Skip to main content

Advertisement

SpringerLink
Log in

Imaging of the seronegative spondyloarthropathies

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

The group of seronegative spondyloarthropathies consists of ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, enteropathic spondylitis, and a fifth entity known as undifferentiated spondyloarthropathy. All of these diseases share common clinical and radiographic features with characteristic involvement of the sacroiliac joints, spine, and to various degrees, the peripheral joints. Although plain radiographs are the first line of imaging investigation, they are often insensitive for demonstrating the early changes of sacroiliitis, an important feature for establishing the early diagnosis of seronegative spondyloarthropathy. Other imaging modalities, including conventional tomography, bone scintigraphy, and computed tomography, have improved visualization of inflammatory changes at the sacroiliac joints. This article will review these modalities and emphasize the role of magnetic resonance imaging. By directly imaging changes in the synovium, articular cartilage, and subchondral bone, findings on magnetic resonance imaging are the most sensitive and specific for sacroiliitis and other changes in the axial skeleton. Its role and that of ultrasound in the assessment of the peripheral joints will also be highlighted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Braun J, Bollow M, Sieper J: Radiologic diagnosis and pathology of the spondyloarthropathies. Rheum Clin North Am 1998, 24:697–735.

    Article  CAS  Google Scholar 

  2. Resnick D, Niwayama G: Ankylosing spondylitis. In Diagnosis of Bone and Joint Disorders. Edited by Resnick, D. Philadelphia: WB Saunders, 1995:1008–1074. Provides an excellent overview of ankylosing spondylitis.

    Google Scholar 

  3. Dougados M, van der Linden S, Juhlin R, et al.: The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991, 34:1218–1227.

    Article  PubMed  CAS  Google Scholar 

  4. Zeidler H, Mau W, Khan MA: Undifferentiated spondyloarthropathies. Rheum Clin North Am 1992, 18:187–201.

    CAS  Google Scholar 

  5. van der Linden S, van der Heijde D: Ankylosing spondylitis. Rheum Clin North Am 1998, 24:663–676.

    Article  Google Scholar 

  6. Amor B, Dougados M, Mijiyama M: Critères de classification des spondylarthropathies. Rev Rhum 1990, 57:85–89.

    PubMed  CAS  Google Scholar 

  7. Steven MM, van der Linden SM, Cats A: Evaluation of diagnostic criteria for ankylosing spondylitis: a comparison of the Rome, New York and modified New York Criteria in patients with a positive family history screening test for ankylosing spondylitis. Br J Rheumatol 1985, 24:242–249.

    Article  PubMed  Google Scholar 

  8. van der Linden S, Valkenburg H, Cats A: Evaluation of the diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 1984, 27:361–368.

    Article  PubMed  Google Scholar 

  9. Resnick D, Niwayama G.: Psoriatic arthritis. In Diagnosis of Bone and Joint Disease. Edited by Resnick, D. Philadelphia: WB Saunders; 1995:1075–1102. Provides an excellent overview of psoriatic arthritis.

    Google Scholar 

  10. Resnick D: Reiter’s Syndrome. In Diagnosis of Bone and Joint Disorders. Edited by Resnick, D. Philadelphia: WB Saunders; 1995:1103–1119. Provides an excellent overview of Reiter’s syndrome.

    Google Scholar 

  11. Resnick D: Enteropathic arthropathies. In Diagnosis of Bone and Joint Disorders. Edited by Resnick, D. Philadelphia: WB Saunders; 1995:1120–1149. Provides an excellent overview of spondyloarthropathy associated with inflammatory bowel disease.

    Google Scholar 

  12. Lawson TL, Foley WD, Carrera GF, et al.: The sacroiliac joints: anatomic, plain roentgenographic, and computed tomographic analysis. J Comput Assist Tomogr 1982, 6:307–314.

    Article  PubMed  CAS  Google Scholar 

  13. Forrester DM, Hollingsworth PN, Dawkins RL: Difficulties in the radiographic diagnosis of sacroiliitis. Clin Rheum Dis 1983, 9:323–332.

    PubMed  CAS  Google Scholar 

  14. Battisone MJ, Manaster BJ, Reda DJ, et al.: Radiographic diagnosis of sacroiliitis: are sacroiliac views really better? J Rheumatol 1998, 25:2395–2401.

    Google Scholar 

  15. Yacizi H, Turunée M, Özdogan H, et al.: Observer variation in grading sacroiliac radiographs might be a casue of "sacroiliitis" reported in certain disease states. Ann Rheum Dis 1987, 46:139–145.

