TOPLINE:

Repeat MRI scans found active inflammation in nearly half of patients with axial spondyloarthritis (axSpA) with ongoing symptoms, with inflammatory scans prompting treatment escalation or change more often than non‑inflammatory scans.

METHODOLOGY:

• Researchers conducted a retrospective service evaluation of how MRI was used to monitor disease activity and whether it guided clinical decision-making in axSpA.
• They evaluated 346 monitoring MRI scans of the whole spine and sacroiliac joints from 335 patients (mean age, 46.1 years; 60% men) at two large tertiary rheumatology centres in the UK between May 2020 and December 2023.
• Clinical records were reviewed to identify patients with preexisting diagnoses who underwent MRI for the assessment of disease activity or treatment non-response to various therapies, including non-steroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs (DMARDs).

TAKEAWAY:

• About half of monitoring MRI scans (51.7%) showed inflammation, and 44.9% of these were found in patients on biologic/targeted synthetic DMARDs. The remaining 48.3% showed non-inflammatory findings, including degenerative changes, disk disease, ankylosis, a few fractures, or possible malignancies.
• Patients with MRI inflammation were more likely to have treatment escalation or change than those without MRI inflammation (59.3% vs 23.2%).
• Patients without MRI inflammation were more often referred to other specialties like spinal surgery, pain medicine, or oncology than those with MRI inflammation (10.2% vs 6.1%).
• Bath Ankylosing Spondylitis Disease Activity Index scores were not higher in patients with vs without MRI inflammation, and C-reactive protein positivity did not differ significantly between the groups.

IN PRACTICE:

"[The study] results highlight the crucial role of MRI in evaluating treatment non-response in axSpA, supporting clinical decision-making and guiding interventions such as treatment escalation or specialist referrals," the authors of the study wrote.

SOURCE:

This study was led by Jake Weddell, Leeds Teaching Hospitals NHS Trust, Leeds, England. It was published online on October 17, 2025, in RMD Open.

LIMITATIONS:

Certain baseline and follow-up outcome data were missing, and follow-up durations varied after treatment changes. This study was retrospective; thus, MRI results may have already influenced treatment decisions. The frequency of MRI and outcome documentation may have been affected by the COVID-19 pandemic.

DISCLOSURES:

Two authors reported receiving support from the National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre (BRC), and one author reported receiving support from the NIHR University College London Hospitals BRC. Three authors reported receiving research grants, speaker or consultancy fees, and/or honoraria from several pharmaceutical, biotechnology, and healthcare companies, including AbbVie, Roche, and Pfizer.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.