Aktuelle Rheumatologie 2019; 44(05): 321-331
DOI: 10.1055/a-0994-9814
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Bildgebung bei axialer Spondyloarthritis – Herausforderungen und Limitationen

Imaging in Axial Spondyloarthritis – Challenges and Limitations
David Kiefer
1   Rheumazentrum Ruhrgebiet Sankt Josefs-Krankenhaus, Rheumatologie, Herne
2   Ruhr-Universität Bochum, Rheumatologie, Bochum
,
Xenofon Baraliakos
1   Rheumazentrum Ruhrgebiet Sankt Josefs-Krankenhaus, Rheumatologie, Herne
2   Ruhr-Universität Bochum, Rheumatologie, Bochum
› Author Affiliations
Further Information

Publication History

Publication Date:
10 September 2019 (online)

Zusammenfassung

Die Bildgebung hat in der Diagnostik der axialen Spondyloarthritis, neben Anamnese, Klinik und der Bestimmung von HLA B27, einen zentralen Stellenwert, zum einen in der täglichen klinischen Praxis zur Diagnosefindung und zum anderen in der klinischen Forschung. Patienten mit axialer Spondyloarthritis leiden unter tiefsitzenden entzündlichen Rückenschmerzen sowie einer morgendlich betonten Steifigkeit des Achsenskelettes. Die zugrunde liegenden z. T. pathognomonischen bildgebenden Befunde sind osteoresorptive und osteoproliferative Veränderungen der Sakroiliakalgelenke und der Wirbelsäule. Initial sind entzündliche Veränderungen, hinweisend auf eine Sakroiliitis oder Spondylitis, die hauptsächlichen Manifestationen im Achsenskelett, gefolgt von strukturellen Läsionen, die zu Knochenneubildungen bis hin zur vollständigen Ankylose, wie sie bei fortgeschrittenen Erkrankungen zu beobachten sind, führen können. Die Darstellung von aktiven und chronischen Veränderungen sowie ihre richtige Interpretation ist die Herausforderung an die bildgebenden Verfahren sowie an die Befunder. Derzeit kann in der klinischen Routine nur die MRT, durch gleichzeitige Darstellung von aktiven und strukturellen Läsionen und ihrer anatomischen Lage, sowohl Entzündungen als auch Knochenumbauten erfassen. Da Knochenmarködeme in der MRT der Sakroiliakalgelenke auch bei Gesunden oder Sportlern auftreten können, sollten sie im Kontext mit gleichzeitig bestehenden strukturellen Schäden sowie zusammen mit den klinischen Symptomen und der Anamnese interpretiert werden. Obwohl die klassische Röntgenaufnahme des Beckens noch der aktuelle Standard der Bildgebung zur Diagnostik der axSpA ist und ein fester Bestandteil der New York Kriterien, ist ein kritisches Auseinandersetzen mit dem konventionellen Röntgen aufgrund eingeschränkter Sensitivität und Interreaderrealibilität sowie der bestehenden Strahlenbelastung durchaus gerechtfertigt. Die CT ist, v. a. zur detaillierten Darstellung struktureller Läsionen, weiterhin eher Gegenstand der klinischen Forschung. Wenn die apparative Möglichkeit besteht, sollte die MRT die bevorzugte bildgebende Methode zur Diagnostik der axSpA sein, um die Diagnose frühzeitig zu stellen. Die kontextbezogene Interpretation der bildgebenden Verfahren sowie die enge Zusammenarbeit zwischen Radiologen und Rheumatologen ist von größter Bedeutung.