    Article  Google Scholar 

  16. Hollingsworth PN, Cheah PS, Dawkins RL, et al.: Observer variation in grading sacroiliac radiographs in HLA-B27 positive individuals. J Rheumatol 1983, 10:247–254.

    PubMed  CAS  Google Scholar 

  17. Namey TC, McIntyre J, Buse M, et al.: Nucleographic studies of axial spondarthritides: quantitative sacroiliac scintigraphy in early HLA-B27-associated sacroiliitis. Arthritis Rheum 1977, 20:1058–1064.

    Article  PubMed  CAS  Google Scholar 

  18. Ho G Jr, Sadovnikoff N, Malhotra CM, et al.: Quantitative sacroiliac joint scintigraphy: a critical assessment. Arthritis Rheum 1979, 22:837–844.

    Article  PubMed  Google Scholar 

  19. Snaith ML, Galvin SEJ, Short MD: The value of quantitative radioisotope scanning in the differential diagnosis of low back pain and sacroiliac disease. J Rheumatol 1982, 9:435–440.

    PubMed  CAS  Google Scholar 

  20. Chase WF, Houk RW, Winn RE, et al.: The clinical usefulness of radionuclide scintigraphy in suspected sacro-iliitis: a prospective study. Br J Rheumatol 1983, 22:67–72.

    Article  PubMed  CAS  Google Scholar 

  21. Miron SD, Wiesen EJ, Kushner I, et al.: The value of quantitative sacroiliac scintigraphy in detection of sacroiliitis. Clin Rheumatol 1983, 2:407–414.

    Article  PubMed  CAS  Google Scholar 

  22. Hanly JG, Barnes DC, Mitchell MJ, et al.: Single photon emission computed tomography (SPECT) in the diagnosis of inflammatory spondyloarthropathies. J Rheumatol 1992, 20:2862–2868.

    Google Scholar 

  23. Fam AG, Rubenstein JD, Ching-Sang H, et al.: Computed tomography in the diagnosis of early ankylosing spondylitis. Arthritis Rheum 1985, 28:930–937.

    Article  PubMed  CAS  Google Scholar 

  24. Versterkold L, Axelsson B, Jacobsson H: A combined method for quantitative pertechnetate scintigraphy in the diagnosis of sacroiliitis: a controlled study. Scand J Rheumatol 1994, 23:16–21.

    Google Scholar 

  25. Wittram C, Whitehouse GH, Williams JW: A comparison of MR and CT in suspected sacroiliitis. J Comput Assist Tomogr 1996, 20:68–72.

    Article  PubMed  CAS  Google Scholar 

  26. Carrera GF, Foley WD, Kozin F, et al.: CT of sacroiliitis. AJR 1981, 136:41–46.

    PubMed  CAS  Google Scholar 

  27. Taggart AJ, Desai SM, Iveson JM, et al.: Computerized tomography of the sacroiliac joints in the diagnosis of sacroiliitis. Br J Rheumatol 1984, 23:258–266.

    Article  PubMed  CAS  Google Scholar 

  28. Kozin F, Carrera GF, Ryan LM, et al.: Computed tomography in the diagnosis of sacroiliitis. Arthritis Rheum 1981, 24:1479–1485.

    Article  PubMed  CAS  Google Scholar 

  29. Carrera GF: Computed tomography in sacroiliitis. Clin Rheum Dis 1983, 9:403–415.

    PubMed  CAS  Google Scholar 

  30. Fewins HE, Whitehouse GH, Bucknall RC: Role of computed tomography in the evaluation of suspected sacroiliac joint disease. J R Soc Med 1990, 83:430–432.

    PubMed  CAS  Google Scholar 

  31. Ahlstrom H, Feltelius N, Nyman R, et al.: Magnetic resonance imaging of sacroiliac joint inflammation. Arthritis Rheum 1990, 33:1763–1769.

    Article  PubMed  CAS  Google Scholar 

  32. Battafarano DF, Sterling GW, Rak KM, et al.: Comparison of bone scan, computed tomography, and magnetic resonance imaging in the diagnosis of active sacroiliitis. Semin Arthritis Rheum 1993, 23:161–176.

    Article  PubMed  CAS  Google Scholar 

  33. Docherty P, Mitchell MJ, MacMillan L, et al.: Magnetic resonance imaging in the detection of sacroiliitis. J Rheumatol 1992, 19:393–401.

