AxSpA Imaging and Treatment Updates
New research shared at the 2025 American College for Rheumatology (ACR) convergence is changing how clinicians think about diagnosing and treating axial spondyloarthritis – often called AxSpA. A recent session focused on AxSpA imaging advances and treatment decisions, with especially important implications for children and adolescents living with this disease.
Here is what stood out and why it matters for patients and families.
Go With Us! to ACR 2025: AxSpA Imaging & Treatment Updates from ACR 2025
Join Brittany Murray, a person living with psoriatic arthritis, as she reports from Day 2 of ACR 2025 through the Go With Us! program by AiArthritis. Brittany attended a session on imaging and Axial Spondyloarthritis (AxSpA) — highlighting how new research is improving diagnosis and treatment, especially for children and young adults.
Pediatric AxSpA Still Lacks Clear Guidelines
One of the most striking takeaways was how limited pediatric-specific guidance still is for AxSpA. There are currently no strong, standalone diagnostic criteria or comprehensive treatment guidelines for children beyond TNF inhibitors.
Because of this, pediatric rheumatologists often have to rely on adult research and adapt it to younger patients. This creates a gap. Adults now have access to many biologic options, while children are often limited to fewer choices, even though the disease can be just as impactful early in life.
That said, change is beginning to happen. Clinicians are increasingly moving pediatric patients from TNF inhibitors directly to interleukin-17 inhibitors such as secukinumab when needed. Importantly, they are skipping methotrexate in many cases, recognizing that there is little evidence it helps AxSpA and that NSAIDs alone do not stop disease progression.
Even though treatment guidelines have not officially caught up yet, clinicians are already applying newer evidence in practice, which is encouraging for families navigating pediatric AxSpA.
Imaging Is Becoming a Tool for Understanding, Not Just Diagnosis
Another major shift discussed in the session was how imaging is being used. Clinicians are increasingly sharing imaging results directly with patients, helping them visualize what is happening inside their bodies.
AxSpA is often described as an invisible disease. Pain, stiffness, and fatigue can be severe even when lab tests look normal. Seeing inflammation on imaging can help patients feel validated and better understand why treatment is necessary.
This visual approach can also strengthen communication between patients and providers, making shared decision-making easier and more meaningful.
MRI Is Changing How AxSpA Is Diagnosed
MRI, or Magnetic Resonance Imaging, is emerging as one of the most valuable tools for diagnosing AxSpA earlier and more accurately. Unlike X-rays, which often only show damage after it has already occurred, MRI can detect active inflammation before structural changes become permanent.
Lesions seen on MRI can serve as early indicators of AxSpA and may even help predict progression to radiographic disease. This allows clinicians to diagnose sooner, start treatment earlier, and potentially slow long-term damage.
Earlier diagnosis is critical. The sooner inflammation is controlled, the better the chances of preserving mobility and quality of life.
Reading MRIs Is Complex and Context Matters
While MRI is powerful, it is not simple. Interpreting AxSpA imaging requires expertise and careful attention to the full clinical picture. In the session, clinicians emphasized that reading these scans often feels like detective work.
AxSpA can mimic other conditions on MRI and X-ray. For example, sacroiliac inflammation is a hallmark of AxSpA, but similar findings can occur during pregnancy. Without context, imaging alone could lead to misdiagnosis.
This reinforces the importance of combining imaging with symptoms, medical history, and physical exam rather than relying on one test alone.
Why These Updates Matter for Patients
The biggest takeaway from this session is that AxSpA care is becoming more precise and preventative. Instead of waiting for irreversible damage to appear on X-rays, clinicians are learning to identify inflammation sooner and act faster.
For pediatric patients especially, this shift is critical. Early treatment decisions can shape long-term outcomes. Avoiding unnecessary medications while targeting the disease more effectively can make a real difference.
While gaps in guidelines still exist, the direction is clear. Imaging is becoming more central, treatment pathways are evolving, and clinicians are actively working to improve how AxSpA is recognized and managed.
Education and updates like these, shared through programs such as “Go With Us!” to Conferences by AiArthritis, help patients and families stay informed and empowered as care continues to advance.
Join the AiArthritis Conferences Program to gain insights into the latest research and advancements in autoimmune and autoinflammatory arthritis. This unique, patient-led initiative connects individuals to cutting-edge information, empowering them to improve their healthcare journeys and advocate for change.
