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Radiographic evaluation of sacroiliac (SI) joints aimed at detection of radiographic sacroiliitis was for many years the only way to depict inflammatory (or more correctly — postinflammatory) changes in patients with ankylosing spondylitis (AS) prior to development of bony changes in the spine (syndesmophytes/bony ankyloses). Consequently, definite radiographic sacroiliitis (≥ grade II both sides or ≥ grade III unilaterally) was included in the modified New York criteria for AS (1984)1 as an obligatory criterion in addition to clinical ones. In the following years, these criteria were used not only for classification but also for making a diagnosis of AS. It was, however, clear that definite structural changes in the SI joints visible on radiography require months to years to develop.Identifying AS at an early stage became possible with the introduction of magnetic resonance imaging (MRI), which is able to depict active inflammation (osteitis or bone marrow edema) prior to development of structural damage visible on radiographs. Of course, identifying disease early also means a wider range of outcomes, including milder forms developing structural damage slowly or not developing it at all. This fact resulted in a change in terminology and the introduction of the term “axial spondyloarthritis (axSpA),” which covers patients with structural damage in the SI joints visible on radiographs (radiographic axSpA or AS), and patients without such damage (nonradiographic axSpA). Both subgroups (or stages) of axSpA are covered by the classification criteria for axSpA (2009)2,3 developed by the Assessment of SpondyloArthritis International Society (ASAS). These criteria consist of 2 arms — imaging and clinical. The more specific imaging arm is fulfilled if either definite radiographic sacroiliitis (as … Address correspondence to Prof. D. Poddubnyy; E-mail: denis.poddubnyy{at}charite.de

Radiographic Evaluation of Sacroiliac Joints in Axial Spondyloarthritis — Still Worth Performing?