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Musculoskeletal
Diagnosis
Non-Trauma
Arthritis
Mixed Erosive and Productive
Ankylosing Spondylitis
Ankylosing Spondylitis
Eva M. Escobedo, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Imaging

    • Clinical Issues

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Ankylosing spondylitis (AS)

        • Definitions

          • Inflammatory arthropathy and enthesopathy with predilection for axial skeleton

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Han Q et al: A comprehensive assessment of hip damage in ankylosing spondylitis, especially early features. Front Immunol. 12:668969, 2021
                                      2. Rocha FAC et al: Tumor necrosis factor inhibitors prevent structural damage in hips in ankylosing spondylitis-time to reconsider treatment guidelines? A case series and review of literature. Clin Rheumatol. 40(5):1881-7, 2021
                                      3. Sepriano A et al: Tumor necrosis factor inhibitors reduce spinal radiographic progression in patients with radiographic axial spondyloarthritis: a longitudinal analysis from the Alberta Prospective Cohort. Arthritis Rheumatol. 73(7):1211-9, 2021
                                      4. Maksymowych WP et al: MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group. Ann Rheum Dis. 78(11):1550-8, 2019
                                      5. Motamedi D et al: MR distribution of active inflammatory and chronic structural sacroiliac joint changes in axial spondyloarthropathy: challenging conventional wisdom. Clin Imaging. 58:70-3, 2019
                                      6. Shah NG et al: Injuries to the rigid spine: what the spine surgeon wants to know. Radiographics. 39(2):449-66, 2019
                                      7. Tsoi C et al: Imaging of sacroiliitis: current status, limitations and pitfalls. Quant Imaging Med Surg. 9(2):318-35, 2019
                                      8. Molnar C et al: TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort. Ann Rheum Dis. 77(1):63-9, 2018
                                      9. Proft F et al: Ankylosing spondylitis and axial spondyloarthritis: recent insights and impact of new classification criteria. Ther Adv Musculoskelet Dis. 10(5-6):129-39, 2018
                                      10. Zhao J et al: Radiographic hip involvement in ankylosing spondylitis: factors associated with severe hip diseases. J Rheumatol. 42(1):106-10, 2015
                                      11. Banegas Illescas ME et al: [New ASAS criteria for the diagnosis of spondyloarthritis: diagnosing sacroiliitis by magnetic resonance imaging.] Radiologia. 56(1):7-15, 2014
                                      12. Canella C et al: MRI in seronegative spondyloarthritis: imaging features and differential diagnosis in the spine and sacroiliac joints. AJR Am J Roentgenol. 200(1):149-57, 2013
                                      13. Carmona R et al: MR imaging of the spine and sacroiliac joints for spondyloarthritis: influence on clinical diagnostic confidence and patient management. Radiology. 269(1):208-15, 2013
                                      14. Navallas M et al: Sacroiliitis associated with axial spondyloarthropathy: new concepts and latest trends. Radiographics. 33(4):933-56, 2013
                                      15. Jang JH et al: Ankylosing Spondylitis: Patterns of radiographic involvement. Radiology 258:192-8,2011
                                      16. Park YS et al: The Andersson lesion in ankylosing spondylitis: distinguishing between the inflammatory and traumatic subtypes. J Bone Joint Surg Br. 93(7):961-6, 2011
                                      17. Althoff CE et al: Magnetic resonance imaging of active sacroiliitis: do we really need gadolinium? Eur J Radiol. 71(2):232-6, 2009
                                      18. Campagna R et al: Fractures of the ankylosed spine: MDCT and MRI with emphasis on individual anatomic spinal structures. AJR Am J Roentgenol. 192(4):987-95, 2009
                                      19. Maksymowych WP et al: Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation. Arthritis Rheum. 60(1):93-102, 2009
                                      20. Restrepo CS et al: Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29(3):839-59, 2009
                                      21. Westerveld LA et al: Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 18(2):145-56, 2009
                                      22. Bennett AN et al: Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum. 58(11):3413-8, 2008
                                      23. Bozgeyik Z et al: Role of diffusion-weighted MRI in the detection of early active sacroiliitis. AJR Am J Roentgenol. 191(4):980-6, 2008
                                      24. Gaspersic N et al: Monitoring ankylosing spondylitis therapy by dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging. Skeletal Radiol. 37(2):123-31, 2008
                                      25. Gensler LS et al: Clinical, radiographic and functional differences between juvenile-onset and adult-onset ankylosing spondylitis: results from the PSOAS cohort. Ann Rheum Dis. 67(2):233-7, 2008
                                      26. Gérard S et al: Six-month response to anti-TNF drugs in axial spondylarthropathy according to the fulfillment or not of New-York criteria for ankylosing spondylitis or French recommendations for anti-TNF use. A "real life" retrospective study on 175 patients. Joint Bone Spine. 75(6):680-7, 2008
                                      27. Kim NR et al: "MR corner sign": value for predicting presence of ankylosing spondylitis. AJR Am J Roentgenol. 191(1):124-8, 2008
                                      28. Koivikko MP et al: MRI of cervical spine injuries complicating ankylosing spondylitis. Skeletal Radiol. 37(9):813-9, 2008
                                      29. Machado P et al: Ankylosing spondylitis and spinal cord injury. Acta Reumatol Port. 33(2):231-7, 2008
                                      30. Rudwaleit M et al: MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Ann Rheum Dis. 67(9):1276-81, 2008
                                      31. Treitl M et al: Magnetic resonance imaging assessment of spinal inflammation in patients treated for ankylosing spondylitis. J Rheumatol. 35(1):126-36, 2008
                                      32. Tuite MJ: Sacroiliac joint imaging. Semin Musculoskelet Radiol. 12(1):72-82, 2008
                                      33. Appel H et al: Whole-body magnetic resonance imaging evaluation of widespread inflammatory lesions in a patient with ankylosing spondylitis before and after 1 year of treatment with infliximab. J Rheumatol. 34(12):2497-8, 2007
                                      34. Pham T et al: Recommendations of the French Society for Rheumatology regarding TNFalpha antagonist therapy in patients with ankylosing spondylitis or psoriatic arthritis: 2007 update. Joint Bone Spine. 74(6):638-46, 2007
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Imaging

