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New Imaging Guidelines Cover Full Spectrum of SpA

A European League Against Rheumatism task force releases its first recommendations on the role of imaging for the diagnosis and management of spondyloarthritis.

Mandl P, Navarro-Compán V, Terslev L, et al., EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice.Ann Rheum Dis. 2015 Apr 2 doi: 10.1136/annrheumdis-2014-206971. [Epub ahead of print]

X-ray and MRI are in, while scintigraphy and ultrasound are out, according to a European task force's recommendations on the use of imaging in clinical practice for specific forms of spondyloarthritis (SpA).

The European League Against Rheumatism (EULAR) task force approve of conventional radiography, with MRI as a backup, for diagnosing sacroiliitis in axial (axSpA), but say that sonography or scintigraphy are not sensitive enough for the task.

However, MRI and ultrasound appear to be better at diagnosing peripheral spondylitis (pSpA), while scintigraphy detects enthesitis, peripheral arthritis, tenosynovitis, and bursitis, the task force states.

The 21-member group conducted a systematic review of data published up to 2013 to draft the guidelines, which cover diagnosis; how to monitor damage and disease activity; how to manage different forms of the disease; and how to detect spinal fractures and osteoporosis.

“We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists, and general practitioners,” the task force members explain.

The recommendations also include the optimal use of computed tomography (CT), positron emission tomography (PET), single-photon emission CT (SPECT), and dual emission x-ray absorptiometry (DXA) in axial and peripheral SpA.

Among the panel’s other recommendations:

•   Use MRI with fat-suppression techniques to image the sacroiliac (SI) joints and/or spine to monitor disease activity in axSpA.
•   Obtain x-rays every 2 years for long-term monitoring of structural changes, especially new bone formation, in axSpA.
•   Rely on x-ray and MRI of the lumbar and cervical spine in patients with non-radiographic axial SpA to monitor outcomes and detect potential syndesmophytes.
•   Use MRI to monitor inflammatory activity, which may aid in the decision to start therapy with tumor necrosis factor-alpha (TNF-α) drugs.
•   Use MRI and non-contrast power Doppler ultrasound to detect inflammation for tracking disease activity, particularly synovitis and enthesitis, in peripheral SpA.
•   Obtain x-rays to check for structural damage in pSpA.