Association between inflammatory back pain features, acute and structural sacroiliitis on MRI, and the diagnosis of spondyloarthritis

  • Shaye Kivity
  • Shany Guly Gofrit
  • Fadi abu Baker
  • Naama Leibushor
  • Shahar Tavor
  • Merav Lidar
  • Iris Eshed
Original Article



To evaluate the association between inflammatory back pain (IBP) features, acute and structural MRI findings suggestive of sacroiliitis, and diagnosis of spondyloarthritis (SpA).


Data from 224 patients who underwent MRI for suspected sacroiliitis (2005–2015) was retrospectively reviewed by an expert rheumatologist for the presence of IBP features and for clinical standard of reference diagnosis. A telephone questionnaire was performed in cases of missing data. Acute and structural MRI parameters were scored by an experienced radiologist for the presence of sacroiliitis using the Assessment of Spondyloarthritis International Society (ASAS) criteria, Berlin score, and observer’s global impression (GI) scores. Association between IBP features and MRI scores, and odds ratio for SpA diagnosis, were calculated.


One hundred ninety-three subjects were included (119 F:74 M, mean age 39.7 ± 15.6, mean follow-up 49 ± 18 months). Fifty-two (26.9%) subjects were diagnosed with SpA. IBP scores were significantly higher in SpA patients (p < 0.001). IBP, ASAS, and GI MRI scores were significantly associated with the SpA diagnosis (p < 0.001 for all). The presence of night pain and morning stiffness was significantly associated with sacroiliac-joints’ bone marrow edema (BME, p < 0.05). Sensitivity for diagnosis of SpA was high for IBP (96%) and low for the MRI parameters (26.9–57.4%), and specificity was low for IBP (32%) and high for the MRI parameters (88.3–94.3%).


The presence of IBP features is highly associated with diagnosis of SpA and correlates with MRI BME, all probably reflect inflammation. The combination of IBP and MRI should be the cornerstone in the clinician’s final diagnosis of SpA.


Axial spondyloarthropathy Inflammatory back pain MRI Sacroiliitis 


Compliance with ethical standards

The study was conducted according to the guidelines of the Declaration of Helsinki and approval of the institute’s review board (9192-11-SMC), allowing for the retrospective retrieval of data, analysis of MRI examinations, and performance of telephone interviews. Due to the retrospective nature of this study, informed consent was waived.




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Shaye Kivity
    • 1
    • 2
    • 3
    • 4
  • Shany Guly Gofrit
    • 1
  • Fadi abu Baker
    • 5
  • Naama Leibushor
    • 2
  • Shahar Tavor
    • 6
  • Merav Lidar
    • 2
    • 4
  • Iris Eshed
    • 4
    • 7
  1. 1.Department of Medicine ASheba Medical CenterRamat GanIsrael
  2. 2.Rheumatology UnitThe Zabludowicz Center for Autoimmune DiseasesRamat GanIsrael
  3. 3.The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013Ramat GanIsrael
  4. 4.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  5. 5.Gastroenterology and Hepatology InstituteHillel Yaffe Medical Center, affiliated to the Ruth and Rappaport Faculty of MedicineHaifaIsrael
  6. 6.Hebrew UniversityJerusalemIsrael
  7. 7.Department of Diagnostic ImagingSheba Medical CenterRamat GanIsrael

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