed  Google Scholar 

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Correspondence to Ulrich Weber.

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Weber, U., Kissling, R.O. & Hodler, J. Advances in musculoskeletal imaging and their clinical utility in the early diagnosis of spondyloarthritis. Curr Rheumatol Rep 9, 353–360 (2007). https://doi.org/10.1007/s11926-007-0057-3

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