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SP0040 Diagnosis of Rheumatoid Arthritis and Spondyloarthritis Using Magnetic Resonance Imaging
  1. M. Østergaard1
  1. 1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Diseases, Copenhagen Univ. Hosp. at Glostrup, Glostrup, Denmark

Abstract

Magnetic resonance imaging (MRI) has over the last few years achieved a key position in the diagnosis of rheumatoid arthritis (RA) as well as spondyloarthritis (SpA).

In the 2010 ACR/EULAR criteria for RA, MRI as well as ultrasonography (US) can be used to count involved joints (1) and can therefore be used to provide an earlier diagnosis of RA. In more detail, classification as definite RA according to the criteria is based on presence of definite clinical synovitis (swelling at clinical examination) in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of at least 6 (of a possible 10) from the individual scores in 4 domains: number/site of involved joints (score range 0-5), serologic abnormality (range 0-3), elevated acute phase response (range 0-1), and symptom duration (range 0-1) Presence of joint inflammation on MRI and/or US count in the “joint involvement domain” (2;3).

In SpA, MRI of the sacroiliac joints is a key examination in the diagnosis of both peripheral SpA (4) and axial SpA (5), according to the definitions of these conditions made by the Assessment of Spondyloarthritis International Society (ASAS). In peripheral SpA (4), a patient can be classified as peripheral SpA, if arthritis or enthesitis or dactylitis is present together with at least one of a number of different criteria, including sacroiliitis on MRI. In axial SpA (5), the requirement for classification is presence of sacroiliitis on either MRI or X-ray plus at least one clinical feature characteristic of SpA. ASAS has defined sacroiliitis on MRI (”A positive MRI”) as active inflammatory lesions highly suggestive of SpA, based on consensus expert opinion (6). The definition of an ASAS “positive MRI” does not include structural changes. However, recent research has documented that including structural changes (erosions) in the criteria would increase the sensitivity of the MRI criteria for SpA, without decreasing the specificity (7;8). An ASAS definition of a positive MRI of the spine has recently been proposed (9).

The present talk will describe the recent criteria and briefly outline the underlying scientific work.

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  2. Østergaard M. Clarification of the role of ultrasonography, magnetic resonance imaging and conventional radiography in the ACR/EULAR 2010 rheumatoid arthritis classification criteria - comment to the article by Aletaha et al. Ann Rheum Dis 2010; e-letter:Published Online December 2, 2010.

  3. Aletaha D et al. Re: Clarification of the role of ultrasonography, magnetic resonance imaging and conventional radiography in the ACR/EULAR 2010 rheumatoid arthritis classification criteria - Reply to comment to the article by Aletaha et al. Ann Rheum Dis 2011; E-letter:Published online January 11, 2011.

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  7. Weber U et al. Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res (Hoboken) 2010; 62(12):1763-71.

  8. Weber U et al. The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum 2010; 62(10):3048-58.

  9. Hermann KG 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. Ann Rheum Dis 2012; 71(8):1278-88.

Disclosure of Interest None Declared

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