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The diagnosis and differential diagnosis of axial spondyloarthritis (axSpA) face several challenges in daily clinical practice. This is especially true when imaging is given an all-decisive role and imaging findings are interpreted without considering the clinical context.

Undoubtedly, imaging – first of all, X-ray and MRI of the axial skeleton – plays an important role for the diagnostic assessment of patients with suspected axSpA and its differentiation from other conditions. A number of recent publications report a substantial variability in the interpretation of conventional radiographs and MRI, which is especially evident when local assessment is compared to a central expert’s judgment. Furthermore, an increasing number of publications cast doubt on the specificity of the "positive MRI" of sacroiliac joints, especially if MRI findings are interpreted without taking the clinical context into account.

The Assessment of Spondyloarthritis International Society (ASAS) has developed this interactive online case library, which compiles a number of carefully selected clinical cases representing the entire spectrum of axSpA and the most common differential diagnoses. For all cases presented, imaging is discussed in the context of clinical findings and laboratory test results.

The ASAS Online Case Library is offered free of charge for educational, non-commercial use.

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