Editorial: Magnetic Resonance Imaging Signals in the Sacroiliac Joints of Healthy Athletes: Refining Disease Thresholds and Treatment Strategies in Axial Spondyloarthritis

Ritchlin, Christopher T.

doi:10.1002/art.40426

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…Accordingly, using BME with the threshold level used in this study (and detailed in the ASAS criteria) bears a considerable risk of false‐positive classification and potential overtreatment. This is important if MRI is used as part of the evaluation and selection of candidates for anti‐TNF therapy, a concern that has been raised previously . The European Medicines Agency mandated that MRI be part of the evaluation of SpA patients who may be candidates for anti‐TNF treatment, without imposing a lower threshold for the level of BME .…”

Section: Discussionmentioning

confidence: 99%

“…Since structural damage is a hallmark sign of fulminant late‐stage SpA, extensive BME seems more likely to be associated with SpA, while low BME levels may be more reflective of axial stress or degenerative changes . Previous studies investigating possible non–SpA‐related causes of SI joint BME are sparse, but a number of factors have been suggested to be associated with BME, including pregnancy/birth‐related stress, obesity, extensive physical activity, and age‐related degeneration . In a study by Weber et al that investigated physically active healthy young individuals, the authors found that, when present, BME was primarily seen at low levels and clustered topographically in distinct SI joint regions .…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, bone marrow edema (BME) detected by MRI in the sacroiliac (SI) joints is considered pivotal in recognition of early SpA and is incorporated in the Assessment of SpondyloArthritis international Society (ASAS) classification criteria . However, the specificity of BME, particularly that of limited extent, and its relationship to SpA remains a subject of debate , because limited BME is relatively prevalent in patients with nonspecific LBP and in healthy individuals . Accordingly, clinical decisions based on the presence of limited BME bear a considerable risk of false‐positive assignment and potential overtreatment.…”

Section: Introductionmentioning

confidence: 99%

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What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four‐Year Magnetic Resonance Imaging Follow‐Up Study of Low Back Pain Patients

Arnbak

Jensen

Schiøttz‐Christensen

et al. 2019

Arthritis & Rheumatology

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Objective. Sacroiliac (SI) joint bone marrow edema (BME) is considered to be pivotal in the detection of early spondyloarthritis. However, the link between BME and development of spondyloarthritis-related bone remodeling remains unclear. This study was undertaken to investigate the evolution of BME and structural lesions in the SI joints over time.Methods. Baseline and 4-year follow-up magnetic resonance imaging scans were conducted in 604 patients ages 18-40 years who were referred with low back pain to an outpatient spine clinic. Eight SI joint regions were scored for BME and categorized as absent, limited (<25% of subcortical bone region), intermediate (25-50%), or extensive (>50%). Structural lesions including erosions and fat lesions were scored as absent or present.Results. SI joint BME was seen at either time point (baseline or at 4 years) in 41% of participants but was persistent at both time points in only 16% of participants. Structural SI joint lesions developed according to the extent of BME at baseline: limited, intermediate, and extensive BME (as compared to absent BME) were independently associated with erosion at follow-up with odds ratios (ORs) of 3, 5, and 46, respectively, and with fat lesions (ORs 3, 7, and 33, respectively). In regions with limited and intermediate BME at baseline, 60% and 50% had resolved by follow-up, respectively, while only 2% and 7% had evolved into extensive BME by follow-up.Conclusion. While extensive SI joint BME was a strong independent predictor of development of structural lesions, limited and intermediate BME were mostly transient and only rarely evolved into extensive BME or structural lesions. These findings enhance our understanding of the natural development of SI joint lesions and indicate different progression patterns for limited/intermediate versus extensive BME, possibly due to different etiologies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four‐Year Magnetic Resonance Imaging Follow‐Up Study of Low Back Pain Patients

Arnbak

Jensen

Schiøttz‐Christensen

et al. 2019

Arthritis & Rheumatology

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“…29 Findings more likely to be supportive of axSpA on MRI, in addition to back muscle endurance, are erosions, fatty change, and ankylosis. 30 One study found that including structural findings (fatty lesions and erosions) in the ASAS axSpA imaging criteria can reliably classify patients in the presence or absence of conventional radiographs. 31 Therapeutics in axSpA Physical therapy, exercise, and inhibition of the TNF pathway Revised treatment recommendations for axSpA have been published.…”

Section: New Perspectives On Spondyloarthritis Based On Revised Definmentioning

confidence: 99%

“…Moreover, substantial variation in the interpretation of back muscle endurance in the SIJ by radiologists remains a challenge 29. Findings more likely to be supportive of axSpA on MRI, in addition to back muscle endurance, are erosions, fatty change, and ankylosis 30. One study found that including structural findings (fatty lesions and erosions) in the ASAS axSpA imaging criteria can reliably classify patients in the presence or absence of conventional radiographs 31…”

Section: New Perspectives On Spondyloarthritis Based On Revised Definmentioning

confidence: 99%

Axial spondyloarthritis: new advances in diagnosis and management

Ritchlin

Adamopoulos

2021

BMJ

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Axial spondyloarthritis (axSpA) is an inflammatory disease of the axial skeleton associated with significant pain and disability. Previously, the diagnosis of ankylosing spondylitis required advanced changes on plain radiographs of the sacroiliac joints. Classification criteria released in 2009, however, identified a subset of patients, under the age of 45, with back pain for more than three months in the absence of radiographic sacroiliitis who were classified as axSpA based on a positive magnetic resonance imaging or HLAB27 positivity and specific clinical features. This subgroup was labeled non-radiographic (nr)-axSpA. These patients, compared with those identified by the older New York criteria, contained a larger percentage of women and demonstrated less structural damage. However, their clinical manifestations and response to biologics were similar to radiographic axSpA. The discovery of the interleukin (IL) IL-23/IL-17 pathway revealed key molecules involved in the pathophysiology of axSpA. This discovery propelled the generation of antibodies directed toward IL-17A, which are highly effective and demonstrate treatment responses in axSpA that are similar to those observed with anti-TNF agents. The finding that agents that block IL-23 were not effective in axSpA came as a surprise and the potential underlying mechanisms underlying this lack of response are discussed. New agents with dual inhibition of the IL-17A and F isoforms and some oral small molecule agents that target the Jak-STAT pathway, have also shown efficacy in axSpA.

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