Abstract
While it has been established that the essential quality of spondyloarthritis(SpA) is enthesitis; in international rheumatology axial SpA, which represents the core disease of SpA, has gained prominence in recent years.
Although this painful condition is highly prevalent, SpA is sometimes misdiagnosed as a psychosomatic disease or psychosis. Therefore, there are many patients who have not received normal medical treatment in Japan. Fujita et al. reported that the prevalence of SpA in Wakayama prefecture was 0.2% ; equal to that of RA(0.2%) in the same district.
MRI findings on the sacroiliac joints have been applied to the criteria of axial spondyloarthritis; the criteria for peripheral spondyloarthritis were also advocated in 2011.
By using both criteria, early and precise recognition of SpA enables advanced intervention and effective treatment for these patients.
In particular, the pathologic recognition of SpA using MRI affects the standard recommendation for the initiation of biological treatment for SpA in Western countries.
STIR positive finding of the sacroiliac joints by MRI is recognized as a window of opportunity, and full efficacy of the biological treatment can be expected during that period.
It may be said that a paradigm shift has been achieved from the time of assessing ankylosing spondylitis with the radiographic diagnosis of sacroiliac joints.
