Husni discusses the use of MRI, detailed patient history in the identification of SpA

HOLLYWOOD, Fla. — At the Fourth Annual Basic and Clinical Immunology for the Busy Clinician, M. Elaine Husni, MD, MPH, discussed the use of MRI in the identification of bone marrow edema and other non-radiographic features of spondyloarthropathies.

Husni said the current treatment goal is to identify the disease earlier. She noted the Assessment of Spondyloarthritis International Society criteria addresses this goal, even in cases without radiographic progression.

“Sometimes you want to get a diagnosis before you start to see those changes,” Husni said.

Synovitis of the sacroiliac joint can be detected on MRI, according to Husni, but interpreting bone marrow edema on MRI in patients with spondyloarthritis (SpA) can be more difficult.

“There are reasons patients might have bone marrow edema and not have ankylosing spondylitis,” Husni said. “MRI is the test of choice for rheumatologists who are seeing inflammatory back pain and are wondering if there are any inflammatory changes. But I am not sure if we are ready to start ordering MRIs and interpreting if you have a low pretest probability, meaning in all young patients with back pain. So you want to have the understanding that there is some inflammatory back pain component, rather than just ordering this as a screening test.”

Identifying inflammatory back pain in younger patients and teaching new physicians to identify it can be challenging, Husni said.

“It is pain that usually improves with exercise, so that is one of the delineating factors vs. mechanical back pain, but there are also other features,” Husni said and noted that asking patients questions, such as whether the pain causes waking in the second half of the night, whether pain alternates from side-to-side or if any trauma was associated with the onset of pain.

Husni said getting a detailed history from the patient may be the most effective way to make a diagnosis.

“This is going to be what is going to help you go on to the rest of the criteria.” – by Shirley Pulawski

Reference:

Husni ME. Advances in Psoriatic Arthritis and Spondyloarthropathy. Presented at: Fourth Annual Basic and Clinical Immunology for the Busy Clinician and Advances in Biologics Therapies Symposium; March 10-12, 2016; Hollywood, Fla.

Disclosure: Husni reports the receipt of grants/research support from the Arthritis National Research Foundation, Genzyme and National Psoriasis Foundation, and consulting fees from Amgen, Bristol-Myers Squibb and Pfizer.