The diagnostic utility of MRI in spondyloarthritis

The recently developed Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial and peripheral spondyloarthritis (SpA) are the first criteria ever to include findings on magnetic resonance imaging (MRI) of the sacroiliac joints. Features indicating sacroiliac joint inflammation on MRI are weighted equally to structural changes on conventional radiography, and thus MRI has become an important tool for use in daily practice to evaluate patients with clinically suspected early spondyloarthritis. However, MRI can also detect structural changes such as erosions and fat infiltrations, and recent studies suggest that assessment of both inflammatory and structural changes of the sacroiliac joints may improve the diagnostic utility of MRI. The present article reviews the evidence for the use of sacroiliac joint and spinal MRI to assess patients with axial and peripheral SpA, focussing on controlled studies of patients with early SpA, which also included patients with mechanical back pain and healthy subjects, published within the last 5 years.