Abstract

In the diagnosis of axial spondyloarthritis (SpA) imaging, in addition to clinical examination and the determination of HLA B27, plays a key role in daily practice and clinical research. Patients with SpA report inflammatory low back pain and pronounced morning stiffness. Pathognomonic osteoresorptive and osteoproloferative changes of the sacroiliac joints (SIJ) and the spine are the underlying imaging findings. Initially inflammatory changes suggestive for sacroiliitis or spondylitis are the main manifestations in the axial skeleton and may be followed by structural lesions leading to new bone formation and complete ankylosis, as sometimes seen in advanced disease. The detection of inflammatory and structural changes as well as their contextual interpretation are the main challenges to imaging modality and the reader. In daily clinical practice magnetic resonance imaging (MRI) can detect active inflammation and structural lesions simultaneously and is currently considered to be the optimal imaging technique in patients with clinically suspected SpA. MRI has the ability to visualize bone marrow edema with morphologic features such as anatomical location, extent and intensity and simultaneously detect contextual presence of specific structural lesions such as erosions. AS bone marrow edema on SIJ MRI may also occur in healthy individuals and athletes, the interpretation should be contextual by incorporating inflammatory and structural changes and appropriatly embedded in the clinical and labatory findings. Although the assessment of SIJ on pelvic radiographs is still the current standard of imaging in SpA and a key item of the modified New York (mNY) criteria, a critical analysis of utility of radiography in the diagnosis of SpA is justified due to the limited sensitivity, the poor interreader-reability and the relevant existing radiation exposure. Strength and limitations of all imaging modalities should be considered in the diagnosis of SpA. However, if accessible in daily routine, MRI should be the preferred imaging technique in early SpA. The contextual interpretation of imaging and the close collaboration between radiologists and rheumatologists is of growing importance.

 
  • Literatur

  • 1 Sieper J, van der Heijde D, Landewe R. et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Annals of the rheumatic diseases 2009; 68: 784-788. doi:10.1136/ard.2008.101501
  • 2 Braun J, Sieper J. Axiale Spondyloarthritis. Bremen, London, Boston: UNI-MED Verlag; 2014
  • 3 Rudwaleit M, van der Heijde D, Landewe R. et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Annals of the rheumatic diseases 2011; 70: 25-31 doi:10.1136/ard.2010.133645
  • 4 Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet (London, England) 2017; 390: 73-84. doi:10.1016/s0140-6736(16)31591-4
  • 5 Baraliakos X, Braun J. Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences?. RMD open 2015; 1: e000053. doi:10.1136/rmdopen-2015-000053
  • 6 Deodhar A, Strand V, Kay J. et al. The term ̒non-radiographic axial spondyloarthritisʼ is much more important to classify than to diagnose patients with axial spondyloarthritis. Annals of the rheumatic diseases 2016; 75: 791-794. doi:10.1136/annrheumdis-2015-208852
  • 7 Baraliakos X, Landewe R, Hermann KG. et al. Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging. Annals of the rheumatic diseases 2005; 64: 730-734 doi:10.1136/ard.2004.029298
  • 8 Jaremko JL, Liu L, Winn NJ. et al. Diagnostic utility of magnetic resonance imaging and radiography in juvenile spondyloarthritis: evaluation of the sacroiliac joints in controls and affected subjects. The Journal of rheumatology 2014; 41: 963-970. doi:10.3899/jrheum.131064
  • 9 Weber U, Lambert RG, Ostergaard M. et al. The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arthritis and rheumatism 2010; 62: 3048-3058. doi:10.1002/art.27571
  • 10 Sepriano A, Regel A, van der Heijde D. et al. Efficacy and safety of biological and targeted-synthetic DMARDs: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD open 2017; 3: e000396 doi:10.1136/rmdopen-2016-000396
  • 11 Braun J, Baraliakos X, Buehring B. et al. Differential diagnosis of axial spondyloarthritis-axSpA mimics. Zeitschrift fur Rheumatologie 2019; 78: 31-42. doi:10.1007/s00393-018-0557-8
  • 12 Baraliakos X, Fruth M, Braun J. Imaging of the sacroiliac joints. Zeitschrift fur Rheumatologie 2017; 76: 876-888. doi:10.1007/s00393-017-0399-9
  • 13 Rudwaleit M, Jurik AG, Hermann KG. et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Annals of the rheumatic diseases 2009; 68: 1520-1527. doi:10.1136/ard.2009.110767
