Active Inflammatory Changes Research Articles

Bildgebende Verfahren in der Frühphase des Morbus Bechterew

Diagnosis of ankylosing spondylitis (AS) is still delayed for several years in some patients. The correct diagnosis of early disease has always been a challenge, which has become even more important as with the introduction of TNF-alpha inhibitors, very effective new treatments have become available. For diagnosis of AS imaging methods such as conventional radiography and computer tomography are well established. Functional imaging modalities including magnetic resonance imaging and contrast-enhanced colour Doppler ultrasound provide additional information on the presence of active inflammatory changes in the sacroiliac joints and may help to diagnose AS before radiographic changes become visible. Magnetic resonance imaging and sonography also identifiy other non-sacroiliac axial manifestations of AS and peripheral involvement such as enthesitis and synovitis of peripheral joints.

Assessment of Clinical Effect and Changes of Sacroiliac Joint by CT and MRI in Patients with Ankylosing Spondylitis during Therapy with Etanercept

Objective: To assess the clinical effect and acute inflammatory and chronic bony changes of the sacroiliac (SI) joints as detected by magnetic resonance (MR) and computerized tomography (CT) imaging in patients with ankylosing spondylitis (AS) during treatment with etanercept. Methods: The all 16 patients with AS were treated with etanercept 25mg twice weekly subcutaneously and the clinical response was assessed by standardized parameters. Active inflammatory lesions and chronic bony changes of SI joints were assessed by the MR and CT images of the sacroiliac joints before and after treatment with etanercept. Results: The mean disease duration was 13.1±0.69 years and the mean duration of treatment was 14.9±4.86 weeks. The mean BASDAI and BASFI score decreased significantly after

Esophageal Intramural Pseudodiverticulosis With Esophageal Strictures Successfully Treated With Dilation Therapy

We report a rare case of esophageal intramural pseudodiverticulosis with esophageal strictures. Barium esophagogram demonstrated multiple flask-shaped diverticula out of the esophageal wall with comprehensive luminal stenosis involving the proximal 8 cm and distal 4 cm of the esophagus. Chest computed tomographic scan demonstrated round wall thickening and several intramural gas collections of the proximal esophagus. Endoscopy revealed a fibrotic stricture and multiple small orifices of pseudodiverticula with mild inflammatory changes. Biopsy specimens showed active chronic inflammatory changes of the mucosa with candidiasis. Dysphagia improved dramatically with esophageal dilation. However, the tiny diverticula did not resolve after treatment.

Bildgebende Verfahren in der Rheumatologie: Bildgebung bei der Psoriasisarthritis (PsA)

Conventional radiography is still the standard method of imaging in PsA since it displays many joints at the same time, thereby allowing different types of joint involvement to be recognized. Moreover, thanks to the high resolution of radiography, bony changes in a single joint are depicted in a brilliant way. Several features of psoriatic arthritis allow the distinction from rheumatoid arthritis, including the frequent involvement of the distal interphalangeal joints, asymmetry of joint involvement, axial involvement of finger joints, oligoarticular involvement; however, symmetric polyarthritis is also possible. At the level of the single joint, there are signs of severe destructive changes potentially leading to mutilation and at the same time signs of periostal bone proliferation and ankylosis may be present. Bony proliferation and/or osteolysis are not restricted to the joint region but can affect also the total phalanx with bone apposition or concentric osteolysis which may lead to a complete disappearance of phalanxes. For purposes of quantification of radiographic changes scoring methods are used that were originally developed for rheumatoid arthritis. So far, there is only one validated scoring method that was specifically designed for PsA and that takes into account both features of PsA, damage as well as proliferation of bone. In contrast to conventional radiography, MRI and sonography are able to visualize inflammatory processes within the soft tissue (joint capsules, tendon sheaths, tendon insertions, etc.), allowing an estimation of disease activity. Scintigraphy is nonspecific and can only be used to detect clinically silent inflammatory spots. The relatively frequent spinal (axial) involvement is similar to that seen in ankylosing spondylitis. However, unilateral sacroiliitis, asymmetry of syndesmophytes and development of parsyndesmophytes may distinguish PsA from ankylosing spondylitis. While conventional radiography demonstrates the bony consequences of inflammation in the spine, MRI also shows the active inflammatory changes in sacroiliacal joints and vertebrae.

