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Five-year follow-up of radiographic sacroiliitis: progression as well as improvement?
  1. Alexandre Sepriano1,2,
  2. Martin Rudwaleit3,4,
  3. Joachim Sieper5,6,
  4. Rosaline van den Berg1,
  5. Robert Landewé7,8,
  6. Désirée van der Heijde1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, Hospital de Egas Moniz-CHLO, Lisbon, Portugal
  3. 3Klinikum Bielefeld and Charité, Berlin, Germany
  4. 4Gent University, Belgium
  5. 5Department of Rheumatology, Med Klinik I, Charité Campus Benjamin Franklin, Berlin, Germany
  6. 6German Rheumatism Research Centre, Berlin, Germany
  7. 7Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  8. 8Rheumatology Department, Atrium Medical Center, Heerlen, The Netherlands
  1. Correspondence to Dr Alexandre Sepriano, Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden 2300 RC, The Netherlands; alexsepriano{at}

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Determining the presence of radiographic sacroiliitis is a key feature in the diagnostic process of radiographic axial spondyloarthritis (r-axSpA), synonymous to ankylosing spondylitis according to the modified New York criteria (mNY).1 Its presence is considered prognostically relevant and paves the way for treatment with biological drugs.2 Multiread and multireader exercises have proven that radiographic sacroiliitis is an ambiguous finding, as reflected by large inter-reader and intrareader variability.3 ,4

Determining progression of radiographic sacroiliitis, which marks the arbitrary but irreversible change from non-radiographic axSpA (nr-axSpA) to r-axSpA, is even more ambiguous. The mNY lack sensitivity-to-change in this slowly progressing condition, and it is conceivable that regression of radiographic sacroiliitis is very rare if not impossible.5 Previous studies addressing progression from nr-axSpA to …

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