  • 14 Hermann KG, Baraliakos X, van der Heijde DM. et al. Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. Annals of the rheumatic diseases 2012; 71: 1278-1288 doi:10.1136/ard.2011.150680
  • 15 Lambert RG, Bakker PA, van der Heijde D. et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Annals of the rheumatic diseases 2016; 75: 1958-1963 doi:10.1136/annrheumdis-2015-208642
  • 16 Lambert RG, Dhillon SS, Jaremko JL. Advanced imaging of the axial skeleton in spondyloarthropathy: techniques, interpretation, and utility. Semin Musculoskelet Radiol 2012; 16: 389-400. doi:10.1055/s-0032-1329882
  • 17 Marzo-Ortega H, McGonagle D, OʼConnor P. et al. Baseline and 1-year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. Relationship between symptoms, HLA-B27 and disease extent and persistence. Annals of the rheumatic diseases 2009; 68: 1721-1727. doi:10.1136/ard.2008.097931
  • 18 de Winter J, de Hooge M, van de Sande M. et al. Magnetic Resonance Imaging of the Sacroiliac Joints Indicating Sacroiliitis According to the Assessment of SpondyloArthritis international Society Definition in Healthy Individuals, Runners, and Women With Postpartum Back Pain. Arthritis Rheumatol 2018; 70: 1042-1048. doi:10.1002/art.40475
  • 19 Eshed I, Miloh-Raz H, Dulitzki M. et al. Peripartum changes of the sacroiliac joints on MRI: increasing mechanical load correlating with signs of edema and inflammation kindling spondyloarthropathy in the genetically prone. Clinical rheumatology 2015; 34: 1419-1426. doi:10.1007/s10067-015-2976-0
  • 20 Varkas G, de Hooge M, Renson T. et al. Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: assessment of military recruits by magnetic resonance imaging study. Rheumatology (Oxford, England) 2018; 57: 588. doi:10.1093/rheumatology/kex534
  • 21 Weber U, Jurik AG, Zejden A. et al. Frequency and Anatomic Distribution of Magnetic Resonance Imaging Features in the Sacroiliac Joints of Young Athletes: Exploring “Background Noise” Toward a Data-Driven Definition of Sacroiliitis in Early Spondyloarthritis. Arthritis Rheumatol 2018; 70: 736-745. doi:10.1002/art.40429
  • 22 Deodhar A. Sacroiliac Joint Magnetic Resonance Imaging in the Diagnosis of Axial Spondyloarthritis: “A Tiny Bit of White on Two Consecutive Slices” May Be Objective, but Not Specific. Arthritis Rheumatol 2016; 68: 775-778. doi:10.1002/art.39549
  • 23 Weber U, Ostergaard M, Lambert RG. et al. Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis. Annals of the rheumatic diseases 2015; 74: 1976-1982. doi:10.1136/annrheumdis-2014-205408
  • 24 Weber U, Jurik AG, Lambert RG. et al. Imaging in Spondyloarthritis: Controversies in Recognition of Early Disease. Curr Rheumatol Rep 2016; 18: 58. doi:10.1007/s11926-016-0607-7
  • 25 Witte T, Baraliakos X. Magnetic resonance imaging (MRI) diagnostics in axial spondyloarthritis. Zeitschrift fur Rheumatologie 2017; 76: 574-579. doi:10.1007/s00393-017-0361-x
  • 26 van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis and rheumatism 1984; 27: 361-368
  • 27 Althoff CE, Sieper J, Song IH. et al. Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI. Annals of the rheumatic diseases 2013; 72: 967-973. doi:10.1136/annrheumdis-2012-201545
  • 28 Maksymowych WP, Wichuk S, Dougados M. et al. MRI evidence of structural changes in the sacroiliac joints of patients with non-radiographic axial spondyloarthritis even in the absence of MRI inflammation. Arthritis research & therapy 2017; 19: 126. doi:10.1186/s13075-017-1342-9
  • 29 Diekhoff T, Hermann KG, Greese J. et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Annals of the rheumatic diseases 2017; 76: 1502-1508. doi:10.1136/annrheumdis-2016-210640
  • 30 Weber U, Pedersen SJ, Ostergaard M. et al. Can erosions on MRI of the sacroiliac joints be reliably detected in patients with ankylosing spondylitis? – A cross-sectional study. Arthritis research & therapy 2012; 14: R124. doi:10.1186/ar3854
  • 31 Diekhoff T, Greese J, Sieper J. et al. Improved detection of erosions in the sacroiliac joints on MRI with volumetric interpolated breath-hold examination (VIBE): results from the SIMACT study. Annals of the rheumatic diseases 2018; 77: 1585-1589. doi:10.1136/annrheumdis-2018-213393
  • 32 Baraliakos X, Hoffmann F, Deng X. et al. Detection of erosions in the sacroiliac joints of patients with axial spondyloarthritis using the magnetic resonance imaging VIBE technique. The Journal of rheumatology 2019; DOI: doi:10.3899/jrheum.181304.
