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Recent Advances in Imaging of the Axial Skeleton in Spondyloarthritis for Diagnosis, Assessment of Treatment Effect, and Prognostication

  • Imaging (P Conaghan, Section Editor)
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Abstract

In the last few years, many studies have investigated the role of imaging for improved diagnosis, assessment of treatment effects, and determining prognosis in patients with axial spondyloarthritis (SpA). Recent research has primarily focused on the utility of magnetic resonance imaging (MRI) for improved diagnosis of patients with non-radiographic axial SpA, and in particular on the classification utility of the MRI criteria as defined by the Assessment of Spondyloarthritis International Society (ASAS). New and more sensitive methods for evaluation of MRI of the sacroiliac joints have been developed and have provided insight into effects of treatment on structural progression and the interrelationships between different lesions visualized by MRI. This review gives an overview of the recent advances in imaging of the axial skeleton in axial SpA from a clinical perspective.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Rudwaleit M, Landewe R, Van Der Heijde D, Listing J, Brandt J, Braun J, et al. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68:770–6.

    Article  CAS  PubMed  Google Scholar 

  2. Rudwaleit M, Van Der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777–83.

    Article  CAS  PubMed  Google Scholar 

  3. Sieper J, Van Der Heijde D, Dougados M, Mease PJ, Maksymowych WP, Brown MA, et al. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Ann Rheum Dis. 2013;72:815–22.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Song IH, Weiss A, Hermann KG, Haibel H, Althoff CE, Poddubnyy D, et al. Similar response rates in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis after 1 year of treatment with etanercept: results from the ESTHER trial. Ann Rheum Dis. 2013;72:823–5.

    Article  CAS  PubMed  Google Scholar 

  5. Landewe R, Braun J, Deodhar A, Dougados M, Maksymowych WP, Mease PJ, et al. Efficacy of certolizumab pegol on signs and symptoms of axial spondyloarthritis including ankylosing spondylitis: 24-week results of a double-blind randomised placebo-controlled phase 3 study. Ann Rheum Dis. 2014;73:39–47.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Maksymowych WP, Wichuk S, Chiowchanwisawakit P, Lambert RG, Pedersen SJ. Development and preliminary validation of the spondyloarthritis research consortium of Canada magnetic resonance imaging sacroiliac joint structural score. J Rheumatol. 2015;42:79–86.

    Article  PubMed  Google Scholar 

  7. Pedersen SJ, Wichuk S, Chiowchanwisawakit P, Lambert RG, Maksymowych WP. Tumor necrosis factor inhibitor therapy but not standard therapy is associated with resolution of erosion in the sacroiliac joints of patients with axial spondyloarthritis. Arthritis Res Ther. 2014;16:R100. Investigates the association between MRI lesions in the sacroiliac joints over 2 years in patients treated with and without tumor-necrosis-factor-alpha inhibitor.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34:1218–27.

    Article  CAS  PubMed  Google Scholar 

  9. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361–8.

    Article  PubMed  Google Scholar 

  10. Rudwaleit M, Jurik AG, Hermann KG, Landewe R, Van Der Heijde D, Baraliakos X, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis. 2009;68:1520–7.

    Article  CAS  PubMed  Google Scholar 

  11. van den Berg R, Lenczner G, Thevenin F, Claudepierre P, Feydy A, Reijnierse M et al. Classification of axial SpA based on positive imaging (radiographs and/or MRI of the sacroiliac joints) by local rheumatologists or radiologists versus central trained readers in the DESIR cohort. Ann Rheum Dis 2014. The study investigates the consequence of the disagreement of local radiologist versus central trained readers in evaluation of conventional radiography and MRI for classification of patients with axial SpA according to the ASAS criteria.

  12. van den Berg R, Lenczner G, Feydy A, Van Der Heijde D, Reijnierse M, Saraux A, et al. Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR cohort. Arthritis Rheumatol. 2014;66:2403–11. This study investigates the agreement between local radiologist and central trained readers in reading conventional radiography according to the modified New York criteria.

    Article  PubMed  Google Scholar 

  13. Jans L, Van PL, Elewaut D, Van Den Bosch F, Carron P, Jaremko JL, et al. MRI of the SI joints commonly shows non-inflammatory disease in patients clinically suspected of sacroiliitis. Eur J Radiol. 2014;83:179–84. Investigates the frequency of other conditions associated with sacroiliitis on MRI in patients suspected for axial SpA.

    Article  CAS  PubMed  Google Scholar 

  14. Weber U, Zhao Z, Rufibach K, Zubler V, Lambert RG, Chan SM, et al. Diagnostic utility of candidate definitions for demonstrating axial spondyloarthritis on magnetic resonance imaging of the spine. Arthritis Rheumatol. 2015;67:924–33. Investigates the diagnostic utility of the ASAS definition of a positive MRI of the spine.

