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Ziade N, Udod M, Kougkas N, Tsiami S, Baraliakos X. Significant overlap of inflammatory and degenerative features on imaging among patients with degenerative disc disease, diffuse idiopathic skeletal hyperostosis and axial spondyloarthritis: a real-life cohort study. Arthritis Res Ther 2024; 26:147. [PMID: 39097721 PMCID: PMC11297750 DOI: 10.1186/s13075-024-03359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/30/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Differentiating between degenerative disc disease (DDD), diffuse idiopathic skeletal hyperostosis (DISH), and axial spondyloarthritis (axSpA) represents a diagnostic challenge in patients with low back pain (LBP). We aimed to evaluate the distribution of inflammatory and degenerative imaging features in a real-life cohort of LBP patients referred to a tertiary university rheumatology center. METHODS In a retrospective cross-sectional analysis of patients referred for LBP, demographics, symptom information, and available imaging were collected. SpA-like changes were considered in the spine in the presence of one of the following lesions typically related to SpA: erosions, sclerosis, squaring, and syndesmophytes on conventional radiographs (CR) and bone marrow oedema (BMO), erosions, sclerosis, and fat lesions (FL) on MRI. SIJ CR were graded per New York criteria; on MRIs, SIJs were evaluated by quadrant for BMO, erosions, FL, sclerosis and ankylosis, similar to the approach used by the Berlin SIJ MRI scoring system. The final diagnosis made by the rheumatologist was the gold standard. Data were presented descriptively, by patient and by quadrant, and compared among the three diagnosis groups. RESULTS Among 136 referred patients, 71 had DDD, 38 DISH, and 27 axSpA; median age 62 years [IQR55-73], 63% males. On CR, SpA-like changes were significantly higher in axSpA in the lumbar (50%, vs. DDD 23%, DISH 22%), in DISH in the thoracic (28%, vs. DDD 8%, axSpA 12%), and in DDD in the cervical spine (67% vs. DISH 0%, axSpA 33%). On MRI, BMO was significantly higher in DISH in the thoracic (37%, vs. DDD 22%, axSpA 5%) and equally distributed in the lumbar spine (35-42%). FL were significantly more frequently identified in DISH and axSpA in the thoracic (56% and 52%) and DDD and axSpA in the lumbar spine (65% and 74%, respectively). Degenerative changes were frequent in the three groups. Sacroiliitis (NY criteria) was identified in 49% (axSpA 76%, DDD 48%, DISH 29%). CONCLUSION A significant overlap was found among DDD, DISH, and axSpA for inflammatory and degenerative imaging features. Particularly, SpA-like spine CR features were found in one-fourth of patients with DISH, and MRI BMO was found in one-third of those patients.
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Affiliation(s)
- Nelly Ziade
- Hotel-Dieu De France, Saint Joseph University, Beirut, Lebanon
| | - Melanie Udod
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Nikolaos Kougkas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany.
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He Z, Tung NTC, Yahara Y, Makino H, Yasuda T, Seki S, Suzuki K, Futakawa H, Kamei K, Kawaguchi Y. Association between serum interleukin-17 levels and ectopic bone formation in OPLL patients with DISH. Rheumatology (Oxford) 2024; 63:2268-2277. [PMID: 37889295 DOI: 10.1093/rheumatology/kead555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE To investigate the relationship between the severity and morphology of heterotopic ossification in the spinal ligaments including sacroiliac (SI) joints, and serum interleukin-17 (IL-17) levels in patients with ossification of the posterior longitudinal ligament (OPLL) with or without diffuse idiopathic skeletal hyperostosis (DISH), as well as a non-OPLL group. METHODS A total of 103 patients with OPLL [DISH (-), n = 50; DISH (+), n = 53] and 53 age- and gender-matched controls were included. The serum levels of IL-17 were analysed, and the severity of ectopic ossification and the morphology of ectopic bone formation were evaluated. The SI joint morphological variations were categorized into four types. RESULTS No significant differences were found in serum IL-17 levels between the OPLL and control groups. However, the DISH (+) group showed higher IL-17 levels than the DISH (-) group, especially in female patients (P = 0.003). Additionally, IL-17 levels were positively correlated with the number of flat vertebral units, this being one of the characteristic DISH ossification types (R2 = 0.199, P = 0.012). IL-17 levels in the type showing bridging osteophyte and bone fusion were significantly higher in the DISH (+) group than in the DISH (-) group. CONCLUSION The morphological characteristics of paravertebral bone formation in the entire spine, including the SI joint, are likely associated with serum IL-17 levels in OPLL. These findings provide pathological and serological evidence of local inflammation contributing to paravertebral ossification of OPLL patients.
