Changes In Sacroiliac Joints Research Articles

Normal subchondral high T2 signal on MRI mimicking sacroiliitis in children: frequency, age distribution, and relationship to skeletal maturity.

To determine patterns of variation of subchondral T2 signal changes in pediatric sacroiliac joints (SIJ) by location, age, sex, and sacral apophyseal closure. MRI of 502 SIJ in 251 children (132 girls), mean age 12.4years (range 6.1-18.0), was obtained with parental informed consent. One hundred twenty-seven out of 251 had asymptomatic joints and were imaged for non-rheumatologic reasons, and 124 had low back pain but no sign of sacroiliitis on initial clinical MRI review. After calibration, three subspecialist radiologists independently scored subchondral signal changes on fat-suppressed fluid-sensitive sequences from 0 to 3 in 4 locations, and graded the degree of closure of sacral segmental apophyses. Associations between patient age, sex, signal changes, and apophyseal closure were analyzed. Rim-like subchondral increased T2 signal or "flaring" was much more common at sacral than iliac SIJ margins (72% vs 16%, p< 0.001) and was symmetrical in > 90% of children. Iliac flaring scores were always lower than sacral, except for 1 child. Signal changes decreased as sacral apophyses closed, and were seen in < 20% of subjects with fully closed apophyses. Signal changes were more frequent in boys, and peaked in intensity later than for girls (ages 8-12 vs. 7-10). Subchondral signal in iliac crests was high throughout childhood and did not correlate with other locations. Subchondral T2 "flaring" is common at SIJ of prepubertal children and is generally sacral-predominant and symmetrical. Flaring that is asymmetrical, greater in ilium than sacrum, or intense in a teenager with closed apophyses, is unusual for normal children and raises concern for pathologic bone marrow edema. • A rim of subchondral high T2 signal is commonly observed on MRI at pediatric sacroiliac joints, primarily on the sacral side before segmental apophyseal closure, and should not be confused with pathology. • Unlike subchondral signal changes elsewhere, high T2 signal underlying the iliac crest apophyses is a near-universal normal finding in children that usually persists throughout adolescence. • The following patterns are unusual in normal children and are suspicious for pathology: definite iliac flaring, iliac flaring more intense than sacral flaring, left-right difference in flaring, definite flaring of any pattern in teenagers after sacral apophyseal closure.

Bone turnover biomarkers, disease activity, and MRI changes of sacroiliac joints in patients with spondyloarthritis.

The lack of valid biomarkers in patients with spondyloarthritis (SpA) requires searching for additional options to increase sacroiliac joint (SIJ) evaluation effectiveness. We assessed the serum levels of bone turnover markers and their relationships with active and chronic changes in SIJs using magnetic resonance imaging (MRI), indices, and laboratory parameters of disease activity in SpA patients. 102 patients with SpA and 15 healthy subjects were included. Testing of serum levels of transforming growth factor-beta (TGF-β1), Wnt3, sclerostin, and Dickkopf-1 (Dkk-1) was conducted. Active inflammatory lesions in SIJs were evaluated using Spondyloarthritis Research Consortium of Canada (SPARCC) MRI SIJ score, and chronic changes using the Danish scoring method. Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Ankylosing Spondylitis Disease Activity Scores with CRP, and ESR were used to assess disease activity. Serum levels of Dkk-1, TGF-β1, and sclerostin were significantly lower in SpA patients compared to healthy controls. The serum levels of Dkk-1 positively correlated with CRP. Dkk-1 had a significant negative correlation with Danish score. The sclerostin serum level had a weak negative correlation with the active inflammatory MRI SIJ lesions. There were positive correlations between TGF-β1 and sclerostin with Dkk-1, and negative correlation between Wnt3 and sclerostin. Dkk-1 positively correlated with CRP and negatively with chronic SIJ changes by Danish score. Sclerostin negatively correlated with the active SIJ lesions by SPARCC. This suggests that Dkk-1 and sclerostin are the most promising candidates to reveal inflammation and bone turnover in patients with SpA.

