Article Text

EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice
  1. P Mandl1,
  2. V Navarro-Compán2,3,
  3. L Terslev4,
  4. P Aegerter5,
  5. D van der Heijde2,
  6. M A D'Agostino6,
  7. X Baraliakos7,
  8. S J Pedersen8,
  9. A G Jurik9,
  10. E Naredo10,
  11. C Schueller-Weidekamm11,
  12. U Weber12,
  13. M C Wick13,
  14. P A C Bakker2,
  15. E Filippucci14,
  16. P G Conaghan15,
  17. M Rudwaleit16,
  18. G Schett17,
  19. J Sieper16,
  20. S Tarp18,
  21. H Marzo-Ortega15,
  22. M Østergaard4
  1. 1Division of Rheumatology, Medical University of Vienna, Vienna, Austria
  2. 2Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3University Hospital La Paz, Madrid, Spain
  4. 4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
  5. 5Public Health Department, Ambroise Paré Hospital, Boulogne-Billancourt, France
  6. 6Department of Rheumatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
  7. 7Rheumazentrum Ruhrgebiet, Herne, Germany
  8. 8Department of Rheumatology, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark
  9. 9Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
  10. 10Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  11. 11Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
  12. 12King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark
  13. 13Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
  14. 14Department of Rheumatology, Università Politecnica delle Marche, Ancona, Italy
  15. 15NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  16. 16Department of Rheumatology, Charité Universitätsmedizin, Berlin, Germany
  17. 17Department of Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
  18. 18Musculoskeletal Statistics Unit, Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
  1. Correspondence to Dr Peter Mandl, Division of Rheumatology, Medical University of Vienna, 18-20 Währinger Gürtel, Vienna 1090, Austria; peter.mandl{at}


A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual-emission x-ray absorptiometry and scintigraphy. Experts applied research evidence obtained from systematic literature reviews using MEDLINE and EMBASE to develop a set of 10 recommendations. The strength of recommendations (SOR) was assessed by taskforce members using a visual analogue scale. A total of 7550 references were identified in the search process, from which 158 studies were included in the systematic review. Ten recommendations were produced using research-based evidence and expert opinion encompassing the role of imaging in making a diagnosis of axial SpA or peripheral SpA, monitoring inflammation and damage, predicting outcome, response to treatment, and detecting spinal fractures and osteoporosis. The SOR for each recommendation was generally very high (range 8.9–9.5). These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities. We aimed to produce recommendations that are practical and valuable in daily practice for rheumatologists, radiologists and general practitioners.

  • Spondyloarthritis
  • Magnetic Resonance Imaging
  • Psoriatic Arthritis
  • Reactive arthritis
  • Ultrasonography

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