A task force convened by the European League Against Rheumatism (EULAR) comprising rheumatologists, radiologists and methodologists from 11 countries developed 10 recommendations, based on both evidence obtained through systemic literature reviews as well as expert opinion. The recommendations encompass the role of imaging in making a diagnosis of axial or peripheral spondyloarthritis (SpA), monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis (OP). Selected aspects of the recommendations are given below (NOT all recommendations and NOT the exact wording, due to space constraints): conventional radiography (CR) of the sacroiliac joint (SIJ) is recommended as the first imaging method to diagnose sacroiliitis as part of axial SpA, while magnetic resonance imaging (MRI) is an alternative first imaging method in certain cases. Ultrasound (US) or MRI may be used to detect peripheral arthritis, tenosynovitis, bursitis and particularly peripheral enthesitis, which may support the diagnosis of SpA. MRI of the SIJ and/or spine may be used to assess and monitor disease activity, while CR of the SIJ and/or spine may be used for long-term monitoring of structural damage, particularly new bone formation in axial SpA. In patients with anklyosing spondylitis (AS) (not nonradiographic axial SpA), initial CRs of the lumbar and cervical spine are recommended to detect syndesmophytes, which are predictive of development of new syndesmophytes. MRI (vertebral corner inflammatory lesion) may also be used to predict development of new radiographic syndesmophytes. When spinal fracture in axial SpA is suspected, CR is the recommended initial imaging method. In axial SpA without radiographic syndesmophytes in the lumbar spine, OP should be assessed by dual-emission x-ray absorptiometry of the hip and spine. The SOR for each recommendation varied, but was generally very high (mean 8.9-9.5). Recommendations for future research were agreed by consensus following the presentation of the evidence obtained from the literature reviews.
Disclosure of Interest None declared