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Walter P Maksymowych - One of the best experts on this subject based on the ideXlab platform.
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performance of 18 f sodium fluoride positron emission tomography with computed tomography to assess inflammatory and structural Sacroiliitis on magnetic resonance imaging and computed tomography respectively in axial spondyloarthritis
Arthritis Research & Therapy, 2019Co-Authors: Marie Raynal, Julian Melchior, Isabelle Charyvalckenaere, A Blum, Remy Ouichka, Fehd Bouderraoui, Olivier Morel, Willy Ngueyon Sime, Veronique Roch, Walter P MaksymowychAbstract:To assess increased sacroiliac joint (SIJ) uptake on 18F-NaF PET/CT and to compare with MRI for inflammation and with CT scan for structural damages in a population of 23 patients with spondyloarthritis (SpA). Twenty-three patients with active SpA according to the Assessment of SpondyloArthritis international Society (ASAS) and/or modified NY criteria were included. All patients had a pelvic radiograph, MRI, and CT scan of the SIJ and 18F-NaF PET/CT examinations within a month, analyzed by three blinded readers. MRIs were assessed according to the ASAS criteria and SPARCC method. On CT scans, erosion and ankylosis were quantified using the same methodology. On the 18F-NaF PET, abnormal uptake was assessed using a qualitative method inspired by the ASAS criteria and two quantitative approaches (the PET-activity score according to the SPARCC method and Maximum Standardized Uptake Value (SUVmax)). Structural Sacroiliitis was observed on 7 radiographs and 10 CT scans; 10 MRIs showed inflammatory Sacroiliitis, and 20 patients had a positive PET. The inter-reader reliability was good for the PET activity score and good to excellent for the SUVmax. A positive PET was not correlated with a positive MRI or with a structural Sacroiliitis on CT scan. The PET-activity score and SUVmax were correlated with the SPARCC inflammation score but not with erosion or ankylosis scores on CT scan. Abnormal uptake by the SIJ on 18F-NaF PET is more frequent than inflammatory and structural Sacroiliitis in a population of SpA patients. The PET activity score and SUVmax had good correlations with inflammatory Sacroiliitis but not with structural lesions on CT scan.
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performance of 18f sodium fluoride positron emission tomography with computed tomography to assess inflammatory and structural Sacroiliitis on magnetic resonance imaging in axial spondyloarthritis
Clinical and Experimental Rheumatology, 2019Co-Authors: Remy Ouichka, Julian Melchior, Isabelle Charyvalckenaere, A Blum, Fehd Bouderraoui, Marie Raynal, Olivier Morel, Willy Ngueyon Sime, Veronique Roch, Walter P MaksymowychAbstract:Objectives To assess increased sacroiliac joint (SIJ) uptake on 18F-NaF PET/CT according to a qualitative and quantitative approach and to compare with MRI SIJ assessments for structural and inflammatory Sacroiliitis in a population of 23 patients with spondyloarthritis (SpA) (IDRCB: 2012-A00568-35; ClinicalTrials.gov: NCT 02869100). Methods This single-center prospective study included 23 patients with active SpA according to the ASAS and/or modified NY criteria. All patients had a pelvic AP-view radiograph, MRI of the SIJ and 18F-NaF PET/CT examinations within a month, which were analysed by three blinded readers. For MRI data, the SIJs were assessed according to the ASAS criteria and SPARCC method for scoring structural lesions (erosion, sclerosis, fat metaplasia, backfill and ankylosis) and inflammation. On the 18F-NaF PET, the SIJs were scored according to a slice-by-slice approach. Abnormal uptake was assessed using a qualitative method inspired by the ASAS criteria and two quantitative approaches (the PET-activity score according to the SPARCC method and the maximum standardised uptake value (SUVmax) for each SIJ). Results Structural Sacroiliitis was observed on 7 radiographs and 15 MRIs. 10 MRIs showed inflammatory Sacroiliitis (mean SPARCC 18.7). Twenty patients had a positive PET with a mean PET-activity score of 18.2 (±8.7). The mean SUVmax for a positive PET was 1.78 vs. 1.45 for a negative one. The inter-reader reliability was good for the PET activity score (ICC= 0.56 [IC-95: 0.32; 0.76]) and good to excellent for the SUVmax (ICC=0.70-0.90 [IC-95: 0.41; 0.96]). According to a binary approach, a positive PET was not correlated with a positive MRI for structural Sacroiliitis. The PET-activity score (r=0.61, p=0.001) and SUVmax (r=0.56, p=0.004) were correlated with the SPARCC inflammation score but not with structural Sacroiliitis or for SPARCC structural lesions. Conclusions Abnormal uptake by the SIJ on 18F-NaF PET is more frequent (87.0%) than inflammatory (43.5%) and structural Sacroiliitis (65.2%) on MRI in a population of SpA patients. The PET activity score and SUVmax had good correlations with inflammatory Sacroiliitis but not with structural lesions on MRI.
