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Practice Guideline
. 2024 Nov 14;83(12):1636-1643.
doi: 10.1136/ard-2024-226280.

Clinical information on imaging referrals for suspected or known axial spondyloarthritis: recommendations from the Assessment of Spondyloarthritis International Society (ASAS)

Torsten Diekhoff  1 , Chiara Giraudo  2 , Pedro M Machado  3   4 , Michael Mallinson  5 , Iris Eshed  6 , Hildrun Haibel  7 , Kay Geert Hermann  8 , Manouk de Hooge  9 , Lennart Jans  10 , Anne Grethe Jurik  11 , Robert Gw Lambert  12 , Walter Maksymowych  13 , Helena Marzo-Ortega  14 , Victoria Navarro-Compán  15 , Mikkel Østergaard  16 , Susanne Juhl Pedersen  17   18 , Monique Reijnierse  19 , Martin Rudwaleit  20 , Fernando A Sommerfleck  21 , Ulrich Weber  22 , Xenofon Baraliakos  23 , Denis Poddubnyy  24
Affiliations
Practice Guideline

Clinical information on imaging referrals for suspected or known axial spondyloarthritis: recommendations from the Assessment of Spondyloarthritis International Society (ASAS)

Torsten Diekhoff et al. Ann Rheum Dis. .

Abstract

Objectives: This study aims to establish expert consensus recommendations for clinical information on imaging requests in suspected/known axial spondyloarthritis (axSpA), focusing on enhancing diagnostic clarity and patient care through guidelines.

Materials and methods: A specialised task force was formed, comprising 7 radiologists, 11 rheumatologists from the Assessment of Spondyloarthritis International Society (ASAS) and a patient representative. Using the Delphi method, two rounds of surveys were conducted among ASAS members. These surveys aimed to identify critical elements for imaging referrals and to refine these elements for practical application. The task force deliberated on the survey outcomes and proposed a set of recommendations, which were then presented to the ASAS community for a decisive vote.

Results: The collaborative effort resulted in a set of six detailed recommendations for clinicians involved in requesting imaging for patients with suspected or known axSpA. These recommendations cover crucial areas, including clinical features indicative of axSpA, clinical features, mechanical factors, past imaging data, potential contraindications for specific imaging modalities or contrast media and detailed reasons for the examination, including differential diagnoses. Garnering support from 73% of voting ASAS members, these recommendations represent a consensus on optimising imaging request protocols in axSpA.

Conclusion: The ASAS recommendations offer comprehensive guidance for rheumatologists in requesting imaging for axSpA, aiming to standardise requesting practices. By improving the precision and relevance of imaging requests, these guidelines should enhance the clinical impact of radiology reports, facilitate accurate diagnosis and consequently improve the management of patients with axSpA.

Keywords: axial spondyloarthritis; health services research; magnetic resonance imaging; patient care team.

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Conflict of interest statement

Competing interests: TD: speakers bureau: Canon MS, Lilly, MSD, Novartis, Pfizer and UCB; consultant: Lilly; grant/research support: Canon MS. CG: speakers bureau: Boehringer Ingelheim. VN-C: has received speakers fees from AbbVie, Eli Lilly, Fresenius Kabi, Janssen, MSD, Novartis, Pfizer, UCB Pharma; consultant of AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma; grant/research support from AbbVie and Novartis. IE: speakers bureau: AbbVie, Novartis. HH: speakers bureau: AbbVie, MSD, Janssen, Roche, Sobi and Pfizer, consultant of Roche, Boehringer Ingelheim, Janssen, MSD, AbbVie, Novartis and Sobi. PMM: honoraria from AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, all unrelated to this manuscript, and is supported by the National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BRC). WM: speaking: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, UCB consultant: AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Novartis, Pfizer, UCB grants: AbbVie, Eli Lilly, Novartis, Pfizer, UCB. HM-O: research grants from Janssen, Novartis, Pfizer and UCB, honoraria/speaker fees from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB. MØ: speaker fees: AbbVie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MEDAC, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi and UCB. XB: consultant: AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Gilead, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB; grant/research support: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Merck, Novartis and UCB. MRu: speaker fees from and/or advisor for AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, UCB. KGH: speaker fees from Novartis, MSD and Pfizer. Consulting for AbbVie and Calyx. Co-founder of BerlinFlame. SJP: speaking fees from MSD, Pfizer, AbbVie, UCB, Novartis; consulting fees and/or honoraria from AbbVie, UCB, Novartis and research support from AbbVie, MSD and Novartis. MRe: ISS grant; ASAS consultant. RGWL: consultant: Calyx, CARE Arthritis, Image Analysis Group. UW: speaker fees: Novartis, Eli Lilly. AGJ: none for this article. MdH: speaker fees from UBC. FAS: speaker fees: Novartis, Pfizer, AbbVie, Janssen.

Figures

Figure 1
Figure 1. Graphical summary of the recommendations for imaging referrals and reports as a mutual give and take between specialties. axSpA, axial spondyloarthritis; SIJ, sacroiliac joint.
Figure 2
Figure 2. Checklists for requesting imaging in axial spondyloarthritis (axSpA).
See this image and copyright information in PMC

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