Differential Gene Expression Profiles in Stage I Primary Biliary Cirrhosis

Primary biliary cirrhosis (PBC) is a progressive disease. However, little is understood about the molecular mechanisms underlying its features. We analyzed gene expression profiles of liver biopsy samples from 16 patients with PBC, seven with autoimmune hepatitis, eight with chronic hepatitis C, and eight normal control livers. In addition to whole liver samples, we selectively analyzed chronic nonsuppurative destructive cholangitis (CNSDC) lesions by laser capture microdissection. Hierarchical clustering analysis using only early-stage liver disease demonstrated 85 genes were upregulated in stage I PBC specifically. Surprisingly, the expression of these genes was not maintained in advanced-stage PBC, while other gene clusters were upregulated. Expression analysis of CNSDC lesions in stage I PBC showed the presence of active inflammatory changes, characterized by the significant elevation of interferon-gamma and the development and maturation of lymphocytes. Expression of these genes was diminished in lymphoid cells aggregation in stage III PBC, and genes reflecting hepatocyte damage were upregulated with disease progression. Gene expression patterns in stage I PBC are different from others. There are distinct changes in molecular pathology from early- to late-stage PBC, which might be a clue to reveal the etiology and progression of PBC.

Serial high-resolution computed tomography imaging in patients with wegener granulomatosis: differentiation between active inflammatory and chronic fibrotic lesions

To evaluate pulmonary pathologies in Wegener granulomatosis with sequential computed tomography (CT) in order to differentiate active inflammatory lesions from chronic fibrotic lesions. Serial CT findings in 38 patients with Wegener granulomatosis were retrospectively analyzed (mean follow-up period, 21 months). The presence, extension, and distribution of the following findings were evaluated with CT: parenchymal nodules, masses, ground-glass attenuation, airspace consolidation, bronchial wall-thickening, bronchiectasis, linear areas of attenuation, pleural irregularities, pleural effusions, hilar and mediastinal lymphadenopathy. Observed in 92% of patients, nodules were the most common CT pathology. Areas of ground-glass attenuation, consolidation, masses of linear attenuation, and tracheal/bronchial wall-thickening were detected in 24%, 26%, 32%, 39%, and 68% of patients. At follow-up, the clearance of lesions was most consistent for areas of ground-glass attenuation (89%), masses (87%), and cavitated nodules (85%). In the follow-up scan, 58% of all nodules, 47% of pulmonary consolidations, and 66% of bronchial wall-thickening were completely resolved. Areas of bronchiectasis and septal/non-septal lines remained stable in 70% and 71% of patients. The majority of the lesions decreased or resolved completely with or without areas of linear attenuation. Ground-glass attenuation, cavitated nodules and masses appear to represent active inflammatory lesions. In most probability, areas of bronchiectasis and septal/non-septal lines more often represent chronic fibrotic changes rather than active inflammatory changes. In combination with clinical evaluation and bronchoscopy, CT assists in the assessment of disease activity.

Fulminant inflammatory leukoencephalopathy associated with HAART-induced immune restoration in AIDS-related progressive multifocal leukoencephalopathy

HAART-induced immune restoration is beneficial for patients with AIDS-related progressive multifocal leukoencephalopathy (PML). However, in rare instances, an immune-reconstitution inflammatory syndrome (IRIS) may cause paradoxical clinical deterioration. We report the neuropathological study of an AIDS patient who presented with progressive cognitive deterioration; CD4(+) count was 117 and the HIV viral load >10(4); imaging showed non-enhancing lesions consistent with PML. Following initiation of HAART, CD4(+) was 300 and HIV viral load <10(3), but his neurological symptoms continued to deteriorate. Imaging revealed an increase in the size and number of lesions and enhancement of all the lesions. A stereotactic biopsy showed severe inflammatory and demyelinating lesions with marked infiltration by macrophages and T lymphocytes in the absence of a detectable infectious agent. Despite high doses of steroids, the patient died 3 months after admission. Autopsy showed two types of lesions: (1) active inflammatory PML changes with abundant JC virus, and intraparenchymal and perivascular infiltration by T lymphocytes, and (2) acute perivenous leukoencephalitis devoid of JC virus. Most lymphocytes were CD8(+) lymphocytes; CD4(+) lymphocytes were virtually absent. Two pathological reactions were associated with the paradoxical clinical deterioration related to dysregulation of the immune response characteristic of IRIS in PML: (1) an accentuation of JCV infection, and (2) a nonspecific acute perivenous leukoencephalitis. We suggest that both these types of lesions are due to an imbalance of CD8(+)/CD4(+) T cells, with massive infiltration of the cerebral parenchyma by CD8(+) cytotoxic T lymphocytes in the absence of sufficient CD4(+) response. Better understanding of the mechanisms of the IRIS may enable prevention or cure of this severe, sometimes fatal complication of HAART.

Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT

To analyze the type and frequency of abnormalities of the sacroiliac joint (SIJ) in early seronegative spondylarthropathy (SpA) by MR in comparison with CT and radiography, assess the most appropriate MR sequences to be used, and introduce a new way of grading MR abnormalities of the SIJ. The SIJs of 41 patients with early SpA (median duration of inflammatory low back pain of 19 months) were evaluated by MR imaging using STIR, T1, T2, and T1 fat saturated (FS) sequences before and after i.v. Gd contrast medium followed by staging of abnormalities. The findings were compared with those obtained by CT and radiography. MR and CT had equal efficacy superior to radiography in staging of erosions and osseous sclerosis. Only MR allowed visualization and grading of active inflammatory changes in the subchondral bone and surrounding ligaments in addition to bone marrow fatty accumulations. T2-weighted sequences did not contribute to assessment of sacroiliitis. MR of the SIJs is reliable in its visualization of joint erosions in early SpA and allows differentiation between active and chronic sacroiliitis. We recommend the following sequences: semicoronal T1 and both semicoronal and semiaxial STIR. If these images are normal, the examination can be finished; otherwise additional semicoronal T1 FS before and after i.v. contrast has to be performed as well as semiaxial post-contrast T1 FS.

中耳真珠腫のＭＭＰ‐１発現と臨床症状との関連

Matrix metalloproteinase-1 (MMP-1) is known as a lytic enzyme and degrades type I collagen which constructs of bony tissue. Recently, attention has been focused to the relation between bone destruction and MMP-1.In this study, we examined the presence of MMP-1 immunohistologically in tissue speciments from 42 cholesteatomas, and studied the relation between MMP-1 and the patient's clinical signs. To examine the effect of age, we divided patients with primary cholesteatoma into two groups; 14 years old or older (24 patients) and younger than 14 (11 patients). As clinical signs, we evaluated the presence of active inflammatory changes such as otorrhea and granulation as well as the degree of bone destruction compared with bone destruction scale.As a result, there was a significant correlation between the signs of active inflammatory findings and the degree of bone destruction.Immunohistological expression of MMP-1 was found in 40 (95%) of 42 specimens. MMP-1 was present in 6 (14%) cholesteatoma epithelium, 39 (93%) cholesteatoma debris and 24 (57%) granulation under the epithelium. In patients with active inflammatory clinical signs, the MMP-1 level appeared significantly elevated in the debris and in the granulation tissue of the cholesteatoma. There was also a significant correlation between the MMP-1 level in granulation tissue and bone destruction.These findings suggest that MMP-1 in inflammatory lesions might accelerate the bone destruction and indicate the necessity to preoperatively treatment inflammation in cholesteatoma patients.

Histopathological analysis of four autopsy cases of HTLV-I-associated myelopathy/tropical spastic paraparesis: inflammatory changes occur simultaneously in the entire central nervous system.

Although brain lesions have been described in some cases with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), little is known about the nature of brain lesion and its relation to the spinal cord lesion. In the present study, we performed histopathological analysis of the brain and the spinal cord of four autopsied cases with HAM/TSP to clarify the relationship between the brain and the spinal cord lesions. In two cases with active-chronic inflammation in the spinal cord, perivascular inflammatory infiltration was also seen in the brain, and the composition of cell subsets was similar both in the spinal cord and in the brain. No active inflammatory change was seen in the brain in two cases with inactive-chronic spinal cord lesions. Inflamed vessels were distributed mainly in the deep white matter and in the area between cerebral cortex and white matter of the brain. In the spinal cord inflamed vessels were mainly seen in the bilateral lateral and the ventral posterior columns. Parenchymal infiltration was diffused in the spinal cord but very sparse in the brain, suggesting the importance of parenchymal infiltration in the destruction of tissues. These results suggest that inflammatory changes occurred simultaneously in the spinal cord and in the brain, and that distribution of inflamed vessels closely correlated with the characteristics of vascular architecture of the brain and the spinal cord, which lead to a slow blood flow. This study may help promote a better understanding of the pathogenesis of HAM/TSP.

Pharmacotherapy for Behcet's syndrome.