  • 33 de Hooge M, van den Berg R, Navarro-Compan V. et al. Patients with chronic back pain of short duration from the SPACE cohort: which MRI structural lesions in the sacroiliac joints and inflammatory and structural lesions in the spine are most specific for axial spondyloarthritis?. Annals of the rheumatic diseases 2016; 75: 1308-1314. doi:10.1136/annrheumdis-2015-207823
  • 34 Weber U, Zubler V, Zhao Z. et al. Does spinal MRI add incremental diagnostic value to MRI of the sacroiliac joints alone in patients with non-radiographic axial spondyloarthritis?. Annals of the rheumatic diseases 2015; 74: 985-992 doi:10.1136/annrheumdis-2013-203887
  • 35 Ez-Zaitouni Z, Bakker PA, van Lunteren M. et al. The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts. Annals of the rheumatic diseases 2017; 76: 1731-1736 doi:10.1136/annrheumdis-2017-211486
  • 36 Braun J, Baraliakos X, Hermann KG. et al. Effect of certolizumab pegol over 96 weeks of treatment on inflammation of the spine and sacroiliac joints, as measured by MRI, and the association between clinical and MRI outcomes in patients with axial spondyloarthritis. RMD open 2017; 3: e000430. doi:10.1136/rmdopen-2017-000430
  • 37 Maksymowych WP, Wichuk S, Dougados M. et al. Modification of structural lesions on MRI of the sacroiliac joints by etanercept in the EMBARK trial: a 12-week randomised placebo-controlled trial in patients with non-radiographic axial spondyloarthritis. Annals of the rheumatic diseases 2018; 77: 78-84 doi:10.1136/annrheumdis-2017-211605
  • 38 Pedersen SJ, Poddubnyy D, Sorensen IJ. et al. Course of Magnetic Resonance Imaging-Detected Inflammation and Structural Lesions in the Sacroiliac Joints of Patients in the Randomized, Double-Blind, Placebo-Controlled Danish Multicenter Study of Adalimumab in Spondyloarthritis, as Assessed by the Berlin and Spondyloarthritis Research Consortium of Canada Methods. Arthritis Rheumatol 2016; 68: 418-429 doi:10.1002/art.39434
  • 39 Braun J, Baraliakos X, Buehring B. et al. Imaging of axial spondyloarthritis. New aspects and differential diagnoses. Clinical and experimental rheumatology 2018; 36 (Suppl 114): 35-42
  • 40 van der Heijde D, Sieper J, Maksymowych WP. et al. Clinical and MRI remission in patients with nonradiographic axial spondyloarthritis who received long-term open-label adalimumab treatment: 3-year results of the ABILITY-1 trial. Arthritis research & therapy 2018; 20: 61. doi:10.1186/s13075-018-1556-5
  • 41 Baraliakos X, Heldmann F, Callhoff J. et al. Which spinal lesions are associated with new bone formation in patients with ankylosing spondylitis treated with anti-TNF agents? A long-term observational study using MRI and conventional radiography. Annals of the rheumatic diseases 2014; 73: 1819-1825 doi:10.1136/annrheumdis-2013-203425
  • 42 Smolen JS, Schols M, Braun J. et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Annals of the rheumatic diseases 2018; 77: 3-17 doi:10.1136/annrheumdis-2017-211734
  • 43 Krober G, Weber U. MRI in spondyloarthritis: when and how?. Current opinion in rheumatology 2018; 30: 324-333 doi:10.1097/bor.0000000000000512
  • 44 Sengupta R, Marzo-Ortega H, McGonagle D. et al. Short-term Repeat Magnetic Resonance Imaging Scans in Suspected Early Axial Spondyloarthritis Are Clinically Relevant Only in HLA-B27-positive Male Subjects. The Journal of rheumatology 2018; 45: 202-205. doi:10.3899/jrheum.170171
