Progress in spondylarthritis. Spondyloarthritis: lessons from imaging |
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Authors: | Walter P Maksymowych |
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Institution: | (1) Department of Medicine, 562 Heritage Medical Research Building, University of Alberta, T6G 2S2 Alberta, Edmonton, Canada;(2) Alberta Heritage Foundation for Medical Research, Alberta, Canada |
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Abstract: | The advent of magnetic resonance imaging (MRI) and advanced sonographic techniques has led to a resurgence of interest in
the role of imaging in the evaluation and management of spondyloarthritis. Radiography remains the cornerstone of diagnosis
although MRI is more sensitive in early stages of the disease. Inflammatory changes in the sacroiliac joints and spine can
now be reliably quantified and can also predict the subsequent development of radiographic changes in the corresponding locations.
MRI-based scoring systems for inflammation are highly responsive, facilitating proof-of-concept studies of new therapies for
spondyloarthritis. Assessment of chronic changes is much less reliable using MRI, while assessment using radiography lacks
sensitivity to change. Assessment of disease modification therefore remains a principle challenge in the development of new
therapies for ankylosing spondylitis. Ultrasound may be the preferred approach to the assessment of peripheral inflammation,
especially enthesitis. Scintigraphy and computed tomography offer few advantages over MRI. |
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