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Affiliation(s)
- Zhongyuan He
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nguyen Tran Canh Tung
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
- Department of Trauma and Orthopaedic Surgery, Vietnam Military Medical University, Hanoi, Vietnam
| | - Yasuhito Yahara
- WPI-Immunology Frontier Research Center, Osaka University, Suita, Osaka, Japan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
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Holgate R, L'Abbé EN, Steyn M. Diffuse Idiopathic Skeletal Hyperostosis (DISH): New evidence from micro-XCT scanning. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 40:48-55. [PMID: 36529049 DOI: 10.1016/j.ijpp.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To observe and describe the development and underlying structure of the spinal manifestations of individuals osteologically diagnosed with DISH (Diffuse Idiopathic Skeletal Hyperostosis), using micro-XCT imaging. MATERIALS A total of 72 individuals with DISH were identified in two modern skeletal collections in South Africa. METHODS Vertebral columns affected by DISH were scanned at the micro-focus x-ray computed tomography facility at the Nuclear Energy Corporation of South Africa. Four features were macroscopically examined: (1) the origin of the new bone growth; (2) retention of the original vertebral cortex at the site of the new bone formation associated with DISH; (3) evidence of trabecular bone with or without sclerosis on the anterolateral surface of affected vertebrae; and (4) abnormal areas of osteosclerosis beyond features associated with DISH. RESULTS Considerable variation across and between the four recorded features was found. Of note, 81% (n = 58) of individuals had both developed trabecular bone within the flowing new bone formation (feature 3), without retention of the original vertebral cortex (feature 2). CONCLUSIONS Possible localised erosive/inflammatory processes destroyed the original cortex of the vertebral body and resulted in the expansion of trabeculae with new bone formation. SIGNIFICANCE Micro-XCT imaging shed new light on the development of DISH, adding to literature suggesting that it could be an inflammatory disease. LIMITATIONS Clinical histories of the individuals were not known. SUGGESTIONS FOR FURTHER RESEARCH The role of chronic inflammatory disease in the development of DISH should be further explored including both the extra-spinal and spinal manifestations.
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Affiliation(s)
- Rlv Holgate
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - E N L'Abbé
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - M Steyn
- Human Variation and Identification Research Unit, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
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Furtado ARR, Moris LM, Esmieu S, Cherubini GB, Mantis P. Low-field magnetic resonance imaging characteristics of multifocal vertebral lesions in dogs. Vet Rec 2021; 189:e78. [PMID: 34505679 DOI: 10.1002/vetr.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/10/2020] [Accepted: 12/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a lack of information regarding magnetic resonance imaging (MRI) features of polyostotic vertebral lesions in dogs. The aim of this retrospective study was to identify and differenciate low-field MRI features of aggressive versus benign multifocal vertebral diseases in dogs. METHODS MRI examinations from 49 dogs with polyostotic vertebral lesions were reviewed. Images were evaluated for vertebral intensity changes, expansile lesions, new bone formation, cortical bone interruption, paravertebral musculature changes, lymphadenomegaly, spinal cord compression and spinal cord signal changes. RESULTS Twenty-nine dogs with non-aggressive bone lesions and 20 dogs with aggressive vertebral lesions were included. Non-aggressive lesions had variable T2-weighted fast spin-echo (T2W) signal intensity and the majority displayed low signal intensity on short tau inversion recovery (STIR). Aggressive lesions predominantly had high T2W and STIR signal intensity, with variable signal intensity on T1-weighted spin-echo and contrast enhancement. Aggressive lesions were associated with spinal pain (p < 0.01), new bone formation (p = 0.02), spinal cord compression (p < 0.01) and lymphadenomegaly (p < 0.01). Cortical interruption (p < 0.01) and paravertebral musculature changes (p < 0.01) were the strongest indicative imaging features for aggressive lesions. CONCLUSION Spinal pain, spinal cord compression, new bone formation, lymphadenomegaly and especially cortical interruption and paravertebral musculature signal intensity changes were the best discriminators for differentiating malignant from benign vertebral lesions.
