Additionally, some patients with symptomatic AS did not have radiographic evidence of axSpA [18], driving the search for additional imaging biomarkers of early disease. As evolving literature accumulated on the utility of MRI in axSpA, the Assessment of SpondyloArthritis international Society (ASAS) established diagnostic criteria in 2009 for axSpA that included MRI in the diagnostic algorithm, promoting the diagnosis of both patients with radiographically evident axSpA (radiographic-axSpA or classic AS) as well as patients with negative radiographs who may have inflammatory changes demonstrated on MRI (nonradiographic-axSpA) [17,19]. It was later shown that a portion of patients with nonradiographic-axSpA will Reprint requests to: publications@acr.org Inflammatory Back Pain progress to radiographic-axSpA over the course of years [20], although it is uncertain if radiographic-axSpA and nonradiographic-axSpA represent a continuum of the same entity or if they are truly separate disease subsets. This is the topic of some debate [1,21-23]. The development of the ASAS criteria facilitated diagnosis of patients at an earlier stage of disease and allowed more patients with axSpA to be considered for biologic therapy [17,19,22]. However, care should be taken to acknowledge that the ASAS criteria are designed for use in clinical research, not for definitive clinical diagnosis. Beyond the important roles of imaging in early diagnosis and treatment in axSpA patients, those with advanced axSpA resulting in ankylosis are a subset of patients that warrants further discussion. These patients, classically considered to have AS, develop spinal rigidity combined with osteoporosis resulting in a risk of fracture even with low energy trauma or no apparent trauma [1,31-33]. These fractures are often unstable and involve all 3 spinal columns [31,34]. The cervical spine is most frequently involved [32,33,35].
Inflammatory Back Pain Known or Suspected Axial Spondyloarthropathy PCAs. Additionally, some patients with symptomatic AS did not have radiographic evidence of axSpA [18], driving the search for additional imaging biomarkers of early disease. As evolving literature accumulated on the utility of MRI in axSpA, the Assessment of SpondyloArthritis international Society (ASAS) established diagnostic criteria in 2009 for axSpA that included MRI in the diagnostic algorithm, promoting the diagnosis of both patients with radiographically evident axSpA (radiographic-axSpA or classic AS) as well as patients with negative radiographs who may have inflammatory changes demonstrated on MRI (nonradiographic-axSpA) [17,19]. It was later shown that a portion of patients with nonradiographic-axSpA will Reprint requests to: publications@acr.org Inflammatory Back Pain progress to radiographic-axSpA over the course of years [20], although it is uncertain if radiographic-axSpA and nonradiographic-axSpA represent a continuum of the same entity or if they are truly separate disease subsets. This is the topic of some debate [1,21-23]. The development of the ASAS criteria facilitated diagnosis of patients at an earlier stage of disease and allowed more patients with axSpA to be considered for biologic therapy [17,19,22]. However, care should be taken to acknowledge that the ASAS criteria are designed for use in clinical research, not for definitive clinical diagnosis. Beyond the important roles of imaging in early diagnosis and treatment in axSpA patients, those with advanced axSpA resulting in ankylosis are a subset of patients that warrants further discussion. These patients, classically considered to have AS, develop spinal rigidity combined with osteoporosis resulting in a risk of fracture even with low energy trauma or no apparent trauma [1,31-33]. These fractures are often unstable and involve all 3 spinal columns [31,34]. The cervical spine is most frequently involved [32,33,35].