Comparıson of sacroılıac joınt mrı wıth dısease actıvıty fındıngs regardıng treatment method, ın ankylosıng spondylıtıs patıent wıth have actıve sacroılııtıs

Seronegative spondyloarthropathies are a group of spinal and oligoarticular peripheral arthritidies that are characterized by synovitis and enthesitis. Ankylosing spondylitis (AS) is the prototype of this group. The earliest and the most characteristic findings of AS is seen in sacroiliac joints. Standard physical examination tests which are useful in other joints cannot be used for diagnosis of sacroiliitis, due to immobility and deep location of the sacroiliac joints, so the imaging tests have a pivotal role in the diagnosis. Magnetic Resonance imaging is accepted as the most efficient imaging modality to diagnose the early and active sacroiliitis. In this study, the aim was to evaluate active (bone marrow edema, osteitis, synovitis, enthesitis, capsulitis) and chronic (fatty infiltration, subchondral sclerosis, ankylosis) changes in active sacroiliitis patients, who have been treated with different therapeutic options, with Magnetic Resonance imaging. Evaluating the correlation between BASDAI scores regarding the disease activity and the various MR parameters was also targeted. Between January 2011 and August 2014, 34 active sacroiliitis patients (M/F: 23/11) who had pre and post-treatment sacroiliac MR imaging in Radiology Department of Adnan Menderes University Faculty of Medicine were enrolled in this retrospective study group. Different treatment options were used in this study group as following: NSAİDs for 13 patients, SSZ for 7 patients and anti-TNF for 14 patients. Cases were divided into two sub-groups as anti-TNF and others. Average BASDAI score for whole group at pre-treatment period was 6,64, declined to 4,13 after treatment and this difference was statistically significant. In anti-TNF sub-group, average BASDAI score declined from 6,53 to 2,87 after treatment which was also statistically significant. Among the active findings, the severity of synovial and subchondral contrast enhancement decreased significantly after treatment. Synovial contrast enhancement especially correlated with BASDAI scores between pre and post-treatment period. Fatty infiltration was the only chronic finding which had changed significantly after treatment, but there wasnot any correlation with average BASDAI scores. As a result, post-contrast MR series are useful in diagnosis and follow-up of active sacroiliitis. Sacroiliac MR imaging with contrast enhanced series are recommended for the evaluation and follow-up of ankylosing spondylitis patients along with BASDAI scores Key words: Ankylosing Spondylitis, Sacroiliitis, Sacroiliac joint MR, Anti TNF, BASDAI