radiographic versus non-radiographic axial spondyloarthritis

Last edited 01/2021 and last reviewed 07/2021

Radiographic versus non-radiographic axial spondyloarthritis (1,2):

  • previously, the diagnosis of ankylosing spondylitis required advanced changes on plain radiographs of the sacroiliac joints
  • classification criteria released in 2009, however, identified a subset of patients, under the age of 45, with back pain for more than three months in the absence of radiographic sacroiliitis who were classified as axSpA based on a positive magnetic resonance imaging or HLAB27 positivity and specific clinical features. This subgroup was labeled non-radiographic axial spondyloarthritis
    • many patients without radiographic findings manifest MRI findings of bone marrow edema (BME) adjacent to the sacroiliac joints, suggestive of osteitis
    • one review suggests progression from non-radiographic to radiographic SpA is 10-20% over the first year, depending on baseline features such as elevated C reactive protein or positive MRI and 20.3% over two to six years (1)
    • another review states high inflammatory activity (inflammation of MRI of thesacroiliac joints, elevated CRP), HLA-B27 positivity, presence of low-grade structural damage and smoking are factors associated with progression from non-radiographic to radiographic stage (2)


  • (1) Ritchlin C, E Adamopoulos IE. Axial spondyloarthritis: new advances in diagnosis and management. BMJ 2021;372:m4447
  • (2) Protopopov M, Poddubnyy D. Radiographic progression in non-radiographic axial spondyloarthritis Expert Review of Clinical Immunology 2018, VOL. 14, NO. 6, 525–533