ArticleRheumatology advances in practice2026
MRI-defined sacroiliitis and spinal inflammation in chronic back pain: real-world patterns in axial spondyloarthritis and axial psoriatic arthritis.
Article in Rheumatology advances in practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: To evaluate the diagnostic performance of MRI-defined sacroiliitis for axial spondyloarthritis (axSpA) in routine clinical practice and to characterize inflammatory spinal lesions (ISLs) and clinical factors associated with sacroiliitis across non-psoriatic axSpA (nPsA-axSpA), axial psoriatic arthritis (axPsA) and non-inflammatory chronic back pain (NI-CBP). Methods: We conducted a retrospective study of adults with chronic back pain who underwent SI joint and whole-spine MRI for suspected axSpA. Following longitudinal follow-up, patients were classified by expert rheumatologists as nPsA-axSpA, axPsA or NI-CBP. Two blinded musculoskeletal radiologists independently assessed MRI scans for sacroiliitis and ISLs using Assessment of SpondyloArthritis international Society/OMERACT definitions. Diagnostic accuracy metrics for MRI-defined sacroiliitis were calculated using expert diagnosis as the reference standard and multivariate logistic regression was used to identify predictors of sacroiliitis. Results: Ninety-five patients were included (29 nPsA-axSpA, 21 axPsA, 45 NI-CBP). MRI-defined sacroiliitis showed high specificity (91%) and moderate sensitivity (77-83%) for axSpA diagnosis. Independent predictors of sacroiliitis included age [odds ratio (OR) 1.05/year], regular physical activity (OR 3.50), expert-assessed inflammatory back pain (OR 35.11) and the number of SpA features (OR 1.72). ISLs were present in 40% of patients overall and were most prevalent in axPsA (76%). In axPsA, ISLs frequently occurred in the absence of sacroiliitis and displayed a broader and more heterogeneous distribution. Conclusion: MRI-defined sacroiliitis is highly specific but insufficient as a stand-alone diagnostic tool for axSpA in real-world settings and should be interpreted in context.
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