Inflammatory Back Pain (IBP) – MRI’s Use depends on when you do it.

In IBP – MRI could be negative or positive at one point and then the opposite later on. Make MRI imaging more dubious than people think.

Scand J Rheumatol. 2014 Sep 15:1-6. [Epub ahead of print]
Natural course of bone marrow oedema on magnetic resonance imaging of the sacroiliac joints in patients with early inflammatory back pain: a 2-year follow-up study.
van Onna M, van Tubergen A, Jurik A, van der Heijde D, andewé R.


Inflammatory back pain was defined according to five Calin criteria:

  • onset of symptoms before the age of 40 years
  • duration of back pain more than 3 months
  • insidious onset
  • morning stiffness
  • improvement with exercise

must have 4/5 criteria unless night pain – in which 3/5 was accepted

HLA B27 status (46% positive) and response to NSAID’s were non-used factors

Other factors and how often positive at start:

History of inflammatory bowel disease
History of anterior uveitis
History of psoriasis
History of peripheral arthritis 28%
Family history of SpA  54%
Elevated CRP 24%
Elevated ESR 35%
Presence of BME [bone marrow edema] on MRI only 35%

BME – of those that were negative 8- 15% were positive in followup

Meeting full criteria not frequent:
ASAS, Assessment in SpondyloArthritis international Society criteria 59%
mNY, modified New York criteria 22%
ESSG, European Spondyloarthropathy Study Group criteria 85%
Amor criteria 71%

Comment – very difficult to follow but clearly inflammatory patterns should not be ignored because MRI could be negative, and ESR/CRP are often negative. Repeat MRI’s may be necessary. I suspect a good proportion of steroid responsive Fibromyalgia falls into this pattern. Meeting the New York Criteria poor.

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