Limited added value of whole spine MRI in spondyloarthritis for disease activity assessment

MRI Findings in Axial Psoriatic Spondylarthritis

“…On the other hand, Gazel et al observed that active changes in the cervical spine are more frequent in AS patients than in PsA patients but with a similar rate of structural change. Compared to AS, PsA patients had numerically fewer changes in the cervical spine without reaching statistical significance [ 69 ].…”

“…Similar findings were confirmed in another study published in 2021, which showed that both active and structural changes in PsA and AS patients had similar rates in the lumbar spine and SIJ and were less frequent in the cervical spine. In the thoracic spine more active and structural damage in PsA patients was recorded, but without reaching statistical significance [ 69 ] ( Table 4 ).…”

“…Recent studies have shown that many patients might have active spine changes without sacroiliitis [ 21 , 25 , 69 ]. In a study published in 2022, 91.7% of cases of MRI-spondylitis were in confirmed PsA patients, while 8.3% of cases were in patients with psoriasis and axial SpA [ 21 ].…”

“…In Gazel et al’s study, only 16% of patients had active inflammation at both sites [ 69 ]. When small, well-defined, abnormal bone marrow signal intensities are seen on the SIJ, such as edema or sclerosis found on one, two, or, far less often, three and four consecutive slices, with no severe associated erosion, they are irrelevant.…”

“…Other studies have shown that an additional spine MRI scan should be recommended when axPsA is clinically suspected, and spine screening does not add value to SIJ MRI scans since there is a low level of confidence regarding active inflammation in the spine [ 21 , 69 ].…”