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Spondyloarthritis (SpA) represents a group of related rheumatic diseases that includes ankylosing spondylitis (AS), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel disease, and reactive arthritis, with 10–20% of patients developing their first symptoms during childhood. Juvenile SpA more often begins with peripheral and root joint arthritis and enthesitis than with back pain, the most common presenting feature in adults, even when the eventual outcome is ankylosing spondylitis (AS)1. These differences have necessitated the adoption of age-specific SpA classification criteria where the most common forms of juvenile SpA are encompassed by enthesitis-related arthritis (ERA), psoriatic arthritis (PsA), and undifferentiated arthritis2. In adults, SpA classification has moved from distinguishing undifferentiated and differentiated disease3,4 toward criteria that identify patients with back pain who have “axial SpA” (axSpA) versus those with peripheral manifestations only5. AxSpA is present if back pain is present for at least 3 months and is associated with evidence of sacroiliac involvement on imaging [radiographs or magnetic resonance imaging (MRI)], or when HLA-B27 and additional features of SpA are present6. Peripheral SpA requires arthritis, enthesitis, or dactylitis, and other features of SpA5. Although axSpA defines individuals who are … Address correspondence to Dr. Colbert, NIH-NIAMS, 10-CRC, Hatfield Clinical Research Center, 1-5142 10 Center Dr., Bethesda, Maryland 20892-1102, USA. E-mail: colbertr{at}mail.nih.gov

Radiography Versus Magnetic Resonance Imaging (MRI) in Juvenile Spondyloarthritis: Is the MR Image Everything?