Frequency and Anatomic Distribution of Magnetic Resonance Imaging Features in the Sacroiliac Joints of Young Athletes

Weber, Ulrich; Jurik, Anne Grethe; Zejden, Anna; Larsen, Eva Ladekjær; Jørgensen, Steen Hylgaard; Rufibach, Kaspar; Schioldan, C.; Schmidt-Olsen, Søren

doi:10.1002/art.40429

Cited by 149 publications

(51 citation statements)

References 33 publications

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“…For example, Weber and colleagues report BMO lesions in 27% of nonspecific back pain patients and 22% of healthy controls [19]. MRI-BMO lesions have also been shown to be common in recreational runners, elite ice hockey players, and women with postpartum back pain fulfilling the ASAS definition of active sacroiliitis and an ASAS-positive MRI of the sacroiliac joints can also occur in runners, women with postpartum back, and even healthy volunteers [21,22]. Our study therefore lends further support to the contention that "Not everything that glisters is gold (standard)" [23], as MR imaging is associated with significant false positive rates in assessment of chronic back pain.…”

Section: Discussionmentioning

confidence: 99%

MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

Liu

Xiao

et al. 2019

Clin Rheumatol

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Objectives To compare the performance of conventional radiography, ldCT, and MRI in the diagnosis of sacroiliitis in suspected axial spondyloarthritis (axSpA). Methods Patients presenting with > 3 months chronic back pain were assessed by axSpA-experienced rheumatologists and diagnosed as axSpA or not; axSpA patients were then considered nr-axSpA or AS using plain radiography. Non-axSpA patients were recruited as controls, and divided into non-inflammatory and inflammatory groups on the basis of inflammatory back pain and/or CRP/ESR elevation. Clinical variables, pelvic radiography, sacroiliac joint (SIJ) ldCT, and SIJ MRI were obtained. Results A total of 121 patients were included and had SIJ radiography and ldCT, of whom 71 additionally had an SIJ MRI. These included 23 non-inflammatory controls, 21 inflammatory controls, 32 nr-axSpA cases, and 45 AS cases. Fourteen of 32 (44%) nr-axSpA patients had positive ldCT scans, 21/24 (88%) had MRI-BMO, and 11/24 (46%) had MRI-structural lesions. ldCT had high specificity with only 1/23 (4%) non-inflammatory controls being positive. MRI-BMO had the highest sensitivity for nr-axSpA, but compared with ldCT lower specificity, with 5/15 (33%) of non-inflammatory controls being positive, and similar sensitivity for AS (20/22 (91%) vs 44/44 for ldCT). Conclusions ldCT identifies evidence of radiographic change in a significant proportion of nr-axSpA cases and is highly specific for axSpA. MRI-BMO lesions are more sensitive than either conventional radiography or MRI-structural assessment for axSpA. The relative position of these imaging modalities in screening for axSpA needs to be reconsidered, also taking into account the costs involved. Key Points • ldCT is more sensitive for erosions or sclerosis in axSpA than plain radiography, with 44% of patients with nr-axSpA having evidence of AS-related sacroiliac joint changes on ldCT. • MRI-structural lesions are no more sensitive but are less specific for AS than ldCT. • MRI-BMO is the most sensitive test for nr-axSpA of the modalities tested but is less specific for axSpA than for ldCT. Keywords axSpA. Conventional radiography. Diagnostics. ldCT. Imaging procedures. MRI Matthew A. Brown and Dan Chen contributed equally to this work.

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Section: Discussionmentioning

confidence: 99%

MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

Liu

Xiao

et al. 2019

Clin Rheumatol

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“…Specifically, certain parts of the criteria, including IBP, family history of SpA, good response to non-steroidal anti-inflammatory drugs, and the presence of enthesitis, lack objectivity and may lead to the misclassification of mechanical back pain or fibromyalgia as nr-axSpA [42]. Additionally, the "positive MRI" definition of the ASAS classification criteria is quite non-specific because mild inflammatory changes of the SIJs can be seen in healthy individuals and athletes, as well as in a wide range of pathologies (e.g., mechanical stresses, trauma, degenerative arthritis of SIJs) [43][44][45]. Hence, the use of positive MRI findings by ASAS criteria alone as a diagnostic test can result in a substantial overdiagnosis of axSpA [43,45].…”

