Abstract

The optimal management of chronic inflammatory arthritis such as rheumatoid arthritis (RA) and spondyloarthritis (SpA) requires tools that allow early and accurate disease diagnosis, prediction of poor prognosis and responsive monitoring of therapeutic outcomes. Conventional radiography has been widely used in both clinical and research settings to assess RA and SpA joint damage, for both diagnosis and prognosis, due to its feasibility. However it has limitations in early disease detection and difficulty distinguishing between active treatments in therapeutic trials. The new imaging modalities such as magnetic resonance imaging (MRI) and ultrasound have the advantage of detecting both joint inflammation and damage and of providing additional and unique information. This can be especially useful in the context of early and/or undifferentiated joint disease when detection of soft tissue and bone marrow abnormalities is desirable. Because they can detect early disease, both ultrasound and MRI will become increasingly important in the diagnosis and management of RA and SpA. Treatment interventions targeting bone marrow edema and synovitis observed on MRI or synovitis and erosions observed on ultrasound may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Actual research is focused on the prognostic significance of those imaging lesions in large cohorts and whether adding MRI or ultrasound to routine care improves clinical and radiographic outcome in patients with inflammatory arthritis. The objective of the lecture is to provide clinicians with an insight into the role of modernimaging for the diagnosis, prognosis and monitoring of chronic inflammatory arthritis.