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radiographs in screening for Sacroiliitis in children what is the value
Arthritis Research & Therapy, 2018Co-Authors: Pamela F Weiss, Rui Xiao, David M Biko, Jacob L Jaremko, Timothy G Brandon, Walter P Maksymowych, Robert G W Lambert, Nancy A ChauvinAbstract:We aimed to evaluate the diagnostic utility of pelvic radiographs versus magnetic resonance imaging (MRI) of the sacroiliac joints in children with suspected Sacroiliitis. This was a retrospective cross-sectional study of children with suspected or confirmed spondyloarthritis who underwent pelvic radiograph and MRI within 6 months of one another. Images were scored independently by five raters. Interrater reliability was calculated using Fleiss’s kappa coefficient (κ). Test properties of radiographs for depiction of Sacroiliitis were calculated using MRI global Sacroiliitis impression as the reference standard. The interrater agreement for global impression was κ = 0.34 (95% CI 0.19–0.52) for radiographs and κ = 0.72 (95% CI 0.52–0.86) for MRI. Across raters, the sensitivity of radiographs ranged from 25 to 77.8% and specificity ranged from 60.8 to 92.2%. Positive and negative predictive values ranged from 25.9 to 52% and from 82.7 to 93.9%, respectively. The misclassification rate ranged from 6 to 17% for negative radiographs/positive MRI scans and from 48 to 74% for positive radiographs/negative MRI scans. When the reference standard was changed to structural lesions consistent with Sacroiliitis on MRI, the misclassification rate was higher for negative radiographs/positive MRI scans (9–23%) and marginally improved for positive radiographs/negative MRI scans (33–52%). Interrater reliability of MRI was superior to radiographs for global Sacroiliitis impression. Misclassification for both negative and positive radiographs was high across raters. Radiographs have limited utility in screening for Sacroiliitis in children and result in a significant proportion of both false negative and positive findings versus MRI findings.
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validation of the asas criteria and definition of a positive mri of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years
Annals of the Rheumatic Diseases, 2012Co-Authors: Sibel Zehra Aydin, Walter P Maksymowych, A N Bennett, Dennis Mcgonagle, Paul Emery, Helena MarzoortegaAbstract:Background The new Assessment of SpondyloArthritis international Society (ASAS) criteria classify axial spondyloarthritis (SpA) into human leucocyte antigen-B27 and/or imaging-based arms. To aid implementation, ASAS has proposed a definition of a positive MRI for active Sacroiliitis. Objective The authors aimed to test the diagnostic and predictive value of the ASAS criteria and definition of a ‘positive’ MRI. Methods Baseline MRI scans on 29 patients with early inflammatory back pain and 18 controls were read independently by four experienced rheumatologists. Both arms of the criteria were tested against a ‘gold standard’ of physician diagnosis of SpA. MRI abnormalities were assessed according to a global assessment of MRI and the ASAS definition. Sensitivity, specificity and likelihood ratios for individual and concordant reader data were calculated for axial SpA diagnosis at baseline and the development of radiographic Sacroiliitis, fulfilling the modified New York criteria at 8 years. Results All patients were classified as having axial SpA, with more patients fulfilling the imaging arm (83%, n=24/29) than the human leucocyte antigen B27 arm (62%, n=18/29). Concordant reader data showed that the baseline MRI had high diagnostic utility for SpA according to global assessment (sensitivity/specificity: 66%/94%, LR+ (positive likelihood ratio) 11.8, LR− (negative likelihood ratio) 0.4) and ASAS definition (sensitivity/specificity: 79%/89%, LR+ 7.1, LR− 0.2). Likewise, a positive baseline MRI had 100% sensitivity for subsequent radiographic Sacroiliitis by either assessment, although specificity was lower (56% for global assessment and 33% for ASAS definition). Conclusion Both arms of the ASAS criteria have good diagnostic utility in early SpA, although they are of limited value for the prediction of radiographic progression. This may be due to the definition of a positive MRI for Sacroiliitis that lacks specificity at baseline.
M Rudwaleit - One of the best experts on this subject based on the ideXlab platform.
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five year follow up of radiographic Sacroiliitis progression as well as improvement
Annals of the Rheumatic Diseases, 2015Co-Authors: Alexandre Sepriano, M Rudwaleit, Joachim Sieper, Rosaline Van Den Berg, Robert Landewe, Desiree Van Der HeijdeAbstract:Determining the presence of radiographic Sacroiliitis is a key feature in the diagnostic process of radiographic axial spondyloarthritis (r-axSpA), synonymous to ankylosing spondylitis according to the modified New York criteria (mNY).1 Its presence is considered prognostically relevant and paves the way for treatment with biological drugs.2 Multiread and multireader exercises have proven that radiographic Sacroiliitis is an ambiguous finding, as reflected by large inter-reader and intrareader variability.3 ,4 Determining progression of radiographic Sacroiliitis, which marks the arbitrary but irreversible change from non-radiographic axSpA (nr-axSpA) to r-axSpA, is even more ambiguous. The mNY lack sensitivity-to-change in this slowly progressing condition, and it is conceivable that regression of radiographic Sacroiliitis is very rare if not impossible.5 Previous studies addressing progression from nr-axSpA to …
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rates and predictors of radiographic Sacroiliitis progression over 2 years in patients with axial spondyloarthritis
Annals of the Rheumatic Diseases, 2011Co-Authors: Denis Poddubnyy, M Rudwaleit, H Haibel, J Listing, Elisabeth Markerhermann, Henning Zeidler, Jurgen Braun, Joachim SieperAbstract:Objective To assess the progression of radiographic Sacroiliitis in a cohort of patients with early axial spondyloarthritis over a period of 2 years and to explore predictors of progression. Methods 210 patients with axial spondyloarthritis from the German Spondyloarthritis Inception Cohort have been selected for this analysis based on availability of radiographs at baseline and after 2 years of follow-up. Radiographs were centrally digitised and the sacroiliac joints were scored independently according to the grading system of the modified New York criteria for ankylosing spondylitis (AS) by two trained readers. The readers scored both time points simultaneously but were blinded for the time point and for all clinical data. Results 115 patients (54.8%) fulfilled the modified New York criteria for AS in their radiographic part in the opinion of both readers at baseline, while 95 patients (45.2%) were classified as non-radiographic axial spondyloarthritis. More patients with non-radiographic spondyloarthritis (10.5%) compared with AS (4.4%) showed an estimated ‘true’ progression by at least one grade according to both readers, although the difference between the two groups was statistically non-significant. The rate of progression from non-radiographic axial spondyloarthritis to AS was 11.6% over 2 years. An elevated level of C-reactive protein (CRP) at baseline was a strong positive predictor of radiographic Sacroiliitis progression in non-radiographic axial spondyloarthritis and AS (OR 3.65 and 5.08, respectively, p Conclusion Progression of radiographic Sacroiliitis by at least one grade after 2 years occurs only in a small percentage of patients with early axial spondyloarthritis. An elevated level of CRP was found to be a strong positive predictor of Sacroiliitis progression.
