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Year : 2013  |  Volume : 8  |  Issue : 6  |  Page : 38-43

Outcome assessment in axial spondyloarthritis- imaging techniques, their relation to outcomes and their use in clinical trials

Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Landgrafenstr. 15, 44652 Herne, Germany

Correspondence Address:
Xenofon Baraliakos
Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Landgrafenstr. 15, 44652 Herne
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Source of Support: None, Conflict of Interest: None

DOI: 10.1016/j.injr.2013.11.008

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Imaging of the axial skeleton is important for the assessment and classification of patients with axial Spondyloarthritis (axSpA). While magnetic resonance imaging (MRI) is useful to assess the inflammatory and post-inflammatory lesions of these patients, the gold stan- dard for imaging of the structural changes, such as syndesmophytes, is conventional ra- diographs (CR). Very recent data indicate that the parallel occurrence of active inflammatory changes (bone marrow edema) and chronic post-inflammatory (fatty degeneration) lesions have prognostic significance for future radiographic progression in axSpA. Scoring tools for spinal inflammation such as the ASspiMRI-a have been success- fully used in several large clinical trials. A comparison of all scoring methods in a multi- reader experiment has shown that none has preferred particular preference based on OMERACT principles. Quantification of structural spinal changes in ankylosing spondylitis (AS) is performed by evaluation of lateral cervical and lumbar radiographs using the mSASS Score, which is a reliable scoring method for patients who are being followed up for a period of no less than 2 years. A disadvantage of the mSASSS is that the thoracic spine is not included in that system because of technical reasons, even though MRI studies have shown that the lower half of the thoracic spine is most frequently affected in AS. A new scoring system, the RASSS, that concentrates only on bone formation and also includes the lower part of the thoracic spine, is currently under evaluation. This overview on the current knowledge on imaging in axSpA highlights the use of imaging techniques for assessment of clinical outcomes and use in clinical trials.

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