To determine the effects of available pharmacological interventions in treating the different clinical features of Behcet's syndrome. We searched the Cochrane Musculoskeletal Group's trials register, the Cochrane Controlled Trials Register, and Medline up to January 1998. The computer search was complemented by a hand search of all bibliographic references from the reference lists of included trials. Principal investigators were contacted to seek unpublished literature. All languages were included. Studies were eligible if they fulfilled all of the four following criteria: 1. Randomized controlled trials, single or double-blind; 2. Participants were patients with Behcet's Syndrome as defined by the International Study Group, 1990 (Int Study Group, 1990); 3. Interventions included any pharmacological therapy compared to placebo or some other pharmacological intervention for the treatment of Behcet's syndrome. 4. Outcome measures included active ocular inflammatory processes, arthritis, mucocutaneous manifestations (oral ulcer, genital ulcer, erythema nodosum), laboratory changes and major events such as adverse effects and death. The 32 potentially relevant references were assessed by two independent reviewers (MA, AS) according to the inclusion criteria. Ten trials fit the inclusion criteria and were included in this review. From the 10 included trials, data were independently extracted by the same two observers and crosschecked. The quality of the included trials was assessed independently by two observers (MA, AS) using a validated scale (Jadad 1996). For dichotomous measures, the treatment effect for each trial was calculated using a fixed effect model [Peto model (Petitti 1994)]. The weighted mean differences were based, if available, on end-of-trial results. The analysis was conducted separately for each different intervention. Since the trials could not be pooled it was not possible to carry out a sensitivity analysis by quality scores or a subgroup analysis by drug dosages. Because of this lack of comparability across trials and the small number of trials, we could not conduct a heterogeneity test or a funnel plot. Ten trials and 679 patients were included. The main results were the lack of efficacy of some of the classic treatments for Behcet's syndrome, including colchicine, cyclophosphamide and steroids for eye involvement, azapropazone and colchicine for arthritis and acyclovir, colchicine and topical interpheron for aphthas. The results confirm the protective effects of cyclosporine and azathioprine for eye involvement and benzathine-penicillin for arthritis. We conclude that further randomized, placebo-controlled, double-blind trials should be carried out to compare cyclosporine, azathioprine and benzathine-penicillin versus placebo in order to make the results generalizable and comparable.

Crohn's esophagitis: a unique cause of esophageal polyposis

Esophageal involvement in adults with Crohn's disease is uncommon. 1 McDonald GB Esophageal diseases caused by infection, systemic illness, medication and trauma. in: Textbook of gastrointestinal disease. WB Saunders, Philadelphia1993: 437 Google Scholar , 2 Geboes K Janssens J Rutgeerts P Vantrappen G Crohn's disease of the esophagus. J Clin Gastroenterol. 1986; 8: 31-37 Crossref PubMed Scopus (81) Google Scholar , 3 Fruhmorgen P Rosch W Endoskopischer Aspeckt des Morbus Crohn in Osophagus, Magen, Duodenum, Jejunum, Ileum und Kolon. Z Gastroenterol. 1974; 12: 592 PubMed Google Scholar , 4 Tishler JMA Helman CA Crohn's disease of the esophagus. J Can Assoc Radiol. 1984; 35: 28-30 PubMed Google Scholar , 5 Marshak RH Granulomatous disease of the intestinal tract (Crohn's disease). Radiology. 1975; 114: 3-22 PubMed Google Scholar The previously described endoscopic and radiologic abnormalities associated with Crohn's esophagitis include erythematous or friable mucosa, “cobblestone” mucosa, superficial aphthoid or “punched out” ulcers, deep ulcers, nodular masses, strictures, intramural sinus tracts, and fistulae. Cockey et al. 6 Cockey BM Jones B Bayless TM Shauer AB Filiform polyps of the esophagus with inflammatory bowel disease. AJR Am J Roentgenol. 1985; 144: 1207-1208 Crossref PubMed Scopus (17) Google Scholar reported a case of esophageal filiform polyposis in the setting of active esophageal Crohn's disease. We present a patient with multiple small esophageal polyps in the setting of active gastric, duodenal, and jejunal Crohn's disease. Pathologically, the polyps consisted of squamous hyperplasia with a predominant plasma cell infiltrate and small granulomas in the lamina propria. These lesions likely represent chronic active inflammatory changes of Crohn's disease. To our knowledge, this variant of esophageal involvement has not been reported and adds Crohn's disease to the differential diagnosis of esophageal polyps and polyposis.