Multicentric Reticulohistiocytosis Exhibiting Positive HLA-B*07 and HLA-B*08: A Case Report

Multicentric reticulohistiocytosis (MRH) is a rare cause of destructive inflammatory arthritis involving both small, as well as larger joints. We report the case of a 40-year-old Caucasian female with a family history of neoplasia who was referred to our service witha two-month history of inflammatory joint pain. On examination, the patient had inflammatory arthritis, mainly involving the peripheral joints, sacroiliac joint pain, and numerous papulonodular mucocutaneous lesions, including periungual “coral beads”. Imaging tests revealed erosive arthritis with synovitis and tenosynovitis, sacroiliac joint changes, as well as papulonodular mucosal lesions in the nasal vestibule, the oropharyngeal mucosa, and supraglottic larynx. She tested positive for HLA-B*07 (Human Leukocyte Antigen B*07) and HLA-B*08, ANA (antinuclear antibodies), RF (rheumatoid factor), anti-Ro52, anti-SSA/Ro, and anti-SSB/La antibodies. The skin biopsy was suggestive of MRH, showing a histiocyte infiltrate and frequent giant multinucleated cells. The patient exhibited favorable outcomes under Methotrexate, then Leflunomide. However, she displayed worsening clinical symptoms while under Azathioprine. To our knowledge, this is the first case of MRH to exhibit positive HLA-B*07 together with HLA-B*08. The rarity of MRH, its unknown etiology and polymorphic clinical presentation, as well as its potential neoplastic/paraneoplastic, and autoimmune nature demand extensive investigation.

OP0106 SECUKINUMAB 150 MG SIGNIFICANTLY IMPROVED SIGNS AND SYMPTOMS OF NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 52-WEEK RESULTS FROM THE PHASE III PREVENT STUDY

Background:Axial spondyloarthritis (axSpA) spectrum covers radiographic axSpA and non-radiographic axSpA (nr-axSpA). PREVENT (NCT02696031) is the first phase III, placebo (PBO) controlled study evaluating secukinumab (SEC) 150 mg with (LD) or without loading (NL) dose, in patients (pts) with nr-axSpA.1The study had 2 independent analysis plans as per EU (Wk 16) and US (Wk 52) regulatory requirements.Objectives:To report efficacy through Wk 52 and safety up to two years for the PREVENT study.Methods:555 pts fulfilling ASAS criteria for axSpA plus abnormal CRP and/or MRI, without evidence of radiographic changes in sacroiliac (SI) joints according to modified New York Criteria for AS were enrolled. All images were assessed centrally before inclusion. Pts were randomised (1:1:1) to SEC 150 mg with LD, NL, or PBO at baseline (BL). LD pts received SEC 150 mg at Wks 1, 2, 3, and 4, and then every 4 wks (q4wk) starting at Wk 4. NL pts received SEC 150 mg at BL and PBO at Wks 1, 2, and 3, and then 150 mg q4wk. Switch to open-label (OL) SEC 150 mg or standard of care (SoC) was permitted after Wk 20. Primary endpoint was ASAS40 at Wk 16 (LD) and at Wk 52 (NL) in anti-TNF-naïve pts. Secondary endpoints (overall population) included ASAS40, BASDAI50, SI joint bone marrow edema (BME) score by MRI at Wks 16 and 52 and ASDAS-CRP inactive disease (ID) at Wk 52. Endpoints were analysed according to statistical hierarchy. Analysis used non responder imputation through Wk 52. Safety analyses included all pts who received ≥1 dose of study treatment.Results:Overall, 481 pts completed 52 wks with no major differences in retention across groups: 84.3% (156/185; LD), 89.7% (165/184; NL) and 86.0% (160/186; PBO). BL characteristics were similar across groups; 90% pts were anti-TNF-naïve, 56-58% pts had elevated CRP, 71-75% pts had evidence of SI joint inflammation by MRI. Proportion of pts who switched to OL or SoC between Wks 20 and 48 was 52.1% (LD), 49.2% (NL), and 67.4% (PBO). Primary endpoints at Wk 16 and Wk 52 were met (Table). SEC 150 mg LD or NL significantly improved secondary endpoints at Wk 16 and 52 vs PBO (Table). SEC significantly reduced SI joint MRI BME score vs PBO at Wk 16 (-1.68 and -1.03 vs -0.39;P= 0.0197 and 0.026, LD and NL respectively). No unexpected safety signals were reported.Conclusion:SEC 150 mg provided significant and sustained improvement in signs and symptoms of pts with nr-axSpA through Wk 52. MRI BME scores were reduced accordingly. There was no major difference between LD and NL. Safety of SEC was consistent with previous reports.2