  • 45 van Onna M, van Tubergen A, Jurik AG. et al. Natural course of bone marrow oedema on magnetic resonance imaging of the sacroiliac joints in patients with early inflammatory back pain: a 2-year follow-up study. Scand J Rheumatol 2015; 44: 129-134. doi:10.3109/03009742.2014.933247
  • 46 Baraliakos X, Sieper J, Chen S. et al. Non-radiographic axial spondyloarthritis patients without initial evidence of inflammation may develop objective inflammation over time. Rheumatology (Oxford, England) 2017; 56: 1162-1166. doi:10.1093/rheumatology/kex081
  • 47 Baraliakos X, Fruth M, Kiltz U. et al. Inflammatory spinal diseases: axial spondyloarthritis : Central importance of imaging. Zeitschrift fur Rheumatologie. 2017. 76 149-162. doi:10.1007/s00393-016-0252-6
  • 48 Rudwaleit M, van der Heijde D, Landewe R. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Annals of the rheumatic diseases 2009; 68: 777-783. doi:10.1136/ard.2009.108233
  • 49 van Hoeven L, Luime J, Han H. et al. Identifying axial spondyloarthritis in Dutch primary care patients, ages 20-45 years, with chronic low back pain. Arthritis care & research 2014; 66: 446-453. doi:10.1002/acr.22180
  • 50 Hoeymans N, Feskens EJ, van den Bos GA. et al. Measuring functional status: cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990-1993). Journal of clinical epidemiology 1996; 49: 1103-1110
  • 51 Arnbak B, Jurik AG, Jensen TS. et al. Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints. Arthritis care & research 2018; 70: 244-251. doi:10.1002/acr.23259
  • 52 Christiansen AA, Hendricks O, Kuettel D. et al. Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis. The Journal of rheumatology 2017; 44: 70-77 doi:10.3899/jrheum.160079
  • 53 Ball J, Jeffrey MR. JH.K The epidemiology of chronic rheumatism: Atlas of Standard Radiographs of Arthritis. Oxford: Blackwell Scientific Publications; 1963
  • 54 van Tubergen A, Heuft-Dorenbosch L, Schulpen G. et al. Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality?. Annals of the rheumatic diseases 2003; 62: 519-525 doi:10.1136/ard.62.6.519
  • 55 Yazici H, Turunc M, Ozdogan H. et al. Observer variation in grading sacroiliac radiographs might be a cause of ̒sacroiliitisʼ reported in certain disease states. Annals of the rheumatic diseases 1987; 46: 139-145 doi:10.1136/ard.46.2.139
  • 56 Macrae IF, Haslock DI, Wright V. Grading of films for sacro-iliitis in population studies. Annals of the rheumatic diseases 1971; 30: 58-66 doi:10.1136/ard.30.1.58
  • 57 Mau W, Zeidler H, Mau R. et al. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. Results of a 10-year followup. The Journal of rheumatology 1988; 15: 1109-1114
  • 58 Dougados M, dʼAgostino MA, Benessiano J. et al. The DESIR cohort: a 10-year follow-up of early inflammatory back pain in France: study design and baseline characteristics of the 708 recruited patients. Joint Bone Spine 2011; 78: 598-603. doi:10.1016/j.jbspin.2011.01.013
  • 59 Poddubnyy D, Brandt H, Vahldiek J. et al. The frequency of non-radiographic axial spondyloarthritis in relation to symptom duration in patients referred because of chronic back pain: results from the Berlin early spondyloarthritis clinic. Annals of the rheumatic diseases 2012; 71: 1998-2001. doi:10.1136/annrheumdis-2012-201945
  • 60 Redeker I, Callhoff J, Hoffmann F. et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford, England) 2019; DOI: 10.1093/rheumatology/kez090..
