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The contribution of imaging in the diagnosis and treatment of axial spondyloarthritis
Author(s) -
Baraliakos Xenofon
Publication year - 2015
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12369
Subject(s) - ankylosing spondylitis , medicine , radiography , pathognomonic , magnetic resonance imaging , tumor necrosis factor alpha , inflammation , spondylitis , axial spondyloarthritis , radiology , stage (stratigraphy) , disease , sacroiliac joint , sacroiliitis , paleontology , biology
Background The concept of axial Spondyloarthritis (axSpA) includes patients with non‐radiographic axSpA and ankylosing spondylitis ( AS ). Inflammatory and chronic/structural changes of the sacroiliac joints and the spine are pathognomonic in patients who are diagnosed with axSpA. Materials and Methods In the last years, the evaluation of the natural course of axSpA has been in the focus of research, especially with respect to the relationship between inflammation or postinflammatory changes [detected by magnetic resonance imaging ( MRI )] and bone formation (detected by conventional radiographs). Results Based on the analysis of spinal MRI data, development of new syndesmophytes is directly associated with the parallel occurrence of inflammatory and postinflammatory (fatty) changes in the edges of the vertebral bodies. In contrast, vertebral edges that show only inflammation but no transformation into fatty lesions show a decreased relative risk for development of new bone formation over time. An inhibitory effect on radiographic progression had not been demonstrated during the first 2 years of continuous anti‐ TNF a treatment, however, very recently first studies reported a decreased rate of radiographic progression when patients were continuously treated with TNF a‐blockers for a time period of ≥4 years. Conclusions These data are crucial in the understanding of the long‐term clinical course of patients with axSpAin daily practice. According to these results, it becomes obvious that anti‐inflammatory treatment, especially by using tumor‐necrosis‐factor alpha ( TNF a)‐blockers, has the best effect on the radiographic outcomes when it is started in anearly disease stage, where only inflammation is driving the disease activity and where structural, postinflammatory changes have not yet occurred.