MRI-defined sacroiliitis and spinal inflammation in chronic back pain: real-world patterns in axial spondyloarthritis and axial psoriatic arthritis

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ID: 318944
2026
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Abstract
Abstract Objectives To evaluate the diagnostic performance of MRI-defined sacroiliitis (SI) for axial spondyloarthritis (axSpA) in routine clinical practice, and to characterize inflammatory spinal lesions (ISL) and clinical factors associated with SI 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 sacroiliac 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 SI and ISL using ASAS/OMERACT definitions. Diagnostic accuracy metrics for MRI-defined SI were calculated using expert diagnosis as the reference standard, and multivariate logistic regression was used to identify predictors of SI. Results Ninety-five patients were included (29 nPsA-axSpA, 21 axPsA, 45 NI-CBP). MRI-defined SI showed high specificity (91%) and moderate sensitivity (77–83%) for axSpA diagnosis. Independent predictors of SI included age (OR 1.05 per year), regular physical activity (OR 3.50), expert-assessed inflammatory back pain (OR 35.11), and the number of spondyloarthritis features (OR 1.72). ISL were present in 40% of patients overall and were most prevalent in axPsA (76%). In axPsA, ISL frequently occurred in the absence of SI and displayed a broader and more heterogeneous distribution. Conclusion MRI-defined sacroiliitis is highly specific but insufficient as a standalone diagnostic tool for axSpA in real-world settings and should be interpreted in context.
Reference Key
openalex_W7166011219 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Mauricio Parada, M. Molina, Daniel Ríos, Daniela Suárez, Mauricio Ochoa, Natalie Hitchin, Cristóbal Bravo, Nancy Guzmán, Pablo Barahona, Annelise Goecke Sariego
Journal Rheumatology Advances in Practice
Year 2026
DOI
10.1093/rap/rkag072
URL
https://doi.org/10.1093/rap/rkag072
Keywords Keywords not found

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