DESCRIPTION:
Learning Objectives

1. To demonstrate that routine spine MRI for lower back pain is not sufficient for finding osteitis in spondyloarthritis.
2. To understand the MRI signs in lumbosacral spondyloarthritis.

Abstract

Spondyloarthropathies (SpA) include a group of long-term (chronic) diseases of joints as well as the spine and sacroiliac joints. It is divided into axial spondyloarthritis axSpA (ankylosing spondylitis AS) and peripheral spondyloarthritis. They share clinical and radiologic manifestations as well as familial aggregation and a strong association with HLA B27 antigen. Inflammatory back pain is the leading symptom of the SpA. ASAS criteria to diagnose axial SpA include MRI of sacroiliac joints to find bone marrow oedema (BME). However, MRI-identified structural lesions are not included (contradictory due to the fact that it is criteria in simple x-ray) as neither are spinal lesions. 23% to 50% of patients with ankylosing spondylitis (with disease clinically active) or “non-radiographic’’ axial SpA can have acute spinal inflammatory lesions without evidence of acute sacroiliitis by MRI. Chronic back pain is often investigated by nonrheumatologists and SI joint scanning may be excluded. On the other hand, ASAS criteria only evaluate sacroiliac joints leaving spine without evaluation. Are current criteria sufficiently capable of including all those patients with potential diagnosis of spondyloarthropathies? In any case, what can modify to achieve a greater range of sensitivity in our studies?