Diagnosis and classification of axial spondyloarthritis : imaging and non-imaging features

In this thesis the focus was on diagnosing axSpA early using clinical features as well as imaging modalities. We have studied multiple elements diagnosing axSpA among patients presenting with chronic back pain. We have emphasized two main themes: (1) the importance of clinical SpA features; and (2) the contribution of imaging to an axSpA diagnosis and classification. We have learned how rheumatologists use imaging results in their diagnostic considerations and thereby have helped reduce certain fears regarding the way diagnosis is made in clinical practice. We have shown that the use of MRI-spine in classification is not efficient. The common thread in all of the studies in this thesis is that axSpA diagnosis is the interaction between the clinical aspects of chronic back pain and imaging findings highly suggestive of axSpA. Clinicians should be aware of mindlessly ‘stacking up’ SpA features in chronic back pain patients in order to avoid unnecessary (biologic) treatment. Additional studies are needed to investigate the numerous phenotypes of axSpA and to predict in which chronic back pain patient axSpA diagnosis is likely.