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Llanos C, Rau F, Uriarte A. Radiographic and MRI characteristics of diffuse idiopathic skeletal hyperostosis in a cat presented with a painful chronic ambulatory paraparesis. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cesar Llanos
- Diagnostic Imaging, Southfields Veterinary Specialists Basildon Essex UK
| | - Friederike Rau
- Diagnostic Imaging, Southfields Veterinary Specialists Basildon Essex UK
| | - Ane Uriarte
- Department of Neurology, Southfields Veterinary Specialists Basildon Essex UK
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Glick K, Novofastovski I, Schwartz N, Mader R. Cardiovascular disease in diffuse idiopathic skeletal hyperostosis (DISH): from theory to reality-a 10-year follow-up study. Arthritis Res Ther 2020; 22:190. [PMID: 32807215 PMCID: PMC7430040 DOI: 10.1186/s13075-020-02278-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Objective To describe actual cardiovascular events over a decade in patients with diffuse idiopathic skeletal hyperostosis (DISH), without previously known CV diseases. Methods The medical records of patients with DISH and controls, beginning in 2006 (without known CV disease), were reviewed. Demographic, constitutional, and laboratory data were collected. Comparison of CV events following 2006 was performed according to the outcome definitions set by the Framingham score 2: coronary event demonstrated by a coronary imaging modality, acute myocardial infarction (MI), coronary death, congestive heart failure with a reduced ejection fraction, and angina pectoris. Results Data were available for 45 patients with DISH and 47 controls without DISH from the original cohort (91.8% and 97.9% respectively). By the Framingham score, 28.6% (± 20.33) of the DISH patients were expected to be affected with CVD at 10 years of follow-up. We observed that nearly 39% of them developed CVD during that period (95% CI 23.8–53.5%). The incidence of MI over the 10-year period was significantly higher in the DISH group (P = 0.005). The DISH group had higher morbidity with a higher composite outcome of 38.8% vs 25.5% in the control cohort, and the number of non-elective hospital admissions per patient, despite neither reaching statistical significance. Conclusion Our study showed that the Framingham score underestimates the real risk for developing CVD in patients with DISH, specifically the risk for MI. We propose more scrutiny is warranted in evaluating CV risk in these patients, more demanding treatment target goals should be established, and earlier and more aggressive medical interventions should be undertaken, particularly primary prevention. Larger prospective studies are needed to corroborate these findings.
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Affiliation(s)
- Karina Glick
- Department of Medicine A, Assuta University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
| | | | | | - Reuven Mader
- Rheumatic Diseases Unit, Ha'Emek MC, 18101, Afula, Israel.
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Bieber A, Masala IF, Mader R, Atzeni F. Differences between diffuse idiopathic skeletal hyperostosis and spondyloarthritis. Immunotherapy 2020; 12:749-756. [DOI: 10.2217/imt-2020-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a skeletal syndrome that has been known for more than 70 years. Yet, its pathogenesis and treatment options are still under investigation. DISH and spondyloarthritidies may manifest itself clinically as very similar disorders causing impaired axial flexibility, axial pain and peripheral tendinopathies. On the other hand, these two processes are different in many ways, from different genetic and metabolic predispositions, to different clinical and imaging manifestations, and at last, a different attitude toward treatment. The knowledge of the similarities and differences between DISH and spondyloarthritidies can guide the clinician toward a better diagnostic and treatment approach. This review tries to emphasize these details.