    Article  PubMed  Google Scholar 

  15. Weber U, Ostergaard M, Lambert RG, Pedersen SJ, Chan SM, Zubler V et al. Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis. Ann Rheum Dis 2014. Data driven proposal for a definition of a positive MRI of the sacroiliac joints.

  16. Weber U, Zubler V, Zhao Z, Lambert RG, Chan SM, Pedersen SJ, et al. Does spinal MRI add incremental diagnostic value to MRI of the sacroiliac joints alone in patients with non-radiographic axial spondyloarthritis? Ann Rheum Dis. 2015;74(6):985–92. Study on the additional value of MRI of the spine to MRI of the sacroiliac joints.

    Article  PubMed  Google Scholar 

  17. Weber U, Pedersen SJ, Zubler V, Rufibach K, Chan SM, Lambert RG, et al. Fat infiltration on magnetic resonance imaging of the sacroiliac joints has limited diagnostic utility in nonradiographic axial spondyloarthritis. J Rheumatol. 2014;41:75–83. Study on the diagnostic utility of fat lesions in the sacroiliac joints.

    Article  PubMed  Google Scholar 

  18. Weber U, Zubler V, Pedersen SJ, Rufibach K, Lambert RG, Chan SM, et al. Development and validation of a magnetic resonance imaging reference criterion for defining a positive sacroiliac joint magnetic resonance imaging finding in spondyloarthritis. Arthritis Care Res. 2013;65:977–85. Describes a data driven development of MRI criteria for axial SpA.

    Article  CAS  Google Scholar 

  19. Weber U, Lambert RG, Pedersen SJ, Hodler J, Ostergaard M, Maksymowych WP. Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res. 2010;62:1763–71.

    Article  Google Scholar 

  20. Jans L, van Langenhove C, Van Praet L, Carron P, Elewaut D, Van Den Bosch F, et al. Diagnostic value of pelvic enthesitis on MRI of the sacroiliac joints in spondyloarthritis. Eur Radiol. 2014;24:866–71.

    Article  CAS  PubMed  Google Scholar 

  21. Hermann KG, Baraliakos X, van der Heijde DM, Jurik AG, Landewe R, Marzo-Ortega H, et al. Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. Ann Rheum Dis. 2012;71:1278–88. The paper from ASAS about the definition of a positive MRI of the spine.

    Article  PubMed  Google Scholar 

  22. Aydin SZ, Maksymowych WP, Bennett AN, McGonagle D, Emery P, Marzo-Ortega H. Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years. Ann Rheum Dis. 2012;71:56–60. Investigates the prognostic value of the ASAS criteria for a positive MRI of the sacroiliac joints.

    Article  PubMed  Google Scholar 

  23. Weber U, Lambert RG, Ostergaard M, Hodler J, Pedersen SJ, Maksymowych WP. The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum. 2010;62:3048–58.

    Article  PubMed  Google Scholar 

  24. Weber U, Hodler J, Kubik RA, Rufibach K, Lambert RG, Kissling RO, et al. Sensitivity and specificity of spinal inflammatory lesions assessed by whole-body magnetic resonance imaging in patients with ankylosing spondylitis or recent-onset inflammatory back pain. Arthritis Rheum. 2009;61:900–8.

    Article  PubMed  Google Scholar 

  25. Bennett AN, Rehman A, Hensor EM, Marzo-Ortega H, Emery P, McGonagle DG. The fatty romanus lesion—a non-inflammatory spinal MRI lesion specific for axial-spondyloarthropathy. Ann Rheum Dis. 2011;70:1519. The first study on the diagnostic utility of fat lesions of the spine for diagnosing axial SpA.

    Article  Google Scholar 

  26. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ArthritisAdvisoryCommittee/UCM366517.pdf 2015.

  27. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ArthritisAdvisoryCommittee/UCM366519.pdf 2015.

  28. Madsen KB, Jurik AG. Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint. Arthritis Care Res. 2010;62:11–8.

    Article  Google Scholar 

  29. Song IH, Hermann KG, Haibel H, Althoff CE, Poddubnyy D, Listing J, et al. Relationship between active inflammatory lesions in the spine and sacroiliac joints and new development of chronic lesions on whole-body MRI in early axial spondyloarthritis: results of the ESTHER trial at week 48. Ann Rheum Dis. 2011;70:1257–63.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Wanders AJ, Landewe RB, Spoorenberg A, Dougados M, van der Linden S, Mielants H, et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the outcome measures in rheumatology clinical trials filter. Arthritis Rheum. 2004;50:2622–32.

