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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Ranked #55 of 160 articles by views in Rheumatology Advances in Practice

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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.
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Authors Mauricio Parada, M. Molina, Daniel Ríos, Daniela Suárez, Mauricio Ochoa, Natalie Hitchin, Cristóbal Bravo, Nancy Guzmán, Pablo Barahona, Annelise Goecke Sariego
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Journal Rheumatology Advances in Practice
Year 2026
DOI
10.1093/rap/rkag072
URL
https://doi.org/10.1093/rap/rkag072
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