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Ankylosing spondylitis (AS)

                                            • Definitions

                                              • Inflammatory arthropathy and enthesopathy with predilection for axial skeleton

                                            IMAGING

                                            • General Features

                                              • Imaging Recommendations

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            • Gross Pathologic & Surgical Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Han Q et al: A comprehensive assessment of hip damage in ankylosing spondylitis, especially early features. Front Immunol. 12:668969, 2021
                                                                          2. Rocha FAC et al: Tumor necrosis factor inhibitors prevent structural damage in hips in ankylosing spondylitis-time to reconsider treatment guidelines? A case series and review of literature. Clin Rheumatol. 40(5):1881-7, 2021
                                                                          3. Sepriano A et al: Tumor necrosis factor inhibitors reduce spinal radiographic progression in patients with radiographic axial spondyloarthritis: a longitudinal analysis from the Alberta Prospective Cohort. Arthritis Rheumatol. 73(7):1211-9, 2021
                                                                          4. Maksymowych WP et al: MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group. Ann Rheum Dis. 78(11):1550-8, 2019
                                                                          5. Motamedi D et al: MR distribution of active inflammatory and chronic structural sacroiliac joint changes in axial spondyloarthropathy: challenging conventional wisdom. Clin Imaging. 58:70-3, 2019
                                                                          6. Shah NG et al: Injuries to the rigid spine: what the spine surgeon wants to know. Radiographics. 39(2):449-66, 2019
                                                                          7. Tsoi C et al: Imaging of sacroiliitis: current status, limitations and pitfalls. Quant Imaging Med Surg. 9(2):318-35, 2019
                                                                          8. Molnar C et al: TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort. Ann Rheum Dis. 77(1):63-9, 2018
                                                                          9. Proft F et al: Ankylosing spondylitis and axial spondyloarthritis: recent insights and impact of new classification criteria. Ther Adv Musculoskelet Dis. 10(5-6):129-39, 2018
                                                                          10. Zhao J et al: Radiographic hip involvement in ankylosing spondylitis: factors associated with severe hip diseases. J Rheumatol. 42(1):106-10, 2015
                                                                          11. Banegas Illescas ME et al: [New ASAS criteria for the diagnosis of spondyloarthritis: diagnosing sacroiliitis by magnetic resonance imaging.] Radiologia. 56(1):7-15, 2014
                                                                          12. Canella C et al: MRI in seronegative spondyloarthritis: imaging features and differential diagnosis in the spine and sacroiliac joints. AJR Am J Roentgenol. 200(1):149-57, 2013
                                                                          13. Carmona R et al: MR imaging of the spine and sacroiliac joints for spondyloarthritis: influence on clinical diagnostic confidence and patient management. Radiology. 269(1):208-15, 2013
                                                                          14. Navallas M et al: Sacroiliitis associated with axial spondyloarthropathy: new concepts and latest trends. Radiographics. 33(4):933-56, 2013
                                                                          15. Jang JH et al: Ankylosing Spondylitis: Patterns of radiographic involvement. Radiology 258:192-8,2011