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defining active Sacroiliitis on magnetic resonance imaging mri for classification of axial spondyloarthritis a consensual approach by the asas omeract mri group
Annals of the Rheumatic Diseases, 2009Co-Authors: M Rudwaleit, Xenofon Baraliakos, J Braun, R Landewe, D Van Der Heijde, A G Jurik, Kaygeert A Hermann, Helena Marzoortega, M Ostergaard, J SieperAbstract:Background: Magnetic resonance imaging (MRI) of sacroiliac joints has evolved as the most relevant imaging modality for diagnosis and classification of early axial spondyloarthritis (SpA) including early ankylosing spondylitis. Objectives: To identify and describe MRI findings in Sacroiliitis and to reach consensus on which MRI findings are essential for the definition of Sacroiliitis. Methods: Ten doctors (two radiologists and eight rheumatologists) from the ASAS/OMERACT MRI working group reviewed and discussed in three workshops MR images depicting Sacroiliitis associated with SpA and other conditions which may mimic SpA. Descriptions of the pathological findings and technical requirements for the appropriate acquisition were formulated. In a consensual approach MRI findings considered to be essential for Sacroiliitis were defined. Results: Active inflammatory lesions such as bone marrow oedema (BMO)/osteitis, synovitis, enthesitis and capsulitis associated with SpA can be detected by MRI. Among these, the clear presence of BMO/osteitis was considered essential for defining active Sacroiliitis. Structural damage lesions such as sclerosis, erosions, fat deposition and ankylosis can also be detected by MRI. At present, however, the exact place of structural damage lesions for diagnosis and classification is less clear, particularly if these findings are minor. The ASAS group formally approved these proposals by voting at the annual assembly. Conclusions: For the first time, MRI findings relevant for Sacroiliitis have been defined by consensus by a group of rheumatologists and radiologists. These definitions should help in applying correctly the imaging feature “active Sacroiliitis by MRI” in the new ASAS classification criteria for axial SpA.
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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
Annals of the Rheumatic Diseases, 2009Co-Authors: M Rudwaleit, J Listing, Jurgen Braun, R Landewe, D Van Der Heijde, J Brandt, Ruben Burgosvargas, Eduardo Collantesestevez, John C Davis, Ben A C DijkmansAbstract:Objective: Non-radiographic axial spondyloarthritis (SpA) is characterised by a lack of definitive radiographic Sacroiliitis and is considered an early stage of ankylosing spondylitis. The objective of this study was to develop candidate classification criteria for axial SpA that include patients with but also without radiographic Sacroiliitis. Methods: Seventy-one patients with possible axial SpA, most of whom were lacking definite radiographic Sacroiliitis, were reviewed as “paper patients” by 20 experts from the Assessment of SpondyloArthritis international Society (ASAS). Unequivocally classifiable patients were identified based on the aggregate expert opinion in conjunction with the expert-reported level of certainty of their judgement. Draft criteria for axial SpA were formulated and tested using classifiable patients. Results: Active Sacroiliitis on magnetic resonance imaging (MRI) (odds ratio 45, 95% CI 5.3 to 383; p x rays in conjunction with one SpA feature or, if sacroilitiis is absent, in the presence of at least three SpA features. In a second set of candidate criteria, inflammatory back pain is obligatory in the clinical arm (sensitivity 86.1%; specificity 94.7%). Conclusion: The ASAS group has developed candidate criteria for the classification of axial SpA that include patients without radiographic Sacroiliitis. The candidate criteria need to be validated in an independent international study.
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the early disease stage in axial spondylarthritis results from the german spondyloarthritis inception cohort
Arthritis & Rheumatism, 2009Co-Authors: M Rudwaleit, H Haibel, Xenofon Baraliakos, J Listing, Elisabeth Markerhermann, Henning Zeidler, Jurgen Braun, Joachim SieperAbstract:Objective Ankylosing spondylitis (AS) is diagnosed late, because radiographs of the sacroiliac joints often do not show definite Sacroiliitis at the time of disease onset. The aim of this study was to investigate whether patients without definite radiographically defined Sacroiliitis, referred to as nonradiographic axial spondylarthritis (SpA), are different from patients with AS with regard to clinical manifestations and disease activity measures. Moreover, we sought to identify determinants of the development of radiographic Sacroiliitis. Methods In a cross-sectional analysis of 462 patients, we compared 226 patients with nonradiographic axial SpA (symptom duration ≤5 years) and 236 patients with AS (symptom duration ≤10 years) who are participants in the German Spondyloarthritis Inception Cohort. Radiographs of the sacroiliac joints and the spine were assessed by 2 readers in a blinded manner. Logistic regression analysis was applied to identify parameters associated with structural damage. Results The 2 groups did not differ in the frequency of HLA–B27 positivity, inflammatory back pain, arthritis, enthesitis, and uveitis and had similar levels of disease activity, using measures such as the Bath Ankylosing Spondylitis Disease Activity Index. In both groups, HLA–B27 positivity determined the age at disease onset. Male sex (adjusted odds ratio [OR] 2.38, 95% confidence interval [95% CI] 1.19–4.73 [P = 0.014]) and an elevated C-reactive protein (CRP) level (adjusted OR 1.85, 95% CI 0.96–3.56 [P = 0.066]) were associated with radiographic Sacroiliitis. In patients with AS, male sex and an elevated CRP level were also associated with the presence of syndesmophytes. Conclusion Clinical manifestations and disease activity measures are highly comparable between patients with early nonradiographic axial SpA and those with early AS, suggesting that these 2 entities are part of the same disease. Male sex and an elevated CRP level are associated with structural damage on radiographs, whereas HLA–B27 positivity determines the age at disease onset.
