[Imaging of inflammatory back pain].

Area of Science:

• Rheumatology
• Radiology
• Orthopedics

Context:

• Inflammatory back disorders, including spondylarthritis, present diagnostic challenges.
• Current diagnostic criteria for spondylarthritis do not incorporate spinal changes.
• Radiography has limitations in visualizing the thoracic spine.

Purpose:

• To recommend optimal imaging strategies for diagnosing inflammatory back disorders.
• To highlight the role of MRI in evaluating sacroiliac joints and the spine.
• To discuss the utility of spinal findings in treatment decisions.

Summary:

• Magnetic resonance imaging (MRI) of the sacroiliac joints is recommended as the first-line imaging modality for suspected inflammatory back disorders.
• Plain X-rays may be used for individuals over 35 years, with nonconclusive findings requiring MRI verification.
• Spinal MRI is advised when possible due to radiography's insensitivity to thoracic spine changes, aiding treatment decisions.

Impact:

• Establishes MRI as the preferred initial imaging technique for sacroiliac joint inflammation.
• Provides guidance on utilizing imaging findings for improved patient management.
• Emphasizes the importance of spinal assessment in the context of inflammatory back conditions.