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Spinal inflammation in ankylosing spondylitis—how and why should it be measured by MRI?

Nature Clinical Practice Rheumatology volume 2, pages 232–233 (2006)Cite this article

The assessment of disease activity in ankylosing spondylitis (AS) constitutes a major challenge for rheumatologists. When assessing patients with AS, clinicians typically evaluate the degree and duration of morning stiffness, the presence of nocturnal pain, the response to nonsteroidal anti-inflammatory agents, and signs of impairment of spinal and hip mobility. Many of these features, however, do not reliably discriminate between inflammatory and mechanical sources of spinal pain, lack sensitivity or correlate poorly with the symptoms of AS.1

The use of MRI is a major advance in the identification of spinal inflammation in AS. MRI detects inflammation within soft tissue, and fat-suppressed sequences enable the detection of inflammatory lesions within bone, which are frequently obscured on conventional MRI by marrow fat. Pathological data indicate that most inflammatory lesions are located in subchondral bone and entheses in the spine, are not detected by plain radiography or CT scan, and that isotope bone scan is less sensitive than MRI.2 MRI also allows comprehensive evaluation of lesions in all dimensions, with excellent contrast and spatial resolution and no overlapping structures. There are, however, several points that need to be considered. First, what evidence is there that the lesions detected by MRI actually reflect the histopathology of inflammation relevant to AS? And second, can these lesions be reliably evaluated and measured in a manner that can affect decisions on disease management?

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Authors and Affiliations

  1. Department of Medicine,

    Walter P Maksymowych & Robert GW Lambert

  2. Department of Radiology at the University of Alberta, Edmonton, AB, Canada

    Walter P Maksymowych & Robert GW Lambert

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  1. Walter P Maksymowych
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  2. Robert GW Lambert
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Correspondence to Walter P Maksymowych.

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Maksymowych, W., Lambert, R. Spinal inflammation in ankylosing spondylitis—how and why should it be measured by MRI?. Nat Rev Rheumatol 2, 232–233 (2006). https://doi.org/10.1038/ncprheum0167

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