  • 61 Spoorenberg A, de Vlam K, van der Linden S. et al. Radiological scoring methods in ankylosing spondylitis. Reliability and change over 1 and 2 years. The Journal of rheumatology 2004; 31: 125-132
  • 62 Le Goff P, Saraux A, Baron D. Radiographic diagnosis of sacroiliitis – are sacroiliac views really better?. The Journal of rheumatology 2001; 28: 212-214
  • 63 Omar A, Sari I, Bedaiwi M. et al. Analysis of dedicated sacroiliac views to improve reliability of conventional pelvic radiographs. Rheumatology (Oxford, England) 2017; 56: 1740-1745 doi:10.1093/rheumatology/kex240
  • 64 Deodhar A, Reveille JD, van den Bosch F. et al. The concept of axial spondyloarthritis: joint statement of the spondyloarthritis research and treatment network and the Assessment of SpondyloArthritis international Society in response to the US Food and Drug Administration's comments and concerns. Arthritis Rheumatol 2014; 66: 2649-2656. doi:10.1002/art.38776
  • 65 Dougados M, Demattei C, van den Berg R. et al. Rate and Predisposing Factors for Sacroiliac Joint Radiographic Progression After a Two-Year Follow-up Period in Recent-Onset Spondyloarthritis. Arthritis Rheumatol 2016; 68: 1904-1913. doi:10.1002/art.39666
  • 66 Poddubnyy D, Rudwaleit M, Haibel H. et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Annals of the rheumatic diseases 2011; 70: 1369-1374. doi:10.1136/ard.2010.145995
  • 67 Blachier M, Canoui-Poitrine F, Dougados M. et al. Factors associated with radiographic lesions in early axial spondyloarthritis. Results from the DESIR cohort. Rheumatology (Oxford, England) 2013; 52: 1686-1693. doi:10.1093/rheumatology/ket207
  • 68 Baraliakos X, Listing J, Rudwaleit M. et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Annals of the rheumatic diseases 2007; 66: 910-915. doi:10.1136/ard.2006.066415
  • 69 Molnar C, Scherer A, Baraliakos X. et al. TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort. Annals of the rheumatic diseases 2018; 77: 63-69 doi:10.1136/annrheumdis-2017-211544
  • 70 Jeong H, Eun YH, Kim IY. et al. Effect of tumor necrosis factor alpha inhibitors on spinal radiographic progression in patients with ankylosing spondylitis. Int J Rheum Dis 2018; 21: 1098-1105. doi:10.1111/1756-185x.13270
  • 71 Haroon N, Inman RD, Learch TJ. et al. The impact of tumor necrosis factor alpha inhibitors on radiographic progression in ankylosing spondylitis. Arthritis and rheumatism 2013; 65: 2645-2654. doi:10.1002/art.38070
  • 72 Maas F, Arends S, Brouwer E. et al. Reduction in Spinal Radiographic Progression in Ankylosing Spondylitis Patients Receiving Prolonged Treatment With Tumor Necrosis Factor Inhibitors. Arthritis care & research 2017; 69: 1011-1019. doi:10.1002/acr.23097
  • 73 Braun J, Baraliakos X, Deodhar A. et al. Secukinumab shows sustained efficacy and low structural progression in ankylosing spondylitis: 4-year results from the MEASURE 1 study. Rheumatology (Oxford, England) 2018; DOI: 10.1093/rheumatology/key375..
