Sacroiliitis in Behçet Syndrome

Abstract

33-year-old woman presented with inflammatory low back pain for 1 year, recurrent painful oral aphthous, and genital ulcers for 6 months with remaining tissue scarring, extensive pseudofolliculitis on the upper and lower limbs, fever, weight loss, and bilateral anterior uveitis. Seven months later, the pa- tient presented bilateral panuveitis. She had no abdominal pain, diarrhea, anemia, or other symptoms that suggested inflam- matory intestinal disease. Human leukocyte antigen B27 and antinuclear antibody tests were negative. The patient was diag- nosed with Behcet disease according to the International Study Group criteria. 1 Most symptoms were resolved with corticoste- roid eye drops, oral corticosteroids, colchicine, and methotrexate, but the low back pain alleviated only with nonsteroidal anti- inflammatory drugs. After 4 years of follow-up, there is no back pain or skin or eye disease on this treatment. Radiography has not been performed again. Radiography of the sacroiliac joints did not show abnor- malities. After gadolinium administration, coronal T1-weighted magnetic resonance imaging of the sacroiliac joints demonstrated left joint space enhancement indicative of synovitis (Figure, arrows). Edema of the sacral surface of the adjacent sacroiliac joint (Figure, open arrow) and sclerosis of the iliac surface (Figure, asterisk) were also observed, indicating sacroiliitis. Behcet disease, a systemic vasculitis of unknown etiology, is characterized by relapsing episodes of oral and genital ulcers, skin lesions, and ophthalmological disease. It can also affect the vascular, gastrointestinal, and neurological systems. 1Y4 Rheu- matic manifestations have been described in 45% of patients with Behcet syndrome, ranking second after skin and mucosal mani- festations. Inflammatory arthralgia is the most common mani- festation (81% of cases), and sacroiliitis is uncommon (7.5% of cases). 1Y5 Some authors have described a high prevalence of sacroiliitis in patients with Behcet disease, but others have found no association between these conditions. 5 The main reason for these differing results could be a high degree of interobserver variation in interpreting radiographs of the sacroiliac joints. In our case, sacroiliitis was demonstrated by magnetic resonance imaging, the most sensitive method for the detection and early diagnosis of this condition. Joint involvement can be an early manifestation of Behcet syndrome, potentially causing significant