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Ultrasound of sacroiliac joints in spondyloarthritis: a systematic review

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Abstract

Ultrasound (US) is an accessible imaging technique with a possible role to diagnose active sacroiliitis, so this technique is projected as a promising diagnostic tool for the diagnosis of SpA. We analyse the available evidence about the use of US as a diagnostic tool in sacroiliitis in patients with SpA, by a systemic review of the literature fulfilling OMERACT criteria. A systematic literature search for original articles was carried out using four databases (Medline, Embase, Scopus and Web of Science). Data from studies were included only if participants had SpA and a US examination of sacroiliac joint (SIJ) was performed. The methodological quality of the studies was assessed using QUADAS-2 tool. Thirteen studies were included. All studies were observational, prospective and cross-sectional. In most articles (76.9%), the main US finding compatible with sacroiliitis evaluated was the presence of vascularisation (Doppler signals) with measurements of the resistive index (RI). The sensitivity and specificity analysis were performed in seven studies (58.8%) and were good, with a median of 90 and 89.2%, respectively. The studies showed a positive to moderate a strong correlation between the US and the gold standard but this was optimal only in four studies. In general, the agreement was good in all studies (≥ 0.80). The methods of evaluation of sacroiliitis vary between the studies included. To date, there is not enough evidence to support the use of ultrasound as a diagnostic method for sacroiliitis but it has potential to identify structural lesions at SIJ’s level.

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Author notes

  1. Marwin Gutierrez and Sheila Rodriguez contributed equally.

Authors and Affiliations

  1. Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion, Luis Guillermo Ibarra Ibarra, Calzada Mexico-Xochimilco 289, Colonia Arenal de Guadalupe, CP 143898, Mexico City, Mexico

    Marwin Gutierrez, Carina Soto-Fajardo, Hugo Sandoval, Chiara Bertolazzi & Carlos Pineda

  2. Rheumatology Center of Excellence, Mexico City, Mexico

    Marwin Gutierrez

  3. Hospital de Alta Complejidad Virgen de la Puerta, Trujillo, Peru

    Sheila Rodriguez

  4. Center of Rheumatoid Arthritis, BIOMAB, Bogota, Colombia

    Pedro Santos-Moreno

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  1. Marwin Gutierrez
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  3. Carina Soto-Fajardo
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  5. Hugo Sandoval
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Contributions

MG and CS-F participated in the design of the review, the acquisition and interpretation of data, the drafting of the manuscript and gave final approval of the version of the paper to be published. SR, HS were involved in the selection of the articles to include in the review, made substantial contributions to the manuscript preparation and were involved in revising the manuscript for important intellectual content. CB, CP, PS-M participated in the review conception and gave substantial input to the data evaluation and manuscript preparation. All authors read and approved the final version of manuscript.

Corresponding author

Correspondence to Carlos Pineda.

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Conflict of interest

The authors declare that they have no conflict of interest regarding this manuscript. M. Gutierrez. Advisory board, scientific consultancies, and consulting fees: AbbVie, Novartis, UCB, Esaote SpA, Janssen, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Sanofi Aventis. SR, CSF, PSM, HS, CB, CP. No disclosures.

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Gutierrez, M., Rodriguez, S., Soto-Fajardo, C. et al. Ultrasound of sacroiliac joints in spondyloarthritis: a systematic review. Rheumatol Int 38, 1791–1805 (2018). https://doi.org/10.1007/s00296-018-4126-x

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