Imaging of the seronegative spondyloarthropathies

Abstract

The group of seronegative spondyloarthropathies consists of ankylosing spondylitis, psoriatic arthritis, Reiter's disease, enteropathic spondylitis, and a fifth entity known as undifferentiated spondyloarthropathy. All of these diseases share common clinical and radiographic features with characteristic involvement of the sacroiliac joints, spine, and to various degrees, the peripheral joints. Although plain radiographs are the first line of imaging investigation, they are often insensitive for demonstrating the early changes of sacroiliitis, an important feature for establishing the early diagnosis of seronegative spondyloarthropathy. Other imaging modalities, including conventional tomography, bone scintigraphy, and computed tomography, have improved visualization of inflammatory changes at the sacroiliac joints. This article will review these modalities and emphasize the role of magnetic resonance imaging. By directly imaging changes in the synovium, articular cartilage, and subchondral bone, findings on magnetic resonance imaging are the most sensitive and specific for sacroiliitis and other changes in the axial skeleton. Its role and that of ultrasound in the assessment of the peripheral joints will also be highlighted.

Clinical and genetic factors associated with sacroiliitis in Crohn's disease

“…Recognition of SI on radiographs of the sacroiliac joints is difficult and requires experience. Many studies have addressed the inter‐ and intra‐observer variability of this technique and CT and MRI scans have proven to be more sensitive and specific 3,15–17,41 . Nevertheless, due to the limited availability, high radiation exposure and/or relative high cost of these techniques, plain sacroiliac radiographs remain the initial diagnostic tool 11,18 .…”

“…11,13 The prevalence rate of radiographic SI is probably underestimated as reflected by higher prevalence rates found in studies using more sensitive imaging techniques than plain radiographs, such as quantitative SI scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI). [15][16][17][18][19] These newer techniques are not useful for screening purposes and plain radiographs remain the first line of imaging investigation. Despite the high prevalence of SI in IBD, data on the association with different clinical phenotypes are scarce.…”

Severe back pain and lower extremities weakness in a young male

“…Other classic findings include ligament ossification, vertebral fusion and regional osteopenia, which were all absent in this case [6]. The patient also lacked the extra-articular clinical manifestations such as psoriasis, inflammatory bowel disease or urethritis.…”

Arthritides

“…687 However, because of its lack of sensitivity to the early stages of the disease and consequent delay in disease diagnosis, other modalities, such as MRI, CT, ultrasound, and bone scintigraphy, have become more heavily used for diagnosis confirmation and monitoring disease progression, depending on the stage of the disease and area of involvement. 233,401,452 Radiographic findings, regardless of the location, reflect the underlying inflammatory condition associated with AS, which is characterized by erosions, osseous proliferation, and bony ankylosis. Joint involvement in the axial and appendicular skeleton is typically bilateral and symmetric, although this may vary early in the disease process.…”