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Affiliation(s)
- Amir Bieber
- Rheumatic diseases Unit, Ha'Emek MC, Afula, Israel
| | | | - Reuven Mader
- Rheumatic diseases Unit, Ha'Emek MC, Afula, Israel
| | - Fabiola Atzeni
- Trauma & Orthopedic Unit, Santissima Trinità Hospital, Cagliari, Italy
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
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Abstract
PURPOSE OF REVIEW Axial spondyloarthritis (AxSpA) is a distinct clinical entity with characteristic clinical and radiographic features; however, a multitude of other metabolic, infectious and inflammatory disorders mimic it both clinically and radiographically. RECENT FINDINGS We present in this review article recent updates about the various disease entities and conditions that may mimic AxSpA and how to differentiate among them. The sensitivity and specificity of MRI in diagnosing AxSpA has limitations and needs to be interpreted in the context of the clinical picture. Interestingly, some recent studies have highlighted that a relatively high prevalence of bone marrow edema on pelvic MRIs in healthy volunteers which could even be categorized as having a 'positive MRI' as defined by Assessment of Spondyloarthritis International Society. Another study revealed that a substantial proportion of patients with suspected sacroiliitis were more commonly diagnosed with diseases other than inflammatory sacroiliitis. On the basis of these reports, it is prudent to request MRIs in the appropriate clinical context and interpreted with caution taking into considerations the wide differential diagnosis of such MRI changes. SUMMARY Highlighting the clinical pearls that differentiate disorders suspected of having sacroiliitis will lead to earlier and correct diagnosis and management; however, one must always take into considerations the radiographic and MRI findings in addition to the clinical presentations in order to make the appropriate diagnosis.
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Abstract
Axial involvement in psoriatic arthritis is a well-recognized manifestation with a prevalence between 12.5% and 78%. This huge heterogeneity is due to the different criteria used by authors to define psoriatic arthritis with axial involvement combining clinical features with radiographic evidence of disease. Specific genetic and clinical attributes of axial psoriatic arthritis might differentiate it from axial spondyloarthritis with concurrent skin psoriasis. Few studies address the specific management. The purpose of this review is to acknowledge the current understanding of axial involvement in psoriatic arthritis and highlight the need for a definition to facilitate research and clinical recognition.
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Abstract
The classification of axial spondyloarthritis (axSpA) comprises the classical ankylosing spondylitis (AS), which is characterized by already existing structural changes in the sacroiliac joints, and the so-called non-radiographic axSpA (nr-axSpA), in which by definition such changes are not present. This distinction is based on the ASAS classification criteria for axSpA, which are however not suitable for a diagnosis. According to the current classification, spondyloarthritis (SpA) includes axSpA, which can be associated with psoriasis and/or chronic inflammatory bowel diseases (CED), such as Crohn's disease and ulcerative colitis, and peripheral SpA, which is further divided into SpA associated with psoriasis, partially synonymous with psoriatic arthritis (PsA), reactive SpA, partially synonymous with reactive arthritis (ReA) and SpA associated with CED, partially synonymous with arthritis associated with CED (e.g. Crohn's disease, ulcerative colitis) and peripheral undifferentiated SpA, which by definition is not associated with any of the above. In this article only the most important differential diagnoses are discussed, i. e. diffuse idiopathic skeletal hyperostosis (DISH), fractures and infections in the axial skeleton. In addition, the frequency of certain musculoskeletal findings in the normal population examined by magnetic resonance imaging (MRI) are also discussed.