                                                                          16. Park YS et al: The Andersson lesion in ankylosing spondylitis: distinguishing between the inflammatory and traumatic subtypes. J Bone Joint Surg Br. 93(7):961-6, 2011
                                                                          17. Althoff CE et al: Magnetic resonance imaging of active sacroiliitis: do we really need gadolinium? Eur J Radiol. 71(2):232-6, 2009
                                                                          18. Campagna R et al: Fractures of the ankylosed spine: MDCT and MRI with emphasis on individual anatomic spinal structures. AJR Am J Roentgenol. 192(4):987-95, 2009
                                                                          19. Maksymowych WP et al: Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation. Arthritis Rheum. 60(1):93-102, 2009
                                                                          20. Restrepo CS et al: Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 29(3):839-59, 2009
                                                                          21. Westerveld LA et al: Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 18(2):145-56, 2009
                                                                          22. Bennett AN et al: Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum. 58(11):3413-8, 2008
                                                                          23. Bozgeyik Z et al: Role of diffusion-weighted MRI in the detection of early active sacroiliitis. AJR Am J Roentgenol. 191(4):980-6, 2008
                                                                          24. Gaspersic N et al: Monitoring ankylosing spondylitis therapy by dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging. Skeletal Radiol. 37(2):123-31, 2008
                                                                          25. Gensler LS et al: Clinical, radiographic and functional differences between juvenile-onset and adult-onset ankylosing spondylitis: results from the PSOAS cohort. Ann Rheum Dis. 67(2):233-7, 2008
                                                                          26. Gérard S et al: Six-month response to anti-TNF drugs in axial spondylarthropathy according to the fulfillment or not of New-York criteria for ankylosing spondylitis or French recommendations for anti-TNF use. A "real life" retrospective study on 175 patients. Joint Bone Spine. 75(6):680-7, 2008
                                                                          27. Kim NR et al: "MR corner sign": value for predicting presence of ankylosing spondylitis. AJR Am J Roentgenol. 191(1):124-8, 2008
                                                                          28. Koivikko MP et al: MRI of cervical spine injuries complicating ankylosing spondylitis. Skeletal Radiol. 37(9):813-9, 2008
                                                                          29. Machado P et al: Ankylosing spondylitis and spinal cord injury. Acta Reumatol Port. 33(2):231-7, 2008
                                                                          30. Rudwaleit M et al: MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis. Ann Rheum Dis. 67(9):1276-81, 2008
                                                                          31. Treitl M et al: Magnetic resonance imaging assessment of spinal inflammation in patients treated for ankylosing spondylitis. J Rheumatol. 35(1):126-36, 2008
                                                                          32. Tuite MJ: Sacroiliac joint imaging. Semin Musculoskelet Radiol. 12(1):72-82, 2008
                                                                          33. Appel H et al: Whole-body magnetic resonance imaging evaluation of widespread inflammatory lesions in a patient with ankylosing spondylitis before and after 1 year of treatment with infliximab. J Rheumatol. 34(12):2497-8, 2007
                                                                          34. Pham T et al: Recommendations of the French Society for Rheumatology regarding TNFalpha antagonist therapy in patients with ankylosing spondylitis or psoriatic arthritis: 2007 update. Joint Bone Spine. 74(6):638-46, 2007