Pathophysiology of Bone and Cardiac Involvement in Spondyloarthropathies: The indispensible value of magnetic resonance imaging

Spondyloarthropathies (SpA) include a group of inflammatory arthritides encompassing ankylosing spondylitis (AS), reactive arthritis, arthritis/spondylitis associated with psoriasis (PsA) and arthritis/spondylitis associated with inflammatory bowel diseases (IBD).In Spa, inflammation can act either by promoting atherosclerosis or by increasing the effect of conventional CV risk factors.The incidence of cardiovascular (CV) disease in AS is 10-30% and includes aortic valve regurgitation, aortitis, atrioventricular (AV) and/or bundle branch block.In PsA and IBD, there is increased risk of CV events, because high levels of cytokines promote atherosclerosis.Furthermore, the persistence of systemic inflammation promotes the development of myocardial inflammation Magnetic Resonance Imaging (MRI) can identify inflammation in the early stage of SpA, which usually occurs years before the development of structural lesions.Bone marrow edema (BME) has been detected not only at sacroiliac joints, but also at the spine, and it is considered as the hallmark of inflammation.Cardiovascular magnetic resonance (CMR) allows function and tissue characterization and detects subclinical cardiac lesions, including myocardial oedema, myocarditis, replacement and diffuse myocardial fibrosis, despite the presence of well controlled musculoskeletal disease.Considering that bone radiographic, cardiac echocardiographic findings and serum biomarkers are late markers of bone and heart involvement, MRI/CMR can play an indispensible role for early diagnosis/follow up of bone/heart disease in SpA.