(EULAR 2014) Rheumatologists and radiologists from 11 countries have collaborated to draft 10 recommendations for imaging to diagnose axial and peripheral spondyloarthritis.
New recommendations for the imaging of spondyloarthritis (SpA) have been crafted by a task force consisting of 21 rheumatologists, radiologists, and other experts from 11 countries and announced at the annual meeting of the European Union League Against Rheumatism (EULAR) in Paris.
As described by rheumatologist Peter Mandl of the Medical University of Vienna, the development process consisted of a systematic review that hone more than 7500 references to 158 studies, followed by the expert judgment of the task force members. The result was 10 basic recommendations "encompassing the full spectrum of imaging" in diagnosis, monitoring, treatment response, and prognosis of these inflammatory spinal conditions.
Speaking for the EULAR Standing Committee on Imaging in
SpA, Lene Terslev MD of the Center for Rheumatology and Spine Diseases at Glostrip Hospital in Denmark announced key points of the new recommendations:
In assessing axial SpA:
• The first choice for diagnosing sacroiliitis should be conventional radiography of the sacroiliac joint. MRI (magnetic resonance imaging) is an alternative in selected cases.
• To detect peripheral enthesitis as well as peripheral arthritis, tenosynovitis, or bursitis in these cases, either ultrasound or MRI is appropriate.
• To assess and monitor disease activity, MRI of the sacroiliac joint is recommended.
• To monitor long-term for structural damage and especially new bone formation, conventional radiology of the sacroiliac joint and/or spine is acceptable and appropriate.
• To assess suspected spinal fracture, conventional radiology is recommended as the initial method.
• To assess for osteoporosis in cases of axial SpA without radiographic evidence of syndesmophytes in the lumbar spine, dual emission x-ray absorptiometry of the hip and spine is in order.
In assessing anklyosing spondylitis:
• To detect syndesmophytes (and predict development of new syndesmophytes), initial conventional radiographs of the lumbar and cervical spine are "recommended" but MRI of vertebral corner inflammatory lesions "may also be used."
The speakers both stressed that consensus based on the evidence was strong: The mean strength of these recommendations using a visual analogue scale was 8.9-9.5.