In patients undergoing MRI evaluation for inflammatory back pain, how long do you recommend they hold NSAIDs prior to imaging?

The other issue regarding NSAIDs and MRI is whether these agents will suppress the bone marrow edema signal which has been demonstrated in some patients. Therefore, it is recommended to hold NSAIDs for at least 3 days prior to the MRI.

In axSpA, an MRI of the pelvis (I am assuming this is what the question refers to) is typically ordered primarily for two reasons: 1) diagnosis of axSpA/exclusion of other differential etiologies, and 2) to determine disease activity in patients with uncertain disease activity.

For the latter, we would not typically be holding NSAIDs or biologics for axSpA as we are trying to ascertain how effective our current therapy is. So we are primarily looking for the presence or absence of bone marrow edema to see if the disease is active. In this case, there would be no reason to hold therapy.

The question arises in the first instance where we order MRI SIJ to diagnose axSpA. While we are looking for both BME and structural changes when diagnosing ...

I do not hold it as there is no risk of bleeding in a traditional MRI.