Spondylarthropathies. Outline. Introduction. Spondylarthropathy other than AS. Mimickers of spondylarthropathy. Conclusions.

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Introduction Spondylarthropathy other than AS

Introduction Spondylarthropathies: spectrum

from RA Ankylosing spondylitis Psoriatic

Enteropathic arthropathies SAPHO/CRMO Imaging

1 Spondylarthropathies Filip M. Vanhoenacker Johan Van Goethem General Hospital St-Maarten Duffel-Mechelen Universities of Antwerp and Ghent Outline Introduction Spondylarthropathy other than AS Mimickers of spondylarthropathy Conclusions Introduction Spondylarthropathies: spectrum of chronic inflammatory disorders, distinct from RA Ankylosing spondylitis Psoriatic arthritis Reactive arthritis/reiter Enteropathic arthropathies SAPHO/CRMO Imaging features Sacroiliitis Enthesopathy (axial appendicular) Ref: W. Dihlmann variegated sacroiliitis 1

2 bamboo spine Trolley track Dagger Tumor necrosis factor (TNF)-α inhibitors Need early detection of pre-radiographic lesions disease activity monitoring therapy MRI better sensitivity than plain films included in ASAS criteria* specificity? *Rudwaleit M, et al. Ann Rheum Dis 2009 BME Structural changes Sacroiliitis Enthesopathy 2

3 Sacroiliac joint involvement Obl.cor STIR/T2-WI FS (//S2) inflammation BML Obl. cor T1-WI structure erosion (Obl.) ax T1 or T2-WI FS complex anatomy Optional? DWI, WE, CSI, Gado,T2* *Arnbak B, et al. Arthritis Res Ther 2012 Spinal involvement T1-WI T2-WI STIR Spondylitis: vertebral corner lesions (CIL) Spinal involvement Summary: axial skeletal involvement Spondylitis: costovertebral lesions *Lambert R, et al *Lambert R, et al. Sem. Musculoskelet Radiol Patient age at onset (and gender) Inflammatory vs degenerative LBP Look at the skin! Abdominal complaints? SIJ involvement Lesion distribution Pattern Morphology/ Sclerosis Ref: How to guide to axial SpA. Abbvie, sept

4 25-year-old patient with inflammatory LBP Resnick D. Diagnosis of Bone and joint disorders. Saunders, y-old female; inflammatory LBP/known psoriasis Psoriasis Age and gender: (young) adults Skin Dactylitis/arthritis SIJ: asymmetry - sclerosis erosion! Axial and/or appendicular Pattern: bone proliferation Parasyndesmophytes/ DISH like No squaring, less ankylosis AS Other SpA 4

5 Reactive arthritis (Reiter) Age and gender: (young) male Urethritis/balanitis/diarrhea Arthritis, usually lower limb SpA 36-year-o male;balanitis, axial SpA and oligo-arthritis SIJ: often asymmetrical involvement Similar to psoriasis Axial skeleton and peripheral Bone proliferation! 49-year-old female with history of small bowel disease Enteropathic arthropathy Age : early onset Positive family history Crohn s disease, CU, Similar to AS Look at the bowel Terminal ileitis 23-year-old female; inflammatory back pain 23-year-old female; inflammatory back pain 5

6 SAPHO: Synovitis Acne Pustulosis Hyperostosis Osteitis Age and gender: (young) adults more females skin/ SKIBO disease SIJ: less commonly involved Axial and/or appendicular Pattern: Bull s head SCJ Hyperostosis/osteitis 82-year-old patient, incidental finding on CT DISH: osteoblastic diathesis Age: elderly Degenerative or incidental finding Normal skin 82-year-old patient, incidental finding on CT SIJ : preservation joint space ligaments! Axial (+/- Appendicular) Pattern: flowing osteophytes waistline 4 levels sparing para-aortic area Preservation disk space and facet joints 6

7 DISH OPLL 40-year-old female patient, degenerative LBP Osteitis condensans ilii Age and gender: (young) female (35-55 year) Degenerative or incidental finding Normal skin SIJ : preservation joint space Spine and appendicular skeleton: unremarkable Pattern: triangular Sclerosis No or minor BME on MRI 49-year-old male with fever and elevated CRP Septic arthritis of the SIJ Age and gender: variable Fever Labo: Increase CRP/ Sedimentation Immunocompromised SIJ : rapidly destructive Unilateral Large erosions Joint effusion! Involvement of the iliopsoas Ochronosis Age: diagnosis often made at young age Alcaptonuria Black cartilage SIJ: less common Disc calcification Ankylosis Large joints 7

Conclusion SpA: spectrum of diseases with similar

synonymous with SpA Differential diagnostic clues

Age/ gender Skin disease Imaging signs SIJ

8 Conclusion SpA: spectrum of diseases with similar imaging features Ankylosis and BME is not synonymous with SpA Differential diagnostic clues Think clinical! Age/ gender Skin disease Imaging signs SIJ involvement Lesion distribution Pattern Morphology/sclerosis bamboo spine SpA Flowing hair waves DISH 8

Update - Imaging of the Spondyloarthropathies. Spondyloarthropathies. Spondyloarthropathies

Update - Imaging of the Spondyloarthropathies Donald J. Flemming, M.D. Dept of Radiology Penn State Hershey Medical Center Spondyloarthropathies Family of inflammatory arthritides of synovium and entheses