Section: Lack Of Validated Diagnostic Criteriamentioning

confidence: 99%

Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities

Danve

Deodhar

2018

Clin Rheumatol

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Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that primarily affects the sacroiliac joints and spine. Delayed or inadequate treatment may decrease quality of life and lead to poor long-term outcomes, including irreversible loss of spinal function. In this review, we discuss clinical practice related to axSpA within the USA, including prevalence, diagnosis, reasons for delayed/missed diagnosis, and suggestions for making early diagnosis. The US population prevalence of axSpA (0.9-1.4%) is higher than the diagnostic prevalence (0.2-0.7%). Although the estimated diagnostic delay for axSpA is 14 years in the USA, the disease can be identified earlier if appropriately preselected patients are quickly referred to rheumatologists. Only 37% of patients with ankylosing spondylitis in the USA are diagnosed by rheumatologists; the remaining 63% are diagnosed by primary care (26%), chiropractic/physical therapy (7%), orthopedic surgery (4%), pain clinics (4%), acute care (3%), and other settings (19%). To help reduce diagnostic delay, non-rheumatologist-healthcare professionals are urged to refer patients with back pain and ≥ 1 of 3 SpA features (HLA-B27 positivity, current inflammatory back pain, or x-ray/MRI evidence of sacroiliitis) to a rheumatologist. Prevalence and diagnosis rates of axSpA are disparate in the USA due to the lack of awareness and knowledge among non-rheumatologists. Progress has been made in identifying hurdles causing diagnostic delays. Public health initiatives are needed to guide primary care physicians, physical therapists, chiropractors, and other specialists seeing patients with chronic back pain on methods for suspecting or identifying axSpA and early referral to rheumatologists.Keywords Ankylosing spondylitis . Axial spondyloarthritis . Clinical practice in the USA . Inflammatory back pain . Non-radiographic axial spondyloarthritis . Referral strategy

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“…Knochenmarködemen, wie sie in MRT-Untersuchungen z. B. bei Athleten oder nach Geburten beobachtet werden [5,6]. Neben den Veränderungen in der TIRM/STIR-Sequenz, die die akute Sakroiliitis definieren, werden hyperintense, gelenknahe Veränderungen in der T1-Sequenz beobachtet, die auf Grund ihrer ähnlichen Signalintensität wie Fettgewebe als Fettmetaplasie bezeichnet werden [7].…”

Section: Histopathologie Der Sakroiliitis -Korrelation Mit Befunden Bunclassified

Neues zur Pathophysiologie der Spondyloarthritis

Syrbe

2019

Akt Rheumatol

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ZusammenfassungDie Spondyloarthritiden (SpA) umfassen eine Gruppe von Erkrankungen, die durch ähnliche klinische Manifestationen und gemeinsame genetische Assoziationen gekennzeichnet sind. Die axialen Manifestationen umfassen Entzündungen im Achsenskelett, insbesondere in den Sakroiliakalgelenken und in den Wirbelkörpern; bei den peripheren Gelenkmanifestationen dominieren Enthesitiden und Daktylitiden neben oligoartikulären asymmetrischen Arthritiden. Die Pathogenese und Krankheitsentwicklung wird stark durch genetische Anlagen bestimmt. HLA-B27 gilt als wichtigster genetischer Risikofaktor, wobei die pathogenetische Funktion von HLA-B27 nach wie vor ungeklärt ist. Daneben wurden in genomweiten Assoziationsstudien u. a. Risikovarianten in Genen, die den Interleukin (IL)-23-IL-17 Signalweg kontrollieren, identifiziert. Die Bedeutung dieses Signalweges spiegelt sich auch in der klinischen Wirksamkeit von IL-17 Inhibitoren bei Patienten mit SpA wider. Histologische Untersuchungen axialer Krankheitsmanifestationen zeigten ein entzündliches Grauationsgewebe, welches destruierende und reparative Eigenschaften besitzt. So fanden sich neben dem Fibroblasten-reichen Granulationsgewebe randständige Osteoklasten, die die Destruktion der Knochenendplatte vorantreiben und Osteoblasten, die Knochenneubildung vermitteln. In Analysen der IL-23- und IL-17-Expression in Wirbelkörperproben von Patienten mit ankylosierender Spondylitis fand sich die Expression dieser Zytokine v. a. in myeloiden Zellen. Im Tiermodell wurden IL-23 Rezeptor-exprimierende Zellen in Sehnenansätzen identifiziert. Auf IL-23 Exposition reagierten diese Zellen mit der Expression von IL-17 und IL-22, was zur lokalen Entzündung gefolgt von Knochenneubildung führte. Neben der genetischen Assoziation besteht bei der SpA eine große Überlappung mit dem Bestehen einer Psoriasis oder einer chronisch-entzündlichen Darmerkrankung (CED). Darüber hinaus fand sich bei einem Großteil der SpA-Patienten, die keine klinischen Zeichen einer CED zeigen, ebenfalls eine mikroskopische Darmentzündung. Es wird angenommen, dass die entzündlichen Reaktionen an Grenzflächen im Kontext von HLA-B27 zur Entwicklung der axialen und peripheren Gelenkentzündung beitragen, wobei unklar ist, ob Translokation bakterieller Antigene oder die Immunaktivierung im Darm über die Freisetzung löslicher Faktoren oder eine Kreuzreaktivität zwischen mikrobiellen und Gelenkantigenen zu den typischen SpA-Gelenkentzündungen führt.

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Frequency and Anatomic Distribution of Magnetic Resonance Imaging Features in the Sacroiliac Joints of Young Athletes

Cited by 149 publications

References 33 publications

MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities

Neues zur Pathophysiologie der Spondyloarthritis

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