Ultrasound of sacroiliac joints in spondyloarthritis: a systematic review
- 155 Downloads
Ultrasound (US) is an accessible imaging technique with a possible role to diagnose active sacroiliitis, so this technique is projected as a promising diagnostic tool for the diagnosis of SpA. We analyse the available evidence about the use of US as a diagnostic tool in sacroiliitis in patients with SpA, by a systemic review of the literature fulfilling OMERACT criteria. A systematic literature search for original articles was carried out using four databases (Medline, Embase, Scopus and Web of Science). Data from studies were included only if participants had SpA and a US examination of sacroiliac joint (SIJ) was performed. The methodological quality of the studies was assessed using QUADAS-2 tool. Thirteen studies were included. All studies were observational, prospective and cross-sectional. In most articles (76.9%), the main US finding compatible with sacroiliitis evaluated was the presence of vascularisation (Doppler signals) with measurements of the resistive index (RI). The sensitivity and specificity analysis were performed in seven studies (58.8%) and were good, with a median of 90 and 89.2%, respectively. The studies showed a positive to moderate a strong correlation between the US and the gold standard but this was optimal only in four studies. In general, the agreement was good in all studies (≥ 0.80). The methods of evaluation of sacroiliitis vary between the studies included. To date, there is not enough evidence to support the use of ultrasound as a diagnostic method for sacroiliitis but it has potential to identify structural lesions at SIJ’s level.
KeywordsUltrasound Sacroiliac joint Spondylarthritis Validity Reliability Feasibility
MG and CS-F participated in the design of the review, the acquisition and interpretation of data, the drafting of the manuscript and gave final approval of the version of the paper to be published. SR, HS were involved in the selection of the articles to include in the review, made substantial contributions to the manuscript preparation and were involved in revising the manuscript for important intellectual content. CB, CP, PS-M participated in the review conception and gave substantial input to the data evaluation and manuscript preparation. All authors read and approved the final version of manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest regarding this manuscript. M. Gutierrez. Advisory board, scientific consultancies, and consulting fees: AbbVie, Novartis, UCB, Esaote SpA, Janssen, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Sanofi Aventis. SR, CSF, PSM, HS, CB, CP. No disclosures.
- 12.Rudwaleit M, Landewé R, Van Der Heijde D, Listing J, Brandt J, Braun J et al (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis 68(6):770–776CrossRefPubMedGoogle Scholar
- 13.Rudwaleit M, Van Der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J et al (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68(6):777–783CrossRefPubMedGoogle Scholar
- 18.Hu Z, Xu M, Lin Z, Liao Z, Lv Q, Gu J (2015) Color Doppler ultrasonography can be used to detect the changes of sacroiliitis and peripheral enthesitis in patients with ankylosing spondylitis during the treatment of adalimumab. Ann Rheum Dis 74(Suppl 2):1157.2–1157. https://doi.org/10.1136/annrheumdis-2015-eular.2355 CrossRefGoogle Scholar
- 24.Nakagomi D, Ikeda K, Okubo A, Iwamoto T, Sanayama Y, Takahashi K et al (2013) Ultrasound can improve the accuracy of the 2010 American College of Rheumatology/European League against rheumatism classification criteria for rheumatoid arthritis to predict the requirement for methotrexate treatment. Arthritis Rheum 65(4):890–898CrossRefPubMedGoogle Scholar
- 33.OCEBM Levels of Evidence Working Group, Durieux N, Pasleau F, Howick J (2011) The Oxford 2011 Levels of Evidence. Group; 1(version):5653. http://www.cebm.net/index.aspx?o=1025
- 34.O’Connor D, Green S, Higgins JP (2008) Defining the review question and developing criteria for including studies. Cochrane handbook for systematic reviews of interventions: Cochrane book series. p 81–94Google Scholar
- 40.Bandinelli F, Melchiorre D, Scazzariello F, Candelieri A, Conforti D, Matucci-Cerinic M (2013) Clinical and radiological evaluation of sacroiliac joints compared with ultrasound examination in early spondyloarthritis. Rheumatol (United Kingdom) 52(7):1293–1297Google Scholar
- 41.Castillo-Gallego C, De Miguel E, García-Arias M, Plasencia C, Lojo-Oliveira L, Martín-Mola E (2017) Color Doppler and spectral Doppler ultrasound detection of active sacroiliitis in spondyloarthritis compared to physical examination as gold standard. Rheumatol Int 37(12):2043–2047CrossRefPubMedGoogle Scholar
- 42.Ghosh A, Mondal S, Sinha D, Nag A, Chakraborty S (2014) Ultrasonography as a useful modality for documenting sacroiliitis in radiographically negative inflammatory back pain: a comparative evaluation with MRI. Rheumatol (United Kingdom) 53(11):2030–2034Google Scholar
- 44.Klauser A, Sailer-Hoeck M, Abdellah M, Taljanovic M, Siedentopf C, Auer T et al (2016) Feasibility of Ultrasound-Guided Sacroiliac Joint Injections in Children Presenting with Sacroiliitis Durchführbarkeit und Effizienz von ultraschallgezielten Injektionen ins Iliosakralgelenk bei Kindern mit Sakroilitis. Ultraschall der Medizin 37(4):393–398Google Scholar