J Sieper - One of the best experts on this subject based on the ideXlab platform.
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defining active Sacroiliitis on magnetic resonance imaging mri for classification of axial spondyloarthritis a consensual approach by the asas omeract mri group
Annals of the Rheumatic Diseases, 2009Co-Authors: M Rudwaleit, Xenofon Baraliakos, J Braun, R Landewe, D Van Der Heijde, A G Jurik, Kaygeert A Hermann, Helena Marzoortega, M Ostergaard, J SieperAbstract:Background: Magnetic resonance imaging (MRI) of sacroiliac joints has evolved as the most relevant imaging modality for diagnosis and classification of early axial spondyloarthritis (SpA) including early ankylosing spondylitis. Objectives: To identify and describe MRI findings in Sacroiliitis and to reach consensus on which MRI findings are essential for the definition of Sacroiliitis. Methods: Ten doctors (two radiologists and eight rheumatologists) from the ASAS/OMERACT MRI working group reviewed and discussed in three workshops MR images depicting Sacroiliitis associated with SpA and other conditions which may mimic SpA. Descriptions of the pathological findings and technical requirements for the appropriate acquisition were formulated. In a consensual approach MRI findings considered to be essential for Sacroiliitis were defined. Results: Active inflammatory lesions such as bone marrow oedema (BMO)/osteitis, synovitis, enthesitis and capsulitis associated with SpA can be detected by MRI. Among these, the clear presence of BMO/osteitis was considered essential for defining active Sacroiliitis. Structural damage lesions such as sclerosis, erosions, fat deposition and ankylosis can also be detected by MRI. At present, however, the exact place of structural damage lesions for diagnosis and classification is less clear, particularly if these findings are minor. The ASAS group formally approved these proposals by voting at the annual assembly. Conclusions: For the first time, MRI findings relevant for Sacroiliitis have been defined by consensus by a group of rheumatologists and radiologists. These definitions should help in applying correctly the imaging feature “active Sacroiliitis by MRI” in the new ASAS classification criteria for axial SpA.
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the diagnostic value of scintigraphy in assessing Sacroiliitis in ankylosing spondylitis a systematic literature research
Annals of the Rheumatic Diseases, 2008Co-Authors: Inho Song, M Rudwaleit, J Carrascofernandez, J SieperAbstract:Background: The diagnostic value of scintigraphy in detecting Sacroiliitis in patients with spondyloarthritis is not clear. Objective: To assess the diagnostic value of scintigraphy in detecting Sacroiliitis in ankylosing spondylitis (AS) and in patients with clinically probable Sacroiliitis without x -ray changes. Material and methods: A systematic literature research was performed in the Pubmed and Medline database up to August 2007. Articles in English and German on patients with established AS and clinically probable Sacroiliitis without x -ray changes were selected. In addition, studies including patients with mechanical low back pain as a control group were searched. Pooled sensitivity, specificity and positive and negative likelihood ratios were calculated. Results: In total 99 articles about scintigraphy were found. 25 articles were included into the analysis. Overall sensitivity for scintigraphy to detect Sacroiliitis was 51.8% for patients with established AS (n = 361) and 49.4% for patients with probable Sacroiliitis (n = 255). Sensitivity of scintigraphy in patients with AS with inflammatory back pain (indicating ongoing inflammation) was 52.7% (n = 112) and in patients with AS and suspected Sacroiliitis with magnetic resonance imaging showing acute Sacroiliitis (as a gold standard) was 53.2% (n = 62). In controls with mechanical low back pain specificity was 78.3% (n = 60) resulting in likelihood ratios not higher than 2.5–3.0. Conclusion: These data as a result of a literature research suggest that scintigraphy of the sacroiliac joints is at most of limited diagnostic value for the diagnosis of established AS, including the early diagnosis of probable/suspected Sacroiliitis.
