Active Sacroiliitis in Ankylosing Spondylitis Clinical Trial
Official title:
Role of Color Doppler Ultrasonography in Evaluation of Active Sacroiliitis in Ankylosing Spondylitis Patients and Its Relation With Disease Activity
Evaluate the role of color Doppler ultrasonography (CDUS) in detection of active sacroiliitis
in Ankylosing Spondylitis patients using MRI of the sacroiliac joints as a gold standard.
Evaluate the relation of active sacroiliitis detected by color Doppler ultrasonography (CDUS)
with disese activity in patients with ankylosing spondylitis
Ankylosing spondylitis (AS) is the prototype of the spondyloarthropathies as a chronic
inflammatory rheumatic disease presenting mainly with inflammation of the axial skeleton,
peripheral arthritis, and enthesitis.
Sacroiliitis is an important sign of AS, and it is used to describe unilateral or bilateral
involvement of the sacroiliac joint (SIJ) .
Early diagnosis of AS is important, since some changes associated with the disease are
irreversible, and early diagnosis can also improve the ultimate clinical outcomes.
X-ray and magnetic resonance imaging (MRI) are frequently used as image tools to investigate
sacroiliitis in AS patients. X-ray could show the structural lesion of sacroiliac joints
(SIJs), but could not show the lesions in the early stage of disease. MRI can quantify active
in¬flammatory lesions of SIJs.
However, MRI is relatively expensive and time-consuming, and its routine use in patient
visits during ther¬apy would be difficult. Another factor that limits usage of MRI is that an
important proportion of AS patients have prostheses. Therefore, an easier and cheaper method
is needed to detect the degree of spinal inflammation.
Ultrasonography (US) is an inexpensive, non-invasive and non-radiating technique, which can
be used in daily clinical practice .
Musculoskeletal ultrasonography (US) has gained increasing attention in many areas of
rheumatology . In the area of spondyloarthropathy, Doppler US has been used frequently to
assess enthesitis . It was demonstrated that signs of active sacroiliitis could be detected
by the color Doppler ultrasonograpy (CDUS) method including increased vascularization in the
posterior SIJ and a lower resistance index (RI). The RI could be a quantitative indicator of
active sacroiliitis.
Treatment options to AS are limited and mainly consist of non-steroidal anti-inflammatory
drugs (NSAIDs) and physical therapy .Efficacy of dis¬ease-modifying anti-rheumatic drugs
(DMARDs) such as methotrexate is uncertain to AS.
The introduction of biologic drugs for treatment of AS has led to effective treatment of
disease symptoms and signs. However, the effect of these costly drugs on structural damage in
addition to the clinical findings is not clear .
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