    Article  PubMed  Google Scholar 

  31. Maksymowych WP, Wichuk S, Chiowchanwisawakit P, Lambert RG, Pedersen SJ. Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis. Arthritis Rheumatol. 2014;66:2958–67. Investigates the association between MRI lesions in the sacroiliac joints over 2 years.

    Article  PubMed  Google Scholar 

  32. Baraliakos X, Listing J, Rudwaleit M, Sieper J, Braun J. The relationship between inflammation and new bone formation in patients with ankylosing spondylitis. Arthritis Res Ther. 2008;10:R104.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Baraliakos X, Heldmann F, Callhoff J, Listing J, Appelboom T, Brandt J et al. Which spinal lesions are associated with new bone formation in patients with ankylosing spondylitis treated with anti-TNF agents? A long-term observational study using MRI and conventional radiography. Ann Rheum Dis 2013.

  34. Chiowchanwisawakit P, Lambert RG, Conner-Spady B, Maksymowych WP. Focal fat lesions at vertebral corners on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis. Arthritis Rheum. 2011;63:2215–25.

    Article  PubMed  Google Scholar 

  35. Maksymowych WP, Chiowchanwisawakit P, Clare T, Pedersen SJ, Ostergaard M, Lambert RG. Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation. Arthritis Rheum. 2009;60:93–102.

    Article  PubMed  Google Scholar 

  36. Maksymowych WP, Morency N, Conner-Spady B, Lambert RG. Suppression of inflammation and effects on new bone formation in ankylosing spondylitis: evidence for a window of opportunity in disease modification. Ann Rheum Dis. 2013;72:23–8.

    Article  PubMed  Google Scholar 

  37. Pedersen SJ, Chiowchanwisawakit P, Lambert RG, Ostergaard M, Maksymowych WP. Resolution of inflammation following treatment of ankylosing spondylitis is associated with new bone formation. J Rheumatol. 2011;38:1349–54.

    Article  CAS  PubMed  Google Scholar 

  38. Ramiro S, van Tubergen A, Van Der Heijde D, Stolwijk C, Bookelman G, Dougados M, et al. Brief report: erosions and sclerosis on radiographs precede the subsequent development of syndesmophytes at the same site: a twelve-year prospective followup of patients with ankylosing spondylitis. Arthritis Rheumatol. 2014;66:2773–9. Investigates the association between spinal lesions on conventional radiography and progression of radiographic damage.

    Article  PubMed  Google Scholar 

  39. Ramiro S, Stolwijk C, van Tubergen A, Van Der Heijde D, Dougados M, Van Den Bosch F, et al. Evolution of radiographic damage in ankylosing spondylitis: a 12 year prospective follow-up of the OASIS study. Ann Rheum Dis. 2015;74:52–9. Describes radiographic progression and investigates its association with several clinical variables.

    Article  PubMed  Google Scholar 

  40. Ramiro S, Van Der Heijde D, van Tubergen A, Stolwijk C, Dougados M, Van Den Bosch F, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis. 2014;73:1455–61. Investigates the association between structural progression on radiography and disease activity.

    Article  PubMed  Google Scholar 

  41. Baraliakos X, Listing J, von der Recke A, Braun J. The natural course of radiographic progression in ankylosing spondylitis—evidence for major individual variations in a large proportion of patients. J Rheumatol. 2009;36:997–1002.

    Article  PubMed  Google Scholar 

  42. Cortes A, Maksymowych WP, Wordsworth BP, Inman RD, Danoy P, Rahman P et al. Association study of genes related to bone formation and resorption and the extent of radiographic change in ankylosing spondylitis. Ann Rheum Dis 2014.

  43. Bennett AN, Rehman A, Hensor EM, Marzo-Ortega H, Emery P, McGonagle D. Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondylarthritis. Arthritis Rheum. 2009;60:1331–41. Study on the diagnostic utility of bone marrow edema in the spine for diagnosing axial SpA.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Walter P. Maksymowych has received honoraria and/or research grants from Abbvie, Amgen, Boehringer, Eli-Lilly, Janssen, Pfizer, UCB.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

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Authors and Affiliations

  1. Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, University of Copenhagen, Ndr. Ringvej 57, 2600, Glostrup, Copenhagen, Denmark

    Susanne Juhl Pedersen

  2. Department of Medicine, University of Alberta, 562 Heritage Medical Research Building, Edmonton, Alberta, T6G 2S2, Canada

    Walter P. Maksymowych

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  1. Susanne Juhl Pedersen
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  2. Walter P. Maksymowych
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Correspondence to Walter P. Maksymowych.

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Pedersen, S.J., Maksymowych, W.P. Recent Advances in Imaging of the Axial Skeleton in Spondyloarthritis for Diagnosis, Assessment of Treatment Effect, and Prognostication. Curr Rheumatol Rep 17, 60 (2015). https://doi.org/10.1007/s11926-015-0531-2

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