Imaging in spondyloarthritis

Abstract

The role of imaging in the evaluation and management of SpA has experienced a resurgence of interest with the introduction of MRI and more sophisticated sonographic technologies. Several approaches have been developed to score plain radiographic abnormalities in the spine and sacroiliac joints of patients with SpA and this approach remains the standard for assessment of structural damage. The modified Stoke AS Spinal Score (mSASSS) is the most responsive outcome instrument for scoring damage in the spine although responsiveness is limited and requires a minimum of 2 years before significant change becomes apparent in patients on standard therapies. Magnetic resonance imaging (MRI) is the most sensitive imaging abnormality for the detection of inflammation and the advent of fat suppression imaging allows detection of bone marrow inflammation in the sacroiliac joints as one of the earliest abnormalities in AS. Spinal inflammation can now be reliably scored using MRI-based outcome instruments that are highly sensitive to change and this represents a major advance in the objective evaluation of new therapeutic interventions. Moreover, MRI now allows the detection of patients at an earlier stage of their disease course with the potential for new insights into the pathogenesis of disease. Ultrasound provides a more feasible and cost-effective approach to the assessment of peripheral inflammation, especially enthesitis. © 2009 Landes Bioscience and Springer Science+Business Media.