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enthesitis and ankylosis in spondyloarthropathy what is the target of the immune response
Annals of the Rheumatic Diseases, 2000Co-Authors: J Braun, M A Khan, J SieperAbstract:A report from a symposium held at Klinikum Benjamin Franklin, Free University, Berlin, Germany, 25–26 February 2000 This symposium was organised by J Braun and J Sieper (Free University, Berlin) to review the current knowledge of the anatomical, inflammatory, microbiological, and immunological events in enthesitis. The term “enthesopathy” is relatively new and its medical history short, but some important contributions can be listed (boxFB1). Figure FB1 History of “enthesopathy” • 1966 Enthesopathy first used by Niepel • 1970 Entheses centrally affected in ankylosing spondylitis, in contrast with rheumatoid arthritis (RA; Heberden oration lecture by Ball) • 1975 Some enthesitis in Sacroiliitis (Francois) • 1983 Syndrome of seronegative enthesopathy and arthropathy in children (Rosenberg) • 1982 Sacroiliitis starts in the subchondral bone (Shichikawa) • 1991 Enthesopathy discriminative feature of spondyloarthropathy (SpA; European Spondyloarthropathy Study Group criteria, Dougados) • 1998 Entheses more commonly affected in arthritis in SpA compared with RA (McGonagle) The spondyloarthropathies are among the most common inflammatory rheumatic diseases.1 In addition to the strong genetic predisposition, partly due to HLA-B27,2 there are characteristic clinical features of SpA3: inflammatory back pain often due to Sacroiliitis4 and enthesitis occurring mostly at various well defined locations, predominantly of the legs, such as the Achilles tendon, the plantar aponeurosis, the knee, the trochanter regions of the femur, and several pelvic sites.5 Thus entheses are ubiquitous, resulting in a diversity of associated pathological manifestations. Sacroiliitis is the most common early sign of SpA.6Whether or not ligamentous and entheseal structures are affected in sacroiliac inflammation has not yet been entirely clarified. To answer some of the most critical questions an expert symposium on enthesitis was organised:
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imaging of Sacroiliitis
Clinical Rheumatology, 2000Co-Authors: J Braun, J Sieper, M BollowAbstract:Inflammation of one or both sacroiliac joints is a characteristic feature of patients with spondyloarthropathies (SpA). Sacroiliitis often leads to inflammatory back pain (IBP). IBP and asymmetric peripheral arthritis of the lower limbs are the main clinical symptoms and criteria for classification and diagnosis of SpA in which sacroiliac joints are uni- or bilaterally affected with an intensity ranging from mild to very severe inflammation resulting in partial or complete ankylosis Sacroiliitis is a very frequent feature of undifferntiated SpA. In ankylosing spondylitis (AS) inflammation in the axial skeleton occurs rarely in the absence of Sacroiliitis. Objective evidence of Sacroiliitis obtained by imaging procedures, especially x-rays, has always been part of diagnostic and classification criteria for AS. This is in contrast to spinal radiography which, however, has been recently included in a core set of outcome items to be assessed in clinical studies. In early and acute stages of Sacroiliitis the diagnosis can be difficult because conventional radiographs -- which are known to have considerable intra- and interobserver variability -- may be normal. Since IBP is not a specific indicator of Sacroiliitis there is need for valuable imaging techniques. Scintigraphy lacks specificity. Computed tomography (CT) is a very good method to demonstrate already established bony changes and magnetic resonance imaging (MRI) has the advantage of combining a good visualisation of the complicated anatomy of the sacroiliac joint with the ability to localise different degrees of inflammation and oedema and prove a possible spread to muscles as it occurs in septic Sacroiliitis, an important differential diagnosis.
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studying patients with inflammatory back pain and arthritis of the lower limbs clinically and by magnetic resonance imaging many but not all patients with Sacroiliitis have spondyloarthropathy
Rheumatology, 1999Co-Authors: J Brandt, M Rudwaleit, J Sieper, M Bollow, U Eggens, A Distler, J Haberle, J BraunAbstract:Objective. Clinical and magnetic resonance imaging (MRI) data of 170 consecutive patients with inflammatory back pain (IBP) and/or oligoarthritis of the lower limbs were evaluated in a retrospective study. The aim was to determine the frequency of Sacroiliitis and spondyloarthropathy (SpA) in this population, and to assess the significance of HLA B27 measurements for diagnosis in early disease. Methods. Pelvic X-rays were performed in all IBP patients and dynamic MRI of the sacroiliac joints in patients with IBP who had indefinite results on sacroiliac X-rays (n = 32). Results. European Spondyloarthropathy Study Group criteria for SpA were fulfilled by 106/170 patients (62.4%); eight additional patients had symptoms suggestive of SpA (4.7%). The most frequent SpA subset was undifferentiated SpA (uSpA), diagnosed in 46/106 patients (43.4%). Sacroiliitis was detected by MRI in 21/32 patients with IBP and unclear X-rays (65.6%). Of those, 14 were diagnosed as SpA and seven females with moderate unilateral Sacroiliitis, but no features of SpA, also not on follow-up (at least 1 yr), were classified as undifferentiated Sacroiliitis (US). Ten of the 14 SpA (71.4%) and none of the seven US patients were HLA B27 positive. Conclusion. HLA B27 positivity in IBP patients with MRI-proven Sacroiliitis positively predicts SpA. uSpA is a frequent SpA subset. There are HLA B27-negative non-SpA patients with moderate unilateral Sacroiliitis whom we propose to be classified as US.
Julian Melchior - One of the best experts on this subject based on the ideXlab platform.
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performance of 18 f sodium fluoride positron emission tomography with computed tomography to assess inflammatory and structural Sacroiliitis on magnetic resonance imaging and computed tomography respectively in axial spondyloarthritis
Arthritis Research & Therapy, 2019Co-Authors: Marie Raynal, Julian Melchior, Isabelle Charyvalckenaere, A Blum, Remy Ouichka, Fehd Bouderraoui, Olivier Morel, Willy Ngueyon Sime, Veronique Roch, Walter P MaksymowychAbstract:To assess increased sacroiliac joint (SIJ) uptake on 18F-NaF PET/CT and to compare with MRI for inflammation and with CT scan for structural damages in a population of 23 patients with spondyloarthritis (SpA). Twenty-three patients with active SpA according to the Assessment of SpondyloArthritis international Society (ASAS) and/or modified NY criteria were included. All patients had a pelvic radiograph, MRI, and CT scan of the SIJ and 18F-NaF PET/CT examinations within a month, analyzed by three blinded readers. MRIs were assessed according to the ASAS criteria and SPARCC method. On CT scans, erosion and ankylosis were quantified using the same methodology. On the 18F-NaF PET, abnormal uptake was assessed using a qualitative method inspired by the ASAS criteria and two quantitative approaches (the PET-activity score according to the SPARCC method and Maximum Standardized Uptake Value (SUVmax)). Structural Sacroiliitis was observed on 7 radiographs and 10 CT scans; 10 MRIs showed inflammatory Sacroiliitis, and 20 patients had a positive PET. The inter-reader reliability was good for the PET activity score and good to excellent for the SUVmax. A positive PET was not correlated with a positive MRI or with a structural Sacroiliitis on CT scan. The PET-activity score and SUVmax were correlated with the SPARCC inflammation score but not with erosion or ankylosis scores on CT scan. Abnormal uptake by the SIJ on 18F-NaF PET is more frequent than inflammatory and structural Sacroiliitis in a population of SpA patients. The PET activity score and SUVmax had good correlations with inflammatory Sacroiliitis but not with structural lesions on CT scan.
