Preclinical Rheumatic Disease, An Issue of Rheumatic Disease Clinics, E-Book by Unknown

Author:Unknown
Language: eng
Format: epub
Publisher: Elsevier Health Sciences
Published: 2014-08-15T00:00:00+00:00

Imaging for earlier recognition of spondyloarthritis

Although MRI has revolutionized the imaging of axSpA, the specificity of some MRI lesions has not been clearly defined. Sacroiliac MRI lesions considered characteristic of SpA are bone marrow edema, capsulitis, synovitis, and enthesitis. In the spine, corner-based inflammatory lesions, end-plate lesions, diffuse vertebral body lesions, and spinous process bone marrow edema lesions are characteristic.33,34 However, an evaluation of 174 patients with back pain caused by SpA, degenerative arthritis, or malignancy demonstrated that any of the spinal lesions listed may be present in degenerative arthritis or malignancy.35 The spinal inflammatory lesions most suggestive of axSpA, as concluded by ASAS/OMERACT,36 are corner-based inflammatory lesions, anterior/posterior spondylitis in three or more sites, and end-plate lesions. With regard to sacroiliitis, a definition of a positive MRI has been proposed by the same group and is widely used.37 When applied to a cohort of 29 patients with early IBP and 18 control subjects, the ASAS definition of sacroiliitis gave a sensitivity of 79%, specificity of 89%, and likelihood ratio of 7.1.38 The MORPHO study found that the ASAS definition of a positive MRI using bone marrow edema only had a sensitivity of 67% and specificity of 88%. In this study, inclusion of erosions in the definition of a positive MRI improved sensitivity.39 Studies that have included needle biopsy of sacroiliac joints to confirm histologic sacroiliitis have found the specificity of MRI in confirming early sacroiliitis to be high (100%) but sensitivity was low (37.7%).40 The concept of preclinical (asymptomatic) radiologic disease has not been investigated in detail. However, sacroiliac joint lesions are observed in control subjects with no back pain35 and in one study of 35 patients with AS and 35 healthy control subjects, inflammatory SpA-like lesions occurred in 26% of control subjects.41 Asymptomatic radiographic sacroiliitis has been observed in up to 32% of patients with inflammatory bowel disease (IBD).42–44 Further prospective studies are required to investigate long-term outcomes in young patients presenting with back pain and in asymptomatic individuals with apparent inflammatory lesions on MRI. The definition of an inflammatory lesion may need to be reconsidered in the future.

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