Simultaneous sacroiliitis and symphysitis pubis

Abstract

This is the description of a rare, documented association of sacroiliitis with symphysitis pubis. A 37-year-old woman experienced low back pain since 2009 with inflammatory characteristics (worse at rest, improvement during movement) associated with morning stiffness of 2 hours. Her X-ray demonstrated sacroiliitis. A magnetic resonance image (MRI) showed bilateral bone edema of the sacroiliac joints with enhancement after gadolinium injection (Fig. 1). At the same time, a magnetic resonance image revealed edema on her symphysitis pubis better showed after contrast infusion and reduction of joint space (Fig. 2). HLA-B27 was positive. C-reactive protein and erythrocyte sedimentation rate were within normal range, 0.44 mg/l and 11 mm/1st hour, respectively. Rheumatoid factor and antinuclear antibodies were negative. A diagnosis of spondyloarthritis was made and she was treated with non-steroidal antiinflammatory drugs. She experienced slight improvement of her symptoms and she is waiting for anti-TNF therapy. Spondyloarthritis patients may have involvement of their symphysitis pubis. In fact, Helliwell et al. [1] have radiologically evaluated 91 subjects with spondyloarthritis and revealed that 31 % of ankylosing spondylitis patients, 30 % of enteropathic spondyloarthritis, 25 % of psoriatic arthritis and 14 % of reactive arthritis have symphisitis. The authors performed single radiographies in that study. We were not able to find any study that evaluated the frequency of symphisitis pubis in spondyloarthritis patients using modern techniques such as MRI. Recently, we described a case of symphisitis pubis after pregnancy [2].