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首页> 外文期刊>Joint, bone, spine : >A plea for reason in using magnetic resonance imaging for the diagnostic and therapeutic management of spondyloarthropathies.
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A plea for reason in using magnetic resonance imaging for the diagnostic and therapeutic management of spondyloarthropathies.

机译：请使用磁共振成像进行脊椎关节病的诊断和治疗。

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Magnetic resonance imaging (MRI) is being increasingly used by rheumatologists to improve the diagnosis and treatment of axial spondyloarthropathies. However, many questions remain open regarding the use of MRI in everyday practice. Here, we suggest at least partial answers to these questions.Sacroiliac involvement is considered crucial for the diagnosis of ankylosing spondylitis (AS) . Thus, radiological sacroiliitis (bilateral grade 2 or higher or unilateral grade 3 or higher) is among the modified New York criteria for the disease . However, everyday clinical practice teaches that radiological sacroiliitis may develop only after many years - 6 years on average after symptom onset - or not at all. The absence of sacroiliitis is not an obstacle in clinical practice when using Amor's criteria or European Spondylarthropathy Study Group (ESSG) criteria to diagnose a spondyloarthropathy and to recommend treatment with nonsteroidal antiin-" flammatory drugs (NSAID). In some patients, however, a definitive diagnosis must be established. A case in point is the patient with severe disease that is inadequately controlled by NSAID therapy and may, therefore, require administration of a TNF antagonist. TNF antagonists were developed in patients meeting modified New York criteria, and the European license reserves their use for patients with radiological sacroiliitis . Furthermore, most of the international, guidelines, including those issued by the Assessment of SpondyloArthritis International Society (ASAS), list presence of the modified New York criteria among the conditions for starting TNF antagonist therapy in patients with AS . Thus, patients whose clinical symptoms strongly suggest AS but whose imaging studies are normal are not candidates for TNF antagonist therapy, according to international recommendations. The recommendations on TNF antagonist therapy in AS issued by the French Society forRheumatology (SFR) and the Rheumatic Diseases and Inflammation Club (CRI) were designed to ensure that the absence of radiological sacroiliitis does not prevent patients from receiving appropriate treatment [9,10]. The main difference with other recommendations is that patients who have normal radiographs but abnormal findings from other imaging modalities can receive a diagnosis of AS. Thus, the diagnosis of AS can be made in patients who do not meet modified New York criteria: "A definitive diagnosis of AS requires either presence of the modified New York criteria or presence of characteristic involvement of the sacroiliac joints or spine or peripheral joints documented by radiographs or computed tomography (structural damage) or magnetic resonance imaging (inflammation)" [10]. Using MRI to look for inflammation of the sacroiliac joints and/or spine is, therefore, a crucial element of the diagnostic strategy, most notably in patients whose radiographs are normal and who need a definitive diagnosis before starting TNF antagonist therapy. MRI is considerably more informative than standard radiography. It may show evidence of inflammation (subchondral edema on both sides of the sacroiliac joints, high signal on STIR sequences from the anterior vertebral corners or Romanus lesions, and/or discitis or Andersson lesions) [11-13]. The strategy suggested by the SFR was indirectly validated by recent studies showing dramatic responses to TNF antagonists in patients with a strong clinical suspicion of AS, normal radiographs, and suggestive inflammatory changes by MRI [14,15].
机译：风湿病学家越来越多地使用磁共振成像（MRI）来改善轴向脊椎关节病的诊断和治疗。然而，关于在日常实践中使用MRI的许多问题仍然存在。在这里，我们建议对这些问题至少部分回答.Sa的累及被认为对强直性脊柱炎（AS）的诊断至关重要。因此，放射性sa肌炎（双侧2级或更高或单侧3级或更高）是该疾病的纽约修订标准。但是，日常临床实践表明，放射性cro肌炎可能仅在多年后才发展-症状发作后平均6年-或根本不发展。当使用Amor标准或欧洲脊椎病研究小组（ESSG）标准诊断脊椎关节病并建议使用非甾体类抗炎药“ NSAID”进行治疗时，of关节炎的缺失在临床实践中不会成为障碍。必须建立明确的诊断，一个典型的例子是患有严重疾病的患者，该患者没有受到NSAID治疗的控制，因此可能需要给予TNF拮抗剂治疗。许可证保留其用于放射性cro肌炎患者的使用，此外，大多数国际指南，包括国际脊柱关节炎评估协会（ASAS）颁布的指南，都列出了在纽约州开始进行TNF拮抗剂治疗的条件之一。 AS的患者，因此，其临床症状强烈提示A的患者根据国际建议，S但其影像学研究正常的患者不适合进行TNF拮抗剂治疗。法国风湿病学会（SFR）和风湿病与炎症俱乐部（CRI）发布的有关AS的TNF拮抗剂治疗的建议旨在确保不存在放射性cro骨炎不会妨碍患者接受适当的治疗[9,10] 。与其他建议的主要区别在于，射线照相正常但其他影像学检查结果异常的患者可以诊断为AS。因此，可以在不符合纽约标准的患者中进行AS的诊断：“要明确诊断AS，就需要存在纽约标准的修改，或者存在sa关节或脊柱或周围关节的特​​征性侵犯通过射线照相或计算机断层扫描（结构损伤）或磁共振成像（炎症）” [10]。因此，使用MRI查找sa关节和/或脊柱的炎症是诊断策略的关键要素，尤其是在X光片正常且在开始TNF拮抗剂治疗之前需要明确诊断的患者。 MRI比标准X射线照相术具有更多信息。它可能显示出炎症的证据（the关节两侧软骨下水肿，椎体前角或Romanus病变的STIR序列信号高，和/或盘状炎或Andersson病变）[11-13]。 SFR提出的策略在最近的研究中得到了间接验证，这些研究显示，强烈怀疑AS，放射线照相正常，MRI提示炎症性改变的患者对TNF拮抗剂反应显着[14,15]。

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