  • 74 Geijer M, Gothlin GG, Gothlin JH. The clinical utility of computed tomography compared to conventional radiography in diagnosing sacroiliitis. A retrospective study on 910 patients and literature review. The Journal of rheumatology. 2007. 34 1561-1565
  • 75 Geijer M, Sihlbom H, Gothlin JH. et al. The role of CT in the diagnosis of sacro-iliitis. Acta radiologica (Stockholm, Sweden: 1987). 1998. 39 265-268
  • 76 Fam AG, Rubenstein JD, Chin-Sang H. et al. Computed tomography in the diagnosis of early ankylosing spondylitis. Arthritis and rheumatism 1985; 28: 930-937
  • 77 Jurik AG, Hansen J, Puhakka KB. Effective radiation dose from semicoronal CT of the sacroiliac joints in comparison with axial CT and conventional radiography. Eur Radiol 2002; 12: 2820-2825 doi:10.1007/s00330-001-1297-7
  • 78 Braun J, Rudwaleit M, Sieper J. Spondyloarthritides. Der Internist 2011; 52: 657-670 doi:10.1007/s00108-010-2766-3
  • 79 Jurik AG. Technique and radiation dose of conventional X-rays and computed tomography of the sacroiliac joint. Radiologe 2004; 44: 229-233
  • 80 Lee SH, Yun SJ, Jo HH. et al. Diagnostic accuracy of low-dose versus ultra-low-dose CT for lumbar disc disease and facet joint osteoarthritis in patients with low back pain with MRI correlation. Skeletal Radiol 2018; 47: 491-504 doi:10.1007/s00256-017-2811-6
  • 81 Tan S, Yao J, Flynn JA. et al. Quantitative syndesmophyte measurement in ankylosing spondylitis using CT: longitudinal validity and sensitivity to change over 2 years. Annals of the rheumatic diseases 2015; 74: 437-443 doi:10.1136/annrheumdis-2013-203946
  • 82 Tan S, Yao J, Flynn JA. et al. Quantitative measurement of syndesmophyte volume and height in ankylosing spondylitis using CT. Annals of the rheumatic diseases 2014; 73: 544-550 doi:10.1136/annrheumdis-2012-202661
  • 83 Ward MM, Tan S. Better Quantification of Syndesmophyte Growth in Axial Spondyloarthritis. Curr Rheumatol Rep 2018; 20: 46. doi:10.1007/s11926-018-0759-8
  • 84 Maksymowych WP, Lambert RG. Spondyloarthritis: Low-dose CT for spondyloarthritis – a brilliant new chapter?. Nat Rev Rheumatol 2018; 14: 130-131. doi:10.1038/nrrheum.2018.4
  • 85 de Bruin F, de Koning A, van den Berg R. et al. Development of the CT Syndesmophyte Score (CTSS) in patients with ankylosing spondylitis: data from the SIAS cohort. Annals of the rheumatic diseases 2018; 77: 371-377. doi:10.1136/annrheumdis-2017-212553
  • 86 de Koning A, de Bruin F, van den Berg R. et al. Low-dose CT detects more progression of bone formation in comparison to conventional radiography in patients with ankylosing spondylitis: results from the SIAS cohort. Annals of the rheumatic diseases 2018; 77: 293-299 doi:10.1136/annrheumdis-2017-211989
  • 87 Tan S, Dasgupta A, Yao J. et al. Spatial distribution of syndesmophytes along the vertebral rim in ankylosing spondylitis: preferential involvement of the posterolateral rim. Annals of the rheumatic diseases 2016; 75: 1951-1957. doi:10.1136/annrheumdis-2015-208802
  • 88 Song IH, Carrasco-Fernandez J, Rudwaleit M. et al. The diagnostic value of scintigraphy in assessing sacroiliitis in ankylosing spondylitis: A systematic literature research. Annals of the rheumatic diseases 2008; 67: 1535-1540. doi:10.1136/ard.2007.083089
  • 89 Gheita TA, Azkalany GS, Kenawy SA. et al. Bone scintigraphy in axial seronegative spondyloarthritis patients: role in detection of subclinical peripheral arthritis and disease activity. Int J Rheum Dis 2015; 18: 553-559 doi:10.1111/1756-185x.12527
  • 90 Baraliakos X, Braun J. Opinion: Perspectives on imaging in axial spondyloarthritis. Nat Rev Rheumatol 2013; 9: 498-502. doi:10.1038/nrrheum.2013.83