0399: ASAS Recommendations for Requesting and Reporting Imaging in Patients with Suspected Axial Spondyloarthritis

Torsten Diekhoff¹, Iris Eshed², Chiara Giraudo³, Hildrun Haibel⁴, Kay-Geert Hermann⁵, Manouk de Hooge⁶, Lennart Jans⁷, Anne Jurik⁸, Robert G Lambert⁹, Pedro Machado¹⁰, Walter P Maksymowych¹¹, Michael Mallinson¹², Helena Marzo-Ortega¹³, Victoria Navarro-Compán¹⁴, Susanne Pedersen¹⁵, Mikkel Østergaard¹⁶, Monique Reijnierse¹⁷, Martin Rudwaleit¹⁸, Fernando Andres Sommerfleck¹⁹, Ulrich Weber²⁰, Xenofon Baraliakos²¹ and Denis Poddubnyy²², ¹Charité – Universitätsmedizin Berlin, Berlin, Germany, ²Sheba Medical Center, Tel Aviv, Israel, ³University of Padova, Padova, Italy, ⁴Charité - Universitätsmedizin, Berlin, Berlin, Germany, ⁵Charité - Universitätsmedizin Berlin, Berlin, Germany, ⁶Ghent University Hospital, Luxembourg, Luxembourg, ⁷Ghent University Hospital, Ghent, Belgium, ⁸Aarhus University Hospital, Aarhus, Denmark, ⁹University of Alberta, Edmonton, AB, Canada, ¹⁰University College London, London, United Kingdom, ¹¹Department of Medicine, University of Alberta, Edmonton, AB, Canada, ¹²ASIF Axial Spondyloarthritis International Federation, London, United Kingdom, ¹³Leeds Teaching Hospitals Trust and University of Leeds, Leeds, United Kingdom, ¹⁴Department of Rheumatology, La Paz University Hospital, IdiPaz, Madrid, Spain, ¹⁵Rigshospitalet, København, Denmark, ¹⁶Rigshospitalet, University of Copenhagen, Glostrup, Denmark, ¹⁷Leiden University Medical Center, Leiden, Netherlands, ¹⁸University of Bielefeld, Klinikum Bielefeld, Bielefeld; Germany Klinikum Bielefeld and Charité Berlin, Germany, and Gent University, Gent, Belgium, ¹⁹Sanatorio Julio Mendez, Buenos Aires, Argentina, ²⁰Practice Buchsbaum Schaffhausen, Schaffhausen, Switzerland, ²¹Rheumazentrum Ruhrgebiet Herne, Herne, Germany, ²²Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité – Universitätsmedizin Berlin, Berlin, Germany

Background/Purpose: Clinicians face uncertainties in their daily practice when requesting imaging for patients with suspicion of axial spondyloarthritis (axSpA) or producing a report because requirements and desired information of the other disciplines is sometimes not completely known or understood. This project aimed to develop easy-to-follow consensus recommendations for the standardized communication around imaging of sacroiliac joints and spine for diagnosis in patients with suspected axSpA or its management in clinical practice.

Methods: A task force was established combining radiologists and rheumatologists from the Assessment of SpondyloArthritis international Society (ASAS), two members of young-ASAS and a patient representative. The task force defined the project's aims and developed a project statement. Then, under the reflection of the literature and work of other groups, two survey rounds were designed, and all ASAS members invited to respond: first, to identify items for further consideration, second, to consider the detail of information to be transferred. Finally, ASAS members discussed the recommendations during the ASAS annual workshop in January 2022 and voted for the endorsement.

Results: The recommendations were endorsed by ASAS with approval from 73% of voting members. The final set of recommendation is presented in Figure 1. Six recommendations deal with imaging requests in patients with axSpA. The first three cover clinical features, patients' symptoms and risk factors. Recommendations 4 involves previous imaging and reports, 5 contraindications to imaging or contrast media. Number 6 is about the suspected diagnosis, the reason for the exam, and clinical differential diagnoses. Eleven recommendations refer to the radiology report. The first point addresses clinical information included in the report. Recommendations 2 to 4 instruct on information about the technical conduct of the exam, the use of contrast media and image quality. Necessary imaging findings to be included in the report are listed in recommendations 5 to 7. Finally, recommendations 8 to 11 combine advice for the conclusion, for suggesting additional imaging or referral to a rheumatology expert if a different physician requested the imaging.

Conclusion: The ASAS recommendations provide guidance for requesting and reporting imaging in axSpA and for standardizing communication between rheumatologists and radiologists to improve diagnosis and patient care.
Figure 1: ASAS recommendations for requesting and reporting imaging in patients with suspected axial spondyloarthritis.
Disclosures: T. Diekhoff, Novartis, Merck/MSD, Canon MS, Eli Lilly; I. Eshed, None; C. Giraudo, None; H. Haibel, Boehringer-Ingelheim, Janssen, Merck/MSD, Novartis, Roche, Sobi, Pfizer, AbbVie/Abbott; K. Hermann, AbbVie, Merck/MSD, Pfizer, Novartis, BerlinFlame GmbH; M. de Hooge, None; L. Jans, None; A. Jurik, None; R. Lambert, Calyx, CARE Arthritis, Image Analysis Group; P. Machado, AbbVie/Abbott, Eli Lilly, UCB, Novartis, Orphazyme, Galapagos; W. Maksymowych, AbbVie, Boehringer-Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB, CARE Arthritis Limited; M. Mallinson, None; H. Marzo-Ortega, None; V. Navarro-Compán, AbbVie, Eli Lilly, Janssen, Merck/MSD, Novartis, Pfizer, UCB Pharma; S. Pedersen, Novartis, AbbVie/Abbott, UCB, Pfizer, Merck/MSD; M. Østergaard, AbbVie/Abbott, Amgen, Bristol-Myers Squibb(BMS), Celgene, Eli Lilly, Janssen, Gilead, Novartis, Pfizer, UCB; M. Reijnierse, ASAS, International Skeletal Society; M. Rudwaleit, AbbVie, Bristol-Myers Squibb (BMS), Boehringer-Ingelheim, Chugai, Eli Lilly, Janssen, Novartis, Pfizer, UCB Pharma; F. Sommerfleck, AbbVie/Abbott, Novartis, Janssen; U. Weber, None; X. Baraliakos, AbbVie, Lilly, Galapagos, MSD, Novartis, Pfizer, UCB, Bristol-Myers Squibb, Janssen, Roche, Sandoz, Sanofi; D. Poddubnyy, AbbVie, Biocad, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, MSD, Moonlake, Novartis, Pfizer, Samsung-Bioepis, UCB.