    PubMed  CAS  Google Scholar 

  34. Wittram C, Whitehouse GH, BucknallRC: Fat suppressed contrast enhanced MR imaging in the assessment of sacroiliitis. Clin Radiol 1996, 51:554–558.

    Article  PubMed  CAS  Google Scholar 

  35. Murphey MD, Wetzel LH, Bramble JM, et al.: Sacroiliitis: MR imaging findings. Radiology 1991, 180:239–244.

    PubMed  CAS  Google Scholar 

  36. Shichikawa K, Tsujimoto M, Nishioka J, et al.: Histopathology of early sacroiliitis and enthesitis in ankylosing spondylitis. In Advances in Inflammation Research. Edited by Ziff, M. and Cohen, SB. New York: Raven Press; 1985:15–24.

    Google Scholar 

  37. Braun J, Bollow M, Eggens U, et al.: Use of dynamic mangetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondyloarthropathy patients. Arthritis Rheum 1994, 37:1039–1045.

    Article  PubMed  CAS  Google Scholar 

  38. Bollow M, Braun J, Hamm B, et al.: Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology 1995, 194:529–536.

    PubMed  CAS  Google Scholar 

  39. Blum U, Buitrago-Tellez C, Mundinger A, et al.: Magnetic resonance imaging (MRI) for detection of active sacroiliitis: a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol 1996, 23:2107–2115.

    PubMed  CAS  Google Scholar 

  40. Oostveen J, Prevo R, den Boer J, et al.: Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography: a prospective, longitudinal study. J Rheumatol 1999, 26:1953–1958.

    PubMed  CAS  Google Scholar 

  41. Bollow M, Braun J, Biedermann T, et al.: Use of contrastenhanced MR imaging to detect sacroiliitis in children. Skeletal Radiol 1998, 27:606–616.

    Article  PubMed  CAS  Google Scholar 

  42. Jevtic V, Kos-Golja M, Rozman B, et al.: Marginal erosive discovertebral "Romanus" lesions in ankylosing spondylitis demonstrated by contrast enhanced Gd-DTPA mangetic resonance imaging. Skeletal Radiol 2000, 29:27–33.

    Article  PubMed  CAS  Google Scholar 

  43. Olivieri I, Barozzi L, Pierro A, et al.: Toe dactylitis in patients with spndyloarthropathy: assessment by magnetic resonance imaging. J Rheumatol 1997, 24:926–930.

    PubMed  CAS  Google Scholar 

  44. McGonagle D, Khan MA, Marzo-Ortega H, et al.: Enthesitis in spondyloarthropathy. Curr Opin Rheumatol 1999, 11:244–250.

    Article  PubMed  CAS  Google Scholar 

  45. Olivieri I, Barozzi L, Padula A: Enthesiopathy: clinical manifestations, imaging and treatment. Baillieres Clin Rheumatol 1998, 12:665–681.

    Article  PubMed  CAS  Google Scholar 

  46. Backhaus M, Kamradt T, Sandrock D, et al.: Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast enhanced magnetic resonance imaging. Arthritis Rheum 1999, 42:1232–1245.

    Article  PubMed  CAS  Google Scholar 

  47. Coari G, Iagnocco A, Mastrantuono M, et al.: Sonographic and NMR imaging study of sausage digit. Acta Derm Vernereol (Stockh) 1994, 186(S):33–34.

    CAS  Google Scholar 

  48. Olivieri I, Barozzi L, Padula A, et al.: Retrocalcaneal bursitis in spondyloarthropathy: assessment by ultrasonography and magnetic resonance imaging. J Rheumatol 1998, 25:1352–1357.

    PubMed  CAS  Google Scholar 

  49. Calin A, Porta A, Fries JF: Clinical history as screening in ankylosing spondylitis. JAMA 1977, 237:2613–2614.

    Article  PubMed  CAS  Google Scholar 

  50. Khan MA, van der Linden S, Kushner I, et al.: Spondylitic disease without radiologic evidence of sacroiliitis in relatives of HLA-B27 positive ankylosing spondylitis patients. Arthritis Rheum 1985, 28:40–43.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Imaging, 3rd Floor, Fell Pavilion, Toronto Western Hospital, University Health Network, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada

    Angela A. Luong MD & David C. Salonen MD, FRCPC

Authors
  1. Angela A. Luong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David C. Salonen MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luong, A.A., Salonen, D.C. Imaging of the seronegative spondyloarthropathies. Curr Rheumatol Rep 2, 288–296 (2000). https://doi.org/10.1007/s11926-000-0065-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-000-0065-z

Keywords

Search

Navigation