Inflammatory spine disease as a cause of back pain

• Published in: Radiologe Vol. 46; no. 6; pp. 468 - 479
• Main Authors: Schlossbauer, T, Panteleon, A, Becker-Gaab, C
• Format: Journal Article
• Language: German
• Published: Germany 01.06.2006
• Subjects: Anti-Inflammatory Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Back Pain - diagnosis; Back Pain - etiology; Back Pain - prevention & control; Humans; Magnetic Resonance Imaging - methods; Practice Guidelines as Topic; Practice Patterns, Physicians; Prognosis; Spondylarthritis - complications; Spondylarthritis - diagnosis; Spondylarthritis - drug therapy; Spondylitis, Ankylosing - complications; Spondylitis, Ankylosing - diagnosis; Spondylitis, Ankylosing - drug therapy; Treatment Outcome
• ISSN: 0033-832X
• DOI: 10.1007/s00117-006-1387-2

The aim of this review is to evaluate the role of inflammatory spine disease in patients with chronic back pain. The contribution of imaging modalities for the diagnostic evaluation of back pain is discussed. A systematic literature search based on the classification of seronegative spondyloarthropathies and rheumatoid arthritis was performed. The results of this search and the experiences in a large collective of rheumatological patients are analyzed. The prevalence of rheumatoid arthritis (1-2%) is comparable to that of spondyloarthropathies (1.9%). The etiology of these entities is not fully elucidated. Magnetic resonance imaging is increasingly used for early detection and surveillance of therapy with TNF-alpha antagonists. Bone marrow edema, which is only detectable with MRI, represents an early sign of inflammation. Therapy with TNF-alpha antagonists is based on clinical and laboratory criteria, and signs of inflammation in MRI. MRI is useful for assessment of the effectiveness of anti-inflammatory therapy.