Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group

Rudwaleit, Martín; Jurik, Anne Grethe; Hermann, Kay-Geert A.; Landewé, Robert; Heijde, Desirée van der; Baraliakos, Xenofon; Marzo‐Ortega, Helena; Østergaard, Mikkel; Braun, Jürgen; Sieper, Joachim

doi:10.1136/ard.2009.110767

Cited by 755 publications

(609 citation statements)

References 30 publications

(33 reference statements)

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“…The ASAS definition of active inflammatory lesions (bone marrow edema/osteitis) states that lesions should be clearly present and located in typical anatomic areas and that the stronger the hyperintense signal, the more likely it reflects active inflammation (12). In this regard, we can differentiate in the spectrum of a positive MRI, as defined by the ASAS criteria, between lesions which are highly suggestive of SpA and lesions which are merely compatible with a diagnosis of SpA.…”

Section: Discussionmentioning

confidence: 99%

Brief Report: Six‐Week Treatment of Axial Spondyloarthritis Patients With an Optimal Dose of Nonsteroidal Antiinflammatory Drugs: Early Response to Treatment in Signal Intensity on Magnetic Resonance Imaging of the Sacroiliac Joints

Varkas

Jans

Cypers

et al. 2016

Arthritis & Rheumatology

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Objective. To evaluate the early effect of full-dose nonsteroidal antiinflammatory drugs (NSAIDs) on the extent and intensity of bone marrow edema of the sacroiliac (SI) joints on magnetic resonance imaging (MRI) in axial spondyloarthritis (SpA).Methods. A single-center, 6-week study of a cohort of consecutive patients with clinically suspected axial SpA was conducted. A total of 117 patients were screened. Forty patients who were diagnosed as having axial SpA and had presented with a positive MRI of the SI joints as defined by the Assessment of SpondyloArthritis international Society (ASAS) criteria were considered for a followup MRI after 6 weeks of an optimal dose of NSAIDs. Twenty patients completed the study. Disease activity was monitored by determining the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score every 2 weeks and the Bath Ankylosing Spondylitis Functional Index score at baseline and week 6. NSAID intake was assessed by the ASAS NSAID index. Primary end points were improvement in bone marrow edema of the SI joints on MRI and BASDAI response at week 6.Results. Approximately one-third of eligible patients newly diagnosed as having axial SpA were unable to continue the full-dose NSAID schedule. The median NSAID index was 97% in patients who completed the study. There was a reduction of 1.1 units (10.5%) in mean SpondyloarthritisResearch Consortium of Canada (SPARCC) scores at week 6 in comparison to baseline (P 5 0.032). Overall, only 30% of the patients (6 of 20) had a minimal clinically important difference of ‡2.5 in SPARCC score. However, 80% of the patients displayed high-intensity lesions on STIR images at baseline, which decreased significantly at week 6 (P 5 0.011). There was a significant decrease in the relative intensity of the region of interest (P 5 0.007) and a mean decrease of 0.6 in the BASDAI score per 2 weeks of therapy (P 5 0.001). Only 29.4% of the patients met the BASDAI criteria for 50% improvement (BASDAI50) at week 6.Conclusion. Our findings indicate a high level of dropout among patients receiving full-dose NSAID therapy in daily practice. In those who tolerated NSAID therapy, there was no clinically relevant decrease in SPARCC scores and low BASDAI50 response. However, we found a decrease in signal intensity of bone marrow edema of the SI joints as an early response to 6 weeks of optimal NSAID therapy in patients newly presenting with axial SpA.

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Section: Discussionmentioning

confidence: 99%

Brief Report: Six‐Week Treatment of Axial Spondyloarthritis Patients With an Optimal Dose of Nonsteroidal Antiinflammatory Drugs: Early Response to Treatment in Signal Intensity on Magnetic Resonance Imaging of the Sacroiliac Joints

Varkas

Jans

Cypers

et al. 2016

Arthritis & Rheumatology

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“…The definition of a positive SI joint MRI finding in the ASAS criteria was generated by consensus among experts and is entirely based on the presence of bone marrow edema (BME) on the STIR sequence or osteitis on the T1-weighted gadoliniumenhanced sequence (2). Studies using a data-driven approach to defining a positive SI joint MRI finding are scarce (3).…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Magnetic Resonance Imaging Reference Criterion for Defining a Positive Sacroiliac Joint Magnetic Resonance Imaging Finding in Spondyloarthritis

Weber

Zubler

Pedersen

et al. 2013

Arthritis Care & Research

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Using this MRI reference criterion, the cutoff for the number of affected SI joint quadrants needed to reach a predefined specificity of >0.90 was >2 for bone marrow edema (BME) in both cohorts and >1 for erosion in both cohorts, and the BME and/or erosion lesions increased sensitivity without reducing specificity. Conclusion. This data-driven study using 2 inception cohorts and comparing clinical and MRI-based classification supports the case for including both erosion and BME to define a positive SI joint MRI finding for the classification of axial SpA.

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“…Alternatively, if contrast medium administration is not possible, a short tau inversion recovery (STIR) sequence may be used. As a recommendation of the ASAS group, a T1-weighted TSE sequence and a STIR sequence are sufficient for MRI of the sacroiliac joints [28]. However, these recommendations are intended to be applicable worldwide and therefore may be regarded as the "minimal standard".…”

mentioning

confidence: 99%

“…The size of the bone marrow area affected by osteitis is a measure of the inflammatory activity of sacroiliitis and is graded by using semiquantitative techniques [25]. Osteitis is also currently the only parameter that defines a positive MRI finding in the classification of the ASAS group, especially when it is present in two or more slices [28]. The signal intensity of osteitis varies with the interval between image acquisition and contrast medium injection ( • " Fig.…”

mentioning

confidence: 99%

Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and Histology

Hermann

Bollow²

2013

Fortschr Röntgenstr

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Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group.?Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings. Citation Format: ??Hermann KGA, Bollow M. Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and Histology. Fortschr R?ntgenstr 2014; 186: 230???237

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Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group

Cited by 755 publications

References 30 publications

Brief Report: Six‐Week Treatment of Axial Spondyloarthritis Patients With an Optimal Dose of Nonsteroidal Antiinflammatory Drugs: Early Response to Treatment in Signal Intensity on Magnetic Resonance Imaging of the Sacroiliac Joints

Brief Report: Six‐Week Treatment of Axial Spondyloarthritis Patients With an Optimal Dose of Nonsteroidal Antiinflammatory Drugs: Early Response to Treatment in Signal Intensity on Magnetic Resonance Imaging of the Sacroiliac Joints

Development and Validation of a Magnetic Resonance Imaging Reference Criterion for Defining a Positive Sacroiliac Joint Magnetic Resonance Imaging Finding in Spondyloarthritis

Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and Histology

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