Pathologic correlations with magnetic resonance images of osteochondrosis lesions in canine shoulders

Summary: Twelve shoulders in 6 dogs with clinical and radiographic evidence of osteochondrosis were examined by magnetic resonance imaging performed on a 0.5-T superconductive system. Scans were obtained with 5-mm-thick slices and 0.75-mm pixel size. Unenhanced T1-weighted spin-echo and unenhanced T2*-weighted gradient-echo images were obtained, using a high-resolution surface coil. The T1-weighted sequences were repeated after iv injection of 0.1 mmol of gadopentetate dimeglumine/kg of body weight (0.2 ml/kg). In 6 joints, histologic examination of synovia and articular cartilage was carried out. The magnetic resonance images were correlated with arthrographic, arthroscopic, and histologic findings. Magnetic resonance imaging was useful in evaluating the extent of subchondral lesions and the severity of inflammatory changes within the subchondral bone. Areas of low signal (visible subchondrally on T1-weighted images that were enhanced by administration of contrast medium) indicated active inflammatory changes within the subchondral bone. Although articular cartilage discontinuity could be detected, loose cartilage flaps could not always be reliably demonstrated. Signal inhomogeneity within the articular cartilage was presumed to correspond with zones of cartilage degeneration.

Helicobacter pylori infection induces a decrease in immunoreactive-somatostatin concentrations of human stomach.

Immunoreactive-somatostatin (ir-somatostatin) concentrations of the gastric mucosa and gastric juice with Helicobacter pylori infection were measured in the human stomach. One hundred seventy-one patients (106 males, 65 females; mean age, 52.0; range, 19-84 years) were registered. Gastric juice and mucosa were obtained with the usual endoscopy procedure. Somatostatin concentration was measured by radioimmunoassay. The ir-somatostatin concentrations in the H. pylori-negative group were significantly higher than in the positive group gastric mucosa, whereas its levels in gastric juice tended to decrease with H. pylori infection. There was an inverse correlation between luminal ammonia levels and ir-somatostatin concentrations of the gastric mucosa. On the other hand, ir-somatostatin concentrations of the gastric mucosa significantly decreased with chronic and active inflammatory change. This decrease was not correlated with the grade of active inflammation, which was in close relation to H. pylori infection, but with the grade of chronic inflammation. These results indicate that H. pylori may reduce ir-somatostatin concentrations of the human stomach and that its effect is partly mediated via luminal ammonia produced by H. pylori.

Immunohistochemical staining patterns of tenascin in invasive breast carcinomas.

Eighty-two cases of primary invasive breast carcinoma and adjacent "normal" mammary glands were examined immunohistochemically for tenascin expression and distribution. Formalin-fixed tissues pretreated with actinase were processed by the avidin-biotin complex method using anti-human tenascin monoclonal antibody (RBC1). In normal mammary glands, tenascin was distributed around the ducts and ductules but not around the acini. In carcinomas, a high incidence of tenascin-positive cases (greater than 67%) was seen with various histological appearances, with the exception of lobular carcinoma where a low incidence was found (25%). Although intense staining was seen around cancerous foci when compared with normal mammary glands, tenascin was often expressed at cancer-mesenchymal junctions with dense fibrotic stroma, but not at junctions with active inflammatory change and a loose fibrotic stroma. Tenascin, expression is not an all-or-none marker for mammary malignancy and the staining pattern suggests either a role in stimulating cancer cells or a host defence mechanism accompanied by a desmoplastic response to them.

Pseudopseudohypoparathyroidism with recurrent polyneuropathy: an autopsy report with special reference to the peripheral nervous system

The clinical and pathological findings of a 21-year-old girl suffering from pseudopseudohypoparathyroidism (PPHP) with relapsing neuropathy are described. Episodic exacerbations were accompanied by intracranial hypertension and were relieved by the administration of corticosteroids. At autopsy, pathologic changes were almost restricted to the peripheral axons and showed distal dominant depletion of myelinated fibers without any active myelin breakdown or inflammatory changes. The neuropathy is thought to be similar to chronic inflammatory demyelinating polyradiculoneuropathy (CIDP); however, the relationship, if any, between PPHP and CIDP is unknown.

