Progress in Spondylarthritis. Spondyloarthritis: Lessons From Imaging
Progress in Spondylarthritis. Spondyloarthritis: Lessons From Imaging
The advent of magnetic resonance imaging (MRI) and advanced sonographic techniques has led to a resurgence of interest in the role of imaging in the evaluation and management of spondyloarthritis. Radiography remains the cornerstone of diagnosis although MRI is more sensitive in early stages of the disease. Inflammatory changes in the sacroiliac joints and spine can now be reliably quantified and can also predict the subsequent development of radiographic changes in the corresponding locations. MRI-based scoring systems for inflammation are highly responsive, facilitating proof-of-concept studies of new therapies for spondyloarthritis. Assessment of chronic changes is much less reliable using MRI, while assessment using radiography lacks sensitivity to change. Assessment of disease modification therefore remains a principle challenge in the development of new therapies for ankylosing spondylitis. Ultrasound may be the preferred approach to the assessment of peripheral inflammation, especially enthesitis. Scintigraphy and computed tomography offer few advantages over MRI.
Spondyloarthritis (SpA) is a group of inflammatory disorders that primarily affect the sacroiliac joint (SIJ) structures of the spine, large peripheral joints, and entheses, that are associated with the HLA-B27 gene. Most clinicians still use imaging primarily to evaluate structural abnormalities in the axial skeleton. Recent advances, however, now permit the object evaluation of inflammation and its sequelae in both the axial and peripheral skeleton. Five principle methods can be used to evaluate patients with SpA: plain radiography, computed tomography (CT), scintigraphy, ultrasound, and magnetic resonance imaging (MRI). The present review will address the key lessons learnt from studies evaluating each of these imaging modalities according to the following questions: What pathological feature is best shown by each method? What does each method tell us about the pathophysiology of disease? How does each method facilitate evaluation of patients presenting early in their disease course? What are the advantages and limitations of outcome assessment tools developed for each method?
Clarifying the answers to these questions constitutes a prerequisite to understanding how each modality may influence diagnostic and therapeutic decisions by the practicing clinician, how each modality may assist the clinician researcher in the assessment of prognostic factors and therapeutic interventions, and how the basic scientist might approach the examination of immunopathological events occurring early in disease.
Abstract and Introduction
Abstract
The advent of magnetic resonance imaging (MRI) and advanced sonographic techniques has led to a resurgence of interest in the role of imaging in the evaluation and management of spondyloarthritis. Radiography remains the cornerstone of diagnosis although MRI is more sensitive in early stages of the disease. Inflammatory changes in the sacroiliac joints and spine can now be reliably quantified and can also predict the subsequent development of radiographic changes in the corresponding locations. MRI-based scoring systems for inflammation are highly responsive, facilitating proof-of-concept studies of new therapies for spondyloarthritis. Assessment of chronic changes is much less reliable using MRI, while assessment using radiography lacks sensitivity to change. Assessment of disease modification therefore remains a principle challenge in the development of new therapies for ankylosing spondylitis. Ultrasound may be the preferred approach to the assessment of peripheral inflammation, especially enthesitis. Scintigraphy and computed tomography offer few advantages over MRI.
Introduction
Spondyloarthritis (SpA) is a group of inflammatory disorders that primarily affect the sacroiliac joint (SIJ) structures of the spine, large peripheral joints, and entheses, that are associated with the HLA-B27 gene. Most clinicians still use imaging primarily to evaluate structural abnormalities in the axial skeleton. Recent advances, however, now permit the object evaluation of inflammation and its sequelae in both the axial and peripheral skeleton. Five principle methods can be used to evaluate patients with SpA: plain radiography, computed tomography (CT), scintigraphy, ultrasound, and magnetic resonance imaging (MRI). The present review will address the key lessons learnt from studies evaluating each of these imaging modalities according to the following questions: What pathological feature is best shown by each method? What does each method tell us about the pathophysiology of disease? How does each method facilitate evaluation of patients presenting early in their disease course? What are the advantages and limitations of outcome assessment tools developed for each method?
Clarifying the answers to these questions constitutes a prerequisite to understanding how each modality may influence diagnostic and therapeutic decisions by the practicing clinician, how each modality may assist the clinician researcher in the assessment of prognostic factors and therapeutic interventions, and how the basic scientist might approach the examination of immunopathological events occurring early in disease.
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