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Extended report
Active inflammation and structural change in early active axial spondyloarthritis as detected by whole-body MRI
  1. Christian E Althoff1,
  2. Joachim Sieper2,
  3. In-Ho Song2,
  4. Hildrun Haibel2,
  5. Anja Weiß3,
  6. Torsten Diekhoff1,
  7. Martin Rudwaleit2,
  8. Bruce Freundlich4,
  9. Bernd Hamm1,
  10. Kay-Geert A Hermann1
  1. 1Department of Radiology, Charité Medical University, Campus Mitte, Berlin, Germany
  2. 2Department of Rheumatology, Charité Medical University, Campus Benjamin Franklin, Berlin, Germany
  3. 3German Rheumatism Research Center, Berlin, Germany
  4. 4Division of Rheumatology, University of Pennsylvania, Philadelphia, USA
  1. Correspondence to Dr Christian E Althoff, Department of Radiology, Charité Medical University, Campus Mitte, Charitéplatz 1, Berlin 10117, Germany; christian.althoff{at}


Objective To evaluate active inflammatory lesions (AIL) and structural changes (SC) in patients with active non-radiographic axial spondyloarthritis (nr-axSpA) compared with patients with ankylosing spondylitis (AS) on whole-body MRI (wb-MRI).

Method 75 patients with active disease and a symptom duration of <5 years (39 with AS and 36 with nr-axSpA) were investigated with a comprehensive wb-MRI protocol and scored for AIL and SC in the spine, sacroiliac joints (SIJs) and non-axial manifestations.

Results 92% of patients with AS showed active inflammation in the SIJ, 53% in the spine and 94% and 39%, respectively, in the nr-axSpA group. There was a non-significant trend towards more inflammation in patients with AS compared with patients with nr-axSpA in SIJs and spine. Peripheral enthesitis/osteitis was more common in patients with AS (n=22) than in those with nr-axSpA (n=12) (p=0.05). SC were more common in patients with AS than in those with nr-axSpA, with significantly higher scores for SIJ fatty bone marrow deposition (FMD) in patients with AS (4.8±3.2) compared with those with nr-axSpA (2.4±2.7; p=0.001) and more frequent bone proliferation in the spine and the SIJ (p=0.02 and p=0.005, respectively). SIJ erosions were more common in AS (score 4.2±2.3) than in nr-axSpA (score 3.8±1.8) patients (not significant).

Conclusions Wb-MRI detects active inflammation and SC more frequently in the SIJs than in the spine. Half of the patients showed inflammation in non-axial sites. Active inflammatory and structural lesions were present both in patients with AS and those with nr-axSpA, being only slightly more common in patients with AS.

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