It is important to be aware, however, that these findings are inconsistent: some patients with a definite diagnosis of spondyloarthritis and clinical or laboratory evidence of disease activity have normal MRI findings. MRI of the spine can benefit the initial management of the patient, not only to rule out differential diagnoses (e.g., benign or malignant spinal tumors, infections of the disks and vertebras, or inflammatory disk disease), but also to detect other selleck chemical lesion types that suggest spondyloarthritis and may therefore support the

diagnosis. Thus, the presence of a large number of “inflammatory” signals or of fatty involution at the vertebral corners lends some support to the possibility of spondyloarthritis when combined with back pain, particularly in younger patients with involvement of a large number of vertebras. Nevertheless, these MRI abnormalities can be found in non-specific low back pain, vertebral malignancies, and even healthy individuals and, when isolated, are consequently not sufficient to establish a diagnosis of spondyloarthritis. Recent studies have shown that repeating the MRI scans fails to benefit the diagnosis. Finally, the task force points out that criteria intended solely for classification

buy Fulvestrant purposes should be used for diagnostic purposes only with the utmost caution. The work presented here does not apply to pediatric spondyloarthritis, since the ASAS criteria are not relevant to children, in whom the clinical presentation is often different from that seen in adults. In addition, the therapeutic trials referred to in these practice guidelines were conducted only in adults. The strength of the practice guidelines (based on the level of evidence) and the level of agreement among experts (rated from 0 [strongly disagrees] to 10 [strongly

agrees]) are given for each practice guideline. Strength was graded according to standard practice: • A: guideline based on level 1 evidence (meta-analysis of randomized controlled trials or at least one randomized controlled trial); Lck 1) Spondyloarthritis (SpA) is a potentially severe and disabling chronic illness characterized by a variety of manifestations. The management of patients with spondyloarthritis should be coordinated by a rheumatologist, usually in connection with a multidisciplinary team, in collaboration with the primary care physician (C) (10). 6) The goal of management should be to achieve a clinical remission or a low level of disease activity, as assessed based on the various components of the illness (axial, peripheral, and extraarticular manifestations) and on the co-morbidities. Close monitoring of the patient by the rheumatologist until this goal is achieved may be required. Once the goal is achieved, regular individualized follow-up should be provided to ensure that it is maintained (D) (9,7).