First EULAR Imaging Recommendations for Spondyloarthritis

Alice Goodman

June 20, 2014

PARIS — A panel of experts assembled by the European League Against Rheumatism (EULAR) has put together 10 recommendations for the appropriate use of imaging for diagnosis and follow-up in patients with axial and peripheral spondyloarthritis (SpA).

The 21 experts, including rheumatologists and radiologists, from 11 European countries reviewed 158 studies and expert opinions on various aspects of imaging in SpA to come up with the 10 practical and clinical recommendations.

"This is the first time ever that we have tied together evidence to substantiate how to use imaging if you want to diagnose and monitor [this group of diseases]," said Lene Terslev, MD, from Copenhagen University Hospital in Glostrup, Denmark.

Dr. Terslev presented the 10 recommendations here at the EULAR Congress 2014.

In general, the task force recommends continued use of x-rays in several diagnostic and monitoring situations because of their widespread availability and low cost.

X-ray is still the first recommendation for detection of sacroiliitis, but MRI is suggested as an alternative in young patients and patients with short symptom duration. If the diagnosis of SpA is suspected, even if not confirmed by clinical features and x-ray, MRI of the sacroiliac joints should be used.

MRI is also recommended to monitor axial SpA, because it can detect structural changes not seen on x-ray. Inflammatory activity on MRI is thought to be a good predictor of clinical response in axial SpA.

Because of the ability of MRI to detect enthesitis, tenosynovitis, and arthritis, it is recommended for peripheral SpA. Both ultrasound and MRI are suggested for monitoring disease activity, said Dr. Terslev. "MRI can aid in decision-making," she added.

Contrast added to imaging was found to have no added value.

Panel member Peter Mandl, MD, from the Medical University of Vienna in Austria, said that the task force tried to be as comprehensive as possible.

"We looked at the whole scope of the disease and what it means in clinical practice," he explained. The panel also considered cost and the availability of resources in different clinical settings.

Dr. Mandl pointed out that the recommendations for axial SpA had a stronger evidence base than those for peripheral SpA. The recommendations depend heavily on x-ray, MRI, and CT, he said, adding that there was not enough evidence to support the use of additional imaging modalities.

Dr. Terslev and Dr. Mandl have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2014: Abstract SP0143. Presented June 13, 2014.

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