P271 An analysis of short-term repeat MRI scans of vertebral corner lesions in suspected early axSpA: defining the prevalence and evolution of clinically significant spinal lesions without concurrent SIJ changes on imaging

Abstract Background MRI offers an enhanced opportunity to detect early spinal changes of axial spondyloarthritis (axSpA), by identifying characteristic inflammatory and structural lesions, so called Romanus lesions. These include bone marrow oedema lesions on the vertebral corners and fatty replacement of these lesions, both highly suggestive features of axSpA. Current evidence suggests that treatment of these lesions requires early biologic therapy, hence early identification is imperative. We evaluate the prevalence and variation of vertebral corner lesions on short-term repeat MRI scans in patients with suspected early axSpA. Methods 109 MRI scans were performed at baseline and at 4, 8 and 12-weeks on 30 patients with suspected axial spondyloarthritis, who fulfilled the ASAS inflammatory back pain criteria, and had normal sacroiliac joints (SIJs) on antero-posterior pelvis radiographs. The protocol included sagittal T1 and short-tau inversion recovery of the cervico-thoracic spine and thoracolumbar spine. Results 29 patients completed the study (66% were male, 72% HLA-B2-positive). All patients had ≥1 clinical spondyloarthritis (SpA) feature and 86% had ≥2. 13 patients used NSAIDs regularly over the 12-week study period. Overall, 40 corner lesions were present in participants at baseline scanning. 67 new vertebral corner lesion changes occurred at different time points over the follow-up period compared to baseline. 43 changes were new or worsening lesions, while 24 changes were an improvement or resolution of a lesion. 48.6% (14/29) of patients had a minimum of 1 corner lesion present at baseline. 78.5% (11/14) of patients with baseline corner lesions experienced either a decrease/improvement or increase/progression of spinal corner lesions. 20.7% (6/29) of patients demonstrated transient corner lesions at baseline or follow-up with resolution by the 12-week scan (likely artefact). 5/29 patients met spinal imaging criteria suggestive of AS (3 at baseline, 1 only transiently at 1 month, and 1 which persisted from interval scanning). At 12-weeks, 13.8% of patients had at least 3 concomitant baseline or de-novo vertebral corner lesions present (minimum number needed for diagnostic significance). 75% of these patients did not have evidence of concomitant SIJ changes (10.3% of all patients). HLA-B27 status, gender, NSAID use, and number of SpA features were not associated with corner lesion development or improvement. Conclusion Approximately half of all patients who meet ASAS criteria for inflammatory back pain, but do not meet ASAS criteria for axSpA, demonstrated at least 1 vertebral corner lesion on MRI scan at baseline, which may represent artefact or a prelude to future disease progression. 13.8% of patients had at least 3 concomitant baseline or de-novo vertebral corner lesions present on MRI at the conclusion of 12-weeks of follow-up. In cases of suspected axSpA with negative SIJ MRI imaging, 10.3% of patients had significant spinal evidence of axSpA on MRI, highlighting the importance of spinal