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Objective: To evaluate the imaging features of spondyloarthritis on magnetic resonance imaging (MRI) of the sacroiliac (SI) joints in terms of topography (in thirds) and affected margin, since this aspect is rarely addressed in the literature. Methods: Cross-sectional study with MRI (1.5 T) evaluation of the SI in 16 patients with diagnosis of axial spondyloarthritis regarding the presence of acute (subchondral bone edema, enthesitis, synovitis and capsulitis) and chronic changes (erosions, subchondral bone sclerosis, bone bridging and fatty replacement), performed by two radiologists, blinded to clinical data. MRI findings were correlated with clinical data including age, disease duration, medications, HLA-B27, BASDAI, ASDAS-VHS and ASDAS-PCR, BASMI, BASFI, and mSASSS. Results: Bone edema pattern and erosions showed predominance in the upper third of SI (p = 0.050, p = 0.0014, respectively). There was a correlation between the time of disease and structural changes by affected third (p = 0.028-0.037), as well as the presence of bone bridges with BASMI (p = 0.028) and mSASSS (p = 0.014). Patients with osteitis of the lower third had higher ASDAS values (ESRV: p = 0.011 and CRP: p = 0.017). Conclusion: Chronic inflammatory changes and the pattern of bone edema predominated in the upper third of the SI, but there was also concomitant involvement of the middle or lower thirds of the joint. The localization of involvement in the upper third of the SI was insufficient to differentiate between degeneration and inflammation.

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Chronic inflammatory changes and the pattern of bone edema predominated in the upper third of SI, but a simultaneous involvement of middle or lower thirds of the joint was also noted. The location of involvement in the upper third of SI is insufficient to differentiate between degeneration and inflammation.

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