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Margaret A Hall-Craggs, Timothy J P Bray, Alexis Jones, Helena Marzo-Ortega, Pedro M Machado, Comment on: Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK: reply, Rheumatology, Volume 59, Issue 1, January 2020, Pages 261–262, https://doi.org/10.1093/rheumatology/kez510
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Dear Editor, We thank the authors [1] for their interest in our recent paper on the recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in patients suspected of having of axial spondyloarthritis (axSpA) [2]. These recommendations were formulated following a systematic review of the literature [3] and agreement among a multidisciplinary expert group of rheumatologists and radiologists.
We read the cases presented by the authors of this letter with interest. We believe they are atypical for axSpA, clinically and/or radiologically. The cardinal MRI features of axSpA are of subchondral bone marrow oedema/osteitis, enthesitis and erosions, with sclerosis and subcortical fat metaplasia occurring during healing phases, followed ultimately by bone ankylosis. However, even these appearances cannot be taken as diagnostic in the absence of relevant clinical symptomatology. It is important to highlight that clinical history in axSpA is variable and the diagnosis is based on pattern recognition of a combination of features. These may include inflammatory back pain and stiffness, peripheral manifestations (arthritis, dactylitis, enthesitis and tenosynovitis), restriction of spinal mobility and extra-articular manifestations (uveitis, psoriasis and inflammatory bowel disease). It is part of the routine clinical work-up to inquire about other clinical features that may suggest an alternative diagnosis, such as history of trauma, surgery, radiculopathy, chronic widespread pain, osteoporosis, fractures, infection and connective tissue disease symptoms [4].
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