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Fig. 10 Spine abnormalities on magnetic resonance imaging in a patient with ankylosing
spondylitis. Sagittal view of lumbar spine. a Erosion of the anterior portion of a lumbar vertebral body
(arrow) is shown as hypointense signal in T1 weighted image. b Erosions and osteitis (arrowheads)
on adjacent vertebral bodies is shown as hyperintense signal on a STIR weighted image
have shown that anti-TNF therapy can decrease in
ammation as detected by spinal
MRI. Therefore, MRI scoring systems have been developed to assess the in
fl
am-
matory signals and their changes with treatment [
49
]. It has also been reported that
the combination of bone marrow edema and fatty deposits on MRI may predict the
development of new syndesmophytes [
50
]. However,
fl
its utility for evaluating
structural damage is still under investigation.
CT provides an accurate and sensitive assessment of changes of bony structures,
so it is ideal to detect new bone formation. CT of the lower thoracic spine has been
used to quantitate the volume of syndesmophytes and changes in their size over
2 years, and demonstrated good validity. Compared to MRI or plain radiograph, CT
was more sensitive to change [
51
]. At this time, its application is limited to research
due to its radiation exposure.
Spondyloarthritis associated with in
ammatory bowel disease, also called en-
teropathic arthritis, develops in 20 % of patients who have Crohn
fl
'
s disease or
ulcerative colitis, conditions that involve bowel in
ammation. Many have spine
involvement with the same Pathogenetic process of AS.
fl
3.2 Psoriatic Arthritis
3.2.1 De
nition and Occurrence
Psoriatic arthritis is a chronic in
ammatory arthritis in patients with psoriasis that
involves the spine and peripheral joints. In 60
fl
80 % of cases, the skin rash of
psoriasis precedes the development of arthritis; in 15 % patients, arthritis is the
presenting symptom; occasionally, psoriasis and arthritis develop concurrently [
52
].
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