MRI can also detect chronic structural changes on axSpA in the sacroiliac joints and spine, although the clinical utility of follow-up for that purpose is not Inflammatory Back Pain established [110,137]. Noncontrast and contrast-enhanced MRI have overall similar diagnostic utility for evaluation of the sacroiliac joints and spine in axSpA [9,107-111,125-129]. The Spondyloarthritis Research Consortium of Canada and Berlin methods have been used as scoring systems for quantification and follow-up of lesions in the sacroiliac joints and spine on MRI [138-140]. Radiography Sacroiliac Joints There is no standard method of following patients with radiographs to evaluate for progression of structural changes [22], and the American College of Rheumatology recommends against routine radiographic follow-up given the lack of proven benefit [30]. Repeat radiographs can be obtained as necessary for counseling patients on the status and prognosis of their disease, although radiographs are more typically performed to evaluate the spine rather than the sacroiliac joints [30]. This is because of the low utility of sacroiliac joint radiographs for detecting disease progression based on the relatively poor intra- and interreader reliability of interpretation [141]. Radiographs can demonstrate evolving structural changes or bone formation, although these changes occur slowly over time at the sacroiliac joints, often requiring years to detect a change and prompting many authors to suggest a radiographic imaging interval of axSpA patients of no less than 2 years for assessment of disease progression [141-146]. There is evidence that patients on TNF-inhibitors may have slower progression of structural damage at the sacroiliac joints [147,148], although there is some disagreement in the literature [149].
Inflammatory Back Pain Known or Suspected Axial Spondyloarthropathy PCAs. MRI can also detect chronic structural changes on axSpA in the sacroiliac joints and spine, although the clinical utility of follow-up for that purpose is not Inflammatory Back Pain established [110,137]. Noncontrast and contrast-enhanced MRI have overall similar diagnostic utility for evaluation of the sacroiliac joints and spine in axSpA [9,107-111,125-129]. The Spondyloarthritis Research Consortium of Canada and Berlin methods have been used as scoring systems for quantification and follow-up of lesions in the sacroiliac joints and spine on MRI [138-140]. Radiography Sacroiliac Joints There is no standard method of following patients with radiographs to evaluate for progression of structural changes [22], and the American College of Rheumatology recommends against routine radiographic follow-up given the lack of proven benefit [30]. Repeat radiographs can be obtained as necessary for counseling patients on the status and prognosis of their disease, although radiographs are more typically performed to evaluate the spine rather than the sacroiliac joints [30]. This is because of the low utility of sacroiliac joint radiographs for detecting disease progression based on the relatively poor intra- and interreader reliability of interpretation [141]. Radiographs can demonstrate evolving structural changes or bone formation, although these changes occur slowly over time at the sacroiliac joints, often requiring years to detect a change and prompting many authors to suggest a radiographic imaging interval of axSpA patients of no less than 2 years for assessment of disease progression [141-146]. There is evidence that patients on TNF-inhibitors may have slower progression of structural damage at the sacroiliac joints [147,148], although there is some disagreement in the literature [149].