Morphological changes of mucosa in gastric bladders after long term follow up

The body and fundus of the stomach were used to restore the capacity of diseased urinary bladder in 8 patients. Gastric bladder biopsies were taken 4 to 14 years (mean 9.7 years) after the operation and studied with light and transmission electron microscopes. The findings varied from near normal fundic mucosa to moderate atrophy and severe active chronic inflammatory changes. Pyloric metaplasia was present in 2 gastric bladders and intestinal metaplasia was observed in another one. Dysplastic changes were not seen. The finding of essentially normal fundic mucosa in 3 gastric bladders which had functioned for 4 to 14 years showed that gastric fundic mucosa was stable when constantly bathed by urine. The absence of dysplastic changes but the presence of intestinal metaplasia in the gastric bladders suggested that the risk of carcinoma developing was low. The body and fundus of the stomach were used to restore the capacity of diseased urinary bladder in 8 patients. Gastric bladder biopsies were taken 4 to 14 years (mean 9.7 years) after the operation and studied with light and transmission electron microscopes. The findings varied from near normal fundic mucosa to moderate atrophy and severe active chronic inflammatory changes. Pyloric metaplasia was present in 2 gastric bladders and intestinal metaplasia was observed in another one. Dysplastic changes were not seen. The finding of essentially normal fundic mucosa in 3 gastric bladders which had functioned for 4 to 14 years showed that gastric fundic mucosa was stable when constantly bathed by urine. The absence of dysplastic changes but the presence of intestinal metaplasia in the gastric bladders suggested that the risk of carcinoma developing was low.

Hepatocellular carcinoma in adenomatous hyperplasia of the liver

A hepatocellular carcinoma (HCC) measuring 0.2 cm in diameter was found in the center of an adenomatous hyperplasia (AH) measuring 1.7 cm in diameter in a cirrhotic liver. The liver cells of the AH showed a marked fatty change and contained many Mallory bodies. The AH and HCC were studied in relation to liver cell dysplasia in 108 surgically resected livers. The AH was mainly associated with fully developed cirrhosis in 5 (71%) of the 7 cases. The liver cell dysplasia, however was accompanied largely by fibrosis and early-stage incomplete septal cirrhosis in 10 (67%) of the 15 cases. As far as the active inflammatory change was concerned, a fairly active inflammation was found in only 3 (20%) of the 15 livers with liver cell dysplasia, but in 4 (57%) of the 7 livers with AH.

Active inflammatory change of the liver as a cause of postoperative hepatic failure.

Histopathology of cirrhosis was compared to the hepatic functional reserve and to the prognosis. One hundred and thirteen patients including 51 surgically treated for hepatocellular carcinoma (HCC) and 62 subjected to wedge biopsy of the liver during surgery for esophageal varices were studied. The type of cirrhosis associated with hepatocellular carcinoma was classified into 4 groups according to the degree of inflammation and the piecemeal necrosis. Of the 16 without cirrhosis, 13 (81 per cent) are living. Nine had an inactive cirrhosis and 5 (56 per cent) are living. Ten had a slightly active cirrhosis and 4 (40 per cent) are living. Sixteen had a fairly active cirrhosis and 7 (44 per cent) are alive. Immediate postoperative death due to acute hepatic failure occurred in 6, 4 of whom had a fairly active cirrhosis. In patients with active alcoholic hepatitis with numerous Mallory bodies and ballooning degeneration of liver cells, the prognosis was the poorest, if the liver was resected, even though the functional reserve seemed to be adequate. To prevent acute hepatic failure, liver histology during the surgery is predictive and wedge biopsy of the liver is recommended.

Diseases of the pubic symphysis

To determine the prevalence of active inflammatory changes around the pubic symphysis on MRI scans in patients with axial spondyloarthritis, and to evaluate its association with clinical factors.A retrospective analysis of MRI scans of 128 patients clinically diagnosed with axial spondyloarthritis was performed to assess the presence of active inflammatory changes around the pubic symphysis (bone marrow edema/osteitis and enthesitis). The clinical factors of the patients with and without active inflammatory changes around the pubic symphysis were compared.MRI scans showed active inflammatory changes around the pubic symphysis in 23 patients (18.0 %); 9 patients showed bone marrow edema/osteitis in the parasymphyseal pubic bone without soft tissue changes, 9 patients showed enthesitis with bone marrow edema/osteitis, and 5 patients showed enthesitis without bone marrow edema/osteitis. The median age of patients with active symphysis pubis changes was higher than that of those without active symphysis pubis changes (p < 0.001). C-reactive protein level and erythrocyte sedimentation rate in the active symphysis pubis group were both higher than those of the non-active symphysis pubis group (p = 0.001 and <0.001, respectively).Active inflammatory changes around the pubic symphysis were seen in 18.0 % of the patients diagnosed with axial spondyloarthritis undergoing pelvic MRI, and were associated with older age and elevated acute phase proteins.