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O'Neill J, Carmona R, Maksymowych W. Commentary on: reporting in axial spondyloarthritis: proposal for an MRI reporting system. Clin Radiol 2019; 74:684-691. [DOI: 10.1016/j.crad.2019.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/03/2019] [Indexed: 01/02/2023]
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Dan Lantsman C, Herman A, Verlaan JJ, Stern M, Mader R, Eshed I. Abdominal fat distribution in diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis patients compared to controls. Clin Radiol 2018; 73:910.e15-910.e20. [PMID: 30031587 DOI: 10.1016/j.crad.2018.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/04/2018] [Indexed: 12/31/2022]
Abstract
AIM To evaluate abdominal fat distribution (subcutaneous adipose tissue [SAT] and visceral adipose tissue [VAT]) in two enthesopathy-related diseases with known correlation to metabolic syndrome (MS): diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) compared with controls. MATERIALS AND METHODS Abdominal computed tomography (CT) examinations of 43 DISH (Resnick radiographic criteria) patients, 31 AS (Modified New York Criteria) patients and 42 age- and gender-matched (to DISH) controls (males: 29; 29; 27 and mean age: 71.7±7; 56.1±16; 72.7±8 years, respectively) were evaluated and compared for VAT and SAT surface areas on mid L3, L4, L5 levels. RESULTS AS patients were significantly younger compared to DISH patients and controls. No significant differences were observed between VAT and SAT of DISH and AS patients or between SAT values in all groups even after correction for age. VAT was higher in DISH and AS patients compared to controls on all three levels, but reached significance (p<0.05) only for DISH patients (L3: 24.34/23.6/18.43; L4: 23.85/22.21/18.05; L5: 19.09/18.94/14.24 mm2, respectively). This did not change after correction for age. The VAT/SAT ratio was significantly larger in DISH and AS patients on all levels compared to controls. CONCLUSION The higher VAT surface area, a known marker for MS, which by itself is associated with bone proliferation, in DISH and AS patients compared to controls substantiates its role as a potential surrogate marker for MS as well as suggests a potential shared pathogenic pathway for enthesopathic excessive bone production in DISH and AS.
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Affiliation(s)
- C Dan Lantsman
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - A Herman
- Department of Orthopedic Surgery, Assuta Ashdod Medical Center, Ashdod, Affiliated to Ben Gurion University, Beer Sheva, Israel
| | - J J Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - M Stern
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - R Mader
- Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula, Israel affiliated to the B. Rappaport Faculty of Medicine, The Technion Institute of Technology Haifa, Israel
| | - I Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
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Khmelinskii N, Regel A, Baraliakos X. The Role of Imaging in Diagnosing Axial Spondyloarthritis. Front Med (Lausanne) 2018; 5:106. [PMID: 29719835 PMCID: PMC5913283 DOI: 10.3389/fmed.2018.00106] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/29/2018] [Indexed: 01/12/2023] Open
Abstract
Imaging has a central role in the diagnosis, management, and follow-up of patients with axial spondyloarthritis (axSpA). For the early diagnosis of axSpA, magnetic resonance imaging is of utmost relevance. While no novel imaging techniques were developed during the past decade, improvements to the existing modalities have been introduced. This report provides an overview of the applications and limitations of the existing imaging modalities.
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Affiliation(s)
- Nikita Khmelinskii
- Rheumathology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Andrea Regel
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany
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Clinical and imaging mimickers of axial spondyloarthritis. Semin Arthritis Rheum 2017; 47:361-368. [DOI: 10.1016/j.semarthrit.2017.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/08/2017] [Accepted: 05/19/2017] [Indexed: 12/15/2022]
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Mader R, Verlaan JJ, Eshed I, Bruges-Armas J, Puttini PS, Atzeni F, Buskila D, Reinshtein E, Novofastovski I, Fawaz A, Kurt DV, Baraliakos X. Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open 2017; 3:e000472. [PMID: 28955488 PMCID: PMC5604607 DOI: 10.1136/rmdopen-2017-000472] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 01/26/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a well-recognised entity characterised by calcifications and ossifications of the entheses affecting mainly the spine and peripheral sites. DISH is still insufficiently investigated and understood. The objective of this report is to highlight the present limitations of our understanding of the condition and suggest future research paths.
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Affiliation(s)
- Reuven Mader
- Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Jorrit-Jan Verlaan
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iris Eshed
- Department of Radiology, Musculoskeletal Imaging Unit, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Jacome Bruges-Armas
- Medicine, Rheumatology, SEEBMO, Hospital de Santo Espirito da ilha Terceira, Universidade do Porto, Angra do Heroísmo, Portugal.,CEDOC, Nova Medical School, University of Lisbon, Lisbon, Portugal
| | | | - Fabiola Atzeni
- Rheumatology Unit, L. Sacco University Hospital of Milan, Milan, Italy
| | - Dan Buskila
- Department of Medicine, H. Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Reinshtein
- Department of Genetics, Meir Medical Center, Kfar Saba, Israel
| | | | - Abdallah Fawaz
- Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula, Israel
| | - de Vlam Kurt
- Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
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