Advances and challenges in spondyloarthritis imaging for diagnosis and assessment of disease

In recent years there has been an increased focus on use of imaging for diagnosis and assessment of spondyloarthritis (SpA). Magnetic resonance imaging (MRI) has attracted particular interest for its potential to improve diagnostic certainty for early, non-radiographic disease and to assist clinical decision-making. This report summarizes recent developments toward definition of positive sacroiliac joint and spine MRIs for SpA, with erosion as the major determinant for disease classification. The report also highlights recent SpA imaging work relevant to daily practice, focusing on limitations and challenges of SpA imaging and, in particular, on unsolved practical difficulties of using MRI in SpA. Recent data suggest that SpA imaging in daily practice may not be confined to identification and assessment of disease; it may also become essential for monitoring, clinical decision making, and selecting the most appropriate treatment for patients with SpA. Improved use of imaging may have much potential to enable better management of SpA.