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performance of 18f sodium fluoride positron emission tomography with computed tomography to assess inflammatory and structural Sacroiliitis on magnetic resonance imaging in axial spondyloarthritis
Clinical and Experimental Rheumatology, 2019Co-Authors: Remy Ouichka, Julian Melchior, Isabelle Charyvalckenaere, A Blum, Fehd Bouderraoui, Marie Raynal, Olivier Morel, Willy Ngueyon Sime, Veronique Roch, Walter P MaksymowychAbstract:Objectives To assess increased sacroiliac joint (SIJ) uptake on 18F-NaF PET/CT according to a qualitative and quantitative approach and to compare with MRI SIJ assessments for structural and inflammatory Sacroiliitis in a population of 23 patients with spondyloarthritis (SpA) (IDRCB: 2012-A00568-35; ClinicalTrials.gov: NCT 02869100). Methods This single-center prospective study included 23 patients with active SpA according to the ASAS and/or modified NY criteria. All patients had a pelvic AP-view radiograph, MRI of the SIJ and 18F-NaF PET/CT examinations within a month, which were analysed by three blinded readers. For MRI data, the SIJs were assessed according to the ASAS criteria and SPARCC method for scoring structural lesions (erosion, sclerosis, fat metaplasia, backfill and ankylosis) and inflammation. On the 18F-NaF PET, the SIJs were scored according to a slice-by-slice approach. Abnormal uptake was assessed using a qualitative method inspired by the ASAS criteria and two quantitative approaches (the PET-activity score according to the SPARCC method and the maximum standardised uptake value (SUVmax) for each SIJ). Results Structural Sacroiliitis was observed on 7 radiographs and 15 MRIs. 10 MRIs showed inflammatory Sacroiliitis (mean SPARCC 18.7). Twenty patients had a positive PET with a mean PET-activity score of 18.2 (±8.7). The mean SUVmax for a positive PET was 1.78 vs. 1.45 for a negative one. The inter-reader reliability was good for the PET activity score (ICC= 0.56 [IC-95: 0.32; 0.76]) and good to excellent for the SUVmax (ICC=0.70-0.90 [IC-95: 0.41; 0.96]). According to a binary approach, a positive PET was not correlated with a positive MRI for structural Sacroiliitis. The PET-activity score (r=0.61, p=0.001) and SUVmax (r=0.56, p=0.004) were correlated with the SPARCC inflammation score but not with structural Sacroiliitis or for SPARCC structural lesions. Conclusions Abnormal uptake by the SIJ on 18F-NaF PET is more frequent (87.0%) than inflammatory (43.5%) and structural Sacroiliitis (65.2%) on MRI in a population of SpA patients. The PET activity score and SUVmax had good correlations with inflammatory Sacroiliitis but not with structural lesions on MRI.
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radiography abdominal ct and mri compared with sacroiliac joint ct in diagnosis of structural Sacroiliitis
European Journal of Radiology, 2017Co-Authors: Julian Melchior, Yusef Azraq, Isabelle Charyvalckenaere, Pedro Texeira, A Blum, Marion Reignac, Damien LoeuilleAbstract:Abstract Objective To assess the performance of pelvic plain radiograph (radiography), abdominal CT and sacroiliac joint MRI (MRI) compared with sacroiliac joints CT (SI joint CT) for the diagnosis of structural Sacroiliitis in a population suffering from spondyloarthritis (SpA) meeting the New York or ASAS criteria. Methods All SpA patients eligible for biologic treatment who received a pre-therapeutic check-up including the four imaging techniques in the same year were selected from 2005 to 2012. An assessment of Sacroiliitis was based independently by a rheumatologist and a radiologist on radiography according to the modified New York criteria and on abdominal CT, MRI and SI Joint CT depending on the presence of erosion on at least two consecutive slices. A final diagnosis was established for conflicting exams. Results Of the 58 selected patients, Sacroiliitis was diagnosed on radiography, abdominal CT, MRI and SI Joint CT in 32, 26, 34 and 35 patients, respectively. Inter-reader agreements for the grade of Sacroiliitis were substantial with a weighted Kappa that varied between 0.60 and 0.76 and they were moderate for the diagnosis of Sacroiliitis with a Kappa that varied between 0.45 and 0.55 for the four imaging modalities. The sensitivities of radiography, abdominal CT and MRI were 82.8%, 71.4% and 85.7% respectively and the specificities were 86.9%, 100% and 82.6% respectively with excellent accuracy and positive predictive value and good negative predictive value. Conclusion This study demonstrates the relevance of MRI and abdominal CT for the diagnosis of structural Sacroiliitis with good sensitivities and excellent specificities. These imaging modalities may also contribute for the diagnosis of structural Sacroiliitis.
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radiography and abdominal ct compared with sacroiliac joint ct in the diagnosis of Sacroiliitis
Acta Radiologica, 2017Co-Authors: Julian Melchior, Yusef Azraq, Isabelle Charyvalckenaere, Pedro Texeira, A Blum, Damien LoeuilleAbstract:Background The presence of structural Sacroiliitis is strong evidence for the diagnosis of spondyloarthritis (SpA). Purpose To assess the performance of abdominal computed tomography (CT) and pelvic plain radiography for the diagnosis of structural Sacroiliitis compared with sacroiliac CT (SI joint CT) considered the reference technique in patients with SpA. Material and Methods All SpA patients eligible for biologic treatment were selected from 2005 to 2012. An assessment of Sacroiliitis was based on radiography according to the modified New York criteria and on abdominal CT and SI joint CT scans depending on the presence of erosion on at least two consecutive slices. A senior rheumatologist and radiologist independently scored the grade and diagnosis of structural Sacroiliitis for the three imaging modalities. After a consensus reading of conflicting examinations (radiography and CT), a final diagnosis of structural Sacroiliitis was attained. Results Of the 72 patients selected, Sacroiliitis was diagnosed on radiography, abdominal CT, and SI joint CT in 40, 31, and 44 patients, respectively. Inter-reader agreements for the grade of Sacroiliitis were substantial for the three imaging modalities, with a weighted kappa range of 0.63-0.75 (95% confidence interval [CI], 0.52-0.83), and they were moderate for the diagnosis of Sacroiliitis, with a kappa range of 0.50-0.55 (95% CI, 0.32-0.74). The sensitivity and specificity were 79.1% and 70.5%, respectively, for radiography and 82.1% and 100%, respectively, for abdominal CT. Conclusion This study demonstrates the relevance of abdominal CT for the diagnosis of structural Sacroiliitis, with good sensitivity and excellent specificity. These imaging techniques avoid unnecessary examinations.
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sat0617 pelvic plain radiograph and thoraco abdominal and pelvic ct scan compared to ct of the sacroiliac joints taken as gold standard in the diagnosis of structural Sacroiliitis
Annals of the Rheumatic Diseases, 2015Co-Authors: Julian Melchior, A. C. Rat, Yusef Azraq, Isabelle Charyvalckenaere, Pedro Texeira, A Blum, D LoeuilleAbstract:Background In some countries, patients with spondyloarthritis are eligible to receive a TNF blocker only if they present with radiographic spondyloarthritis (AS). This study is therefore of interest with regard to validation of the use of other imaging modalities, particularly thoracic and pelvic CT scanning, to establish the diagnosis of structural Sacroiliitis with the same level of performance as radiography. Objectives To assess the performance of thoraco-abdominal and pelvic CT (TAP-CT) and pelvic plain radiography (RX) for the diagnosis of structural Sacroiliitis compared to sacroiliac CT (SIJ-CT) in patients with spondyloarthritis (SpA). Methods All SpA patients eligible for biologic treatment with or without structural Sacroiliitis on radiography (ASAS criteria) were selected from 2005 to 2012. The three imaging studies were performed in the same year. Sacroiliitis was assessed on RX according to New York criteria, and in TAP-CT and SIJ-CT scans depended on the presence of erosions on two consecutive slides. A senior rheumatologist and radiologist independently scored the grade and the diagnosis of structural Sacroiliitis for the three imaging modalities. After a consensus reading of the conflicting exams (RX and CT), a final diagnosis of structural Sacroiliitis was retained. The gold standard for the diagnosis of structural Sacroiliitis was SIJ-CT. Results Of the 72 patients selected, Sacroiliitis was diagnosed on RX, TAP-CT and SIJ-CT in 40, 31 and 44 respectively. Inter-reader agreements for the grade of Sacroiliitis were good for the three imaging modalities with a weighted kappa that varied between 0.63 and 0.75 (IC-95%: 0.52-0.83). Inter-reader agreements for the diagnosis of Sacroiliitis were moderate with a kappa that varied between 0.50 and 0.55 (CI-95%: 0.32-0.74). For the RX and the TAP-CT, the sensitivity and the specificity were respectively 79.1%, 70.5%, and 82.1%, 100%. Finally, 4 out of 5 patients were correctly classified on RX or TAP-CT Conclusions This study demonstrates the interest of TAP-CT for the diagnosis of structural Sacroiliitis with a good sensitivity and an excellent specificity. This imaging technique systematically performed in various clinical situations would limit the prescription of additional exams to establish the diagnosis of structural Sacroiliitis. References Devauchelle-Pensec V, D9Agostino MA, Marion J, Lapierre M, Jousse-Joulin S, Colin D et al. Computed tomography scanning facilitates the diagnosis of Sacroiliitis in patients with suspected spondylarthritis: results of a prospective multicenter French cohort study. Arthritis Rheum. 2012 May; 64(5):1412-9. Geijer M, Gothlin GG, Gothlin JH. The clinical utility of computed tomography compared to conventional radiography in diagnosing Sacroiliitis. A retrospective study on 910 patients and literature review. J Rheumatol. 2007 Jul; 34(7):1561-5. Slobodin G, Croitoru S, Starikov N, Younis S, Boulman N, Rimar D et al. Incidental computed tomography Sacroiliitis: clinical significance and inappropriateness of the New York radiological grading criteria for the diagnosis. Clin Rheumatol. 2012 Mar;31(3):425-8. Disclosure of Interest None declared
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five year follow up of radiographic Sacroiliitis progression as well as improvement
Annals of the Rheumatic Diseases, 2015Co-Authors: Alexandre Sepriano, M Rudwaleit, Joachim Sieper, Rosaline Van Den Berg, Robert Landewe, Desiree Van Der HeijdeAbstract:Determining the presence of radiographic Sacroiliitis is a key feature in the diagnostic process of radiographic axial spondyloarthritis (r-axSpA), synonymous to ankylosing spondylitis according to the modified New York criteria (mNY).1 Its presence is considered prognostically relevant and paves the way for treatment with biological drugs.2 Multiread and multireader exercises have proven that radiographic Sacroiliitis is an ambiguous finding, as reflected by large inter-reader and intrareader variability.3 ,4 Determining progression of radiographic Sacroiliitis, which marks the arbitrary but irreversible change from non-radiographic axSpA (nr-axSpA) to r-axSpA, is even more ambiguous. The mNY lack sensitivity-to-change in this slowly progressing condition, and it is conceivable that regression of radiographic Sacroiliitis is very rare if not impossible.5 Previous studies addressing progression from nr-axSpA to …
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rates and predictors of radiographic Sacroiliitis progression over 2 years in patients with axial spondyloarthritis
Annals of the Rheumatic Diseases, 2011Co-Authors: Denis Poddubnyy, M Rudwaleit, H Haibel, J Listing, Elisabeth Markerhermann, Henning Zeidler, Jurgen Braun, Joachim SieperAbstract:Objective To assess the progression of radiographic Sacroiliitis in a cohort of patients with early axial spondyloarthritis over a period of 2 years and to explore predictors of progression. Methods 210 patients with axial spondyloarthritis from the German Spondyloarthritis Inception Cohort have been selected for this analysis based on availability of radiographs at baseline and after 2 years of follow-up. Radiographs were centrally digitised and the sacroiliac joints were scored independently according to the grading system of the modified New York criteria for ankylosing spondylitis (AS) by two trained readers. The readers scored both time points simultaneously but were blinded for the time point and for all clinical data. Results 115 patients (54.8%) fulfilled the modified New York criteria for AS in their radiographic part in the opinion of both readers at baseline, while 95 patients (45.2%) were classified as non-radiographic axial spondyloarthritis. More patients with non-radiographic spondyloarthritis (10.5%) compared with AS (4.4%) showed an estimated ‘true’ progression by at least one grade according to both readers, although the difference between the two groups was statistically non-significant. The rate of progression from non-radiographic axial spondyloarthritis to AS was 11.6% over 2 years. An elevated level of C-reactive protein (CRP) at baseline was a strong positive predictor of radiographic Sacroiliitis progression in non-radiographic axial spondyloarthritis and AS (OR 3.65 and 5.08, respectively, p Conclusion Progression of radiographic Sacroiliitis by at least one grade after 2 years occurs only in a small percentage of patients with early axial spondyloarthritis. An elevated level of CRP was found to be a strong positive predictor of Sacroiliitis progression.
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the early disease stage in axial spondylarthritis results from the german spondyloarthritis inception cohort
Arthritis & Rheumatism, 2009Co-Authors: M Rudwaleit, H Haibel, Xenofon Baraliakos, J Listing, Elisabeth Markerhermann, Henning Zeidler, Jurgen Braun, Joachim SieperAbstract:Objective Ankylosing spondylitis (AS) is diagnosed late, because radiographs of the sacroiliac joints often do not show definite Sacroiliitis at the time of disease onset. The aim of this study was to investigate whether patients without definite radiographically defined Sacroiliitis, referred to as nonradiographic axial spondylarthritis (SpA), are different from patients with AS with regard to clinical manifestations and disease activity measures. Moreover, we sought to identify determinants of the development of radiographic Sacroiliitis. Methods In a cross-sectional analysis of 462 patients, we compared 226 patients with nonradiographic axial SpA (symptom duration ≤5 years) and 236 patients with AS (symptom duration ≤10 years) who are participants in the German Spondyloarthritis Inception Cohort. Radiographs of the sacroiliac joints and the spine were assessed by 2 readers in a blinded manner. Logistic regression analysis was applied to identify parameters associated with structural damage. Results The 2 groups did not differ in the frequency of HLA–B27 positivity, inflammatory back pain, arthritis, enthesitis, and uveitis and had similar levels of disease activity, using measures such as the Bath Ankylosing Spondylitis Disease Activity Index. In both groups, HLA–B27 positivity determined the age at disease onset. Male sex (adjusted odds ratio [OR] 2.38, 95% confidence interval [95% CI] 1.19–4.73 [P = 0.014]) and an elevated C-reactive protein (CRP) level (adjusted OR 1.85, 95% CI 0.96–3.56 [P = 0.066]) were associated with radiographic Sacroiliitis. In patients with AS, male sex and an elevated CRP level were also associated with the presence of syndesmophytes. Conclusion Clinical manifestations and disease activity measures are highly comparable between patients with early nonradiographic axial SpA and those with early AS, suggesting that these 2 entities are part of the same disease. Male sex and an elevated CRP level are associated with structural damage on radiographs, whereas HLA–B27 positivity determines the age at disease onset.
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use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced Sacroiliitis in spondylarthropathy patients
Arthritis & Rheumatism, 1994Co-Authors: Jurgen Braun, M Bollow, U Eggens, Hermann Konig, A Distler, Joachim SieperAbstract:Objective. To evaluate the new magnetic resonance imaging (MRI) method of dynamic MRI with fast imaging in the diagnosis of Sacroiliitis among patients with spondylarthropathy. Methods. Fifteen patients with a history of inflammatory back pain without radiographic evidence of grade II or greater Sacroiliitis (group 1), 25 patients with definite ankylosing spondylitis (group 2), and 12 patients with noninflammatory spinal pain (controls) (group 3) were examined. Dynamic MRI with fast imaging was performed after intravenous bolus injection of the contrast agent gadolinium—diethylenetriamine pentaacetic acid. The degree of enhancement was graded as representing acute Sacroiliitis, latent Sacroiliitis, or no Sacroiliitis. Results. Acute Sacroiliitis was detected in 22 of 30 sacroiliac (SI) joints in group 1 patients and in 27 of 50 SI joints in group 2 patients; latent Sacroiliitis was seen in 25 of 80 SI joints in patients from groups 1 and 2. No group 3 patient was found to have Sacroiliitis. Conclusion. Early Sacroiliitis can be demonstrated by dynamic MRI in spondylarthropathy patients in whom abnormalities are not revealed by conventional radiography.
