What are the European League Against Rheumatism (EULAR) guidelines for the use of imaging in the diagnosis and management of ankylosing spondylitis (AS) and undifferentiated spondyloarthropathy (USpA)?

Updated: Feb 02, 2021
  • Author: Lawrence H Brent, MD; Chief Editor: Herbert S Diamond, MD  more...
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Radiographic studies are most helpful in establishing a diagnosis of ankylosing spondylitis (AS). [90] Computed tomography (CT) and magnetic resonance imaging (MRI) may be useful in selected patients but, for reasons of expense, are not typically part of routine evaluation. For full discussion, see Imaging in Ankylosing Spondylitis.

European League Against Rheumatism (EULAR) guidelines for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice, issued in April 2015, recommend conventional radiography of the sacroiliac (SI) joints as the first imaging method to diagnose sacroiliitis as part of axial spondyloarthritis in the majority of cases. Magnetic resonance imaging (MRI) of the SI joints is an alternative in certain cases, such as young patients and those with short duration of symptoms. [91]

EULAR also recommends MRI of the SI joints for patients in whom clinical features and conventional radiography findings are not diagnostic, but axial spondyloarthritis is still suspected. On MRI, findings to consider include both active inflammatory lesions (primarily bone marrow edema) and structural lesions (eg, bone erosion, new bone formation, sclerosis and fat infiltration). [91]

EULAR does not generally recommend imaging modalities other than conventional radiography and MRI for diagnosing axial spondyloarthropathy. CT may provide additional information on structural damage if conventional radiography is negative and MRI cannot be performed. Scintigraphy and ultrasound (US) are not recommended for diagnosis of sacroiliitis as part of axial spondyloarthropathy.

EULAR recommends initial conventional radiography of the lumbar and cervical spine to detect syndesmophytes in patients with AS. MRI may also be used to predict development of new radiographic syndesmophytes. [91]

Power Doppler ultrasonography can be used to document active enthesitis. In addition, this technology may be useful to assess changes in inflammatory activity at entheses during institution of new therapies. [10]

The diagnosis of AS is not dependent on laboratory data; no laboratory tests are specific for AS. Biopsy and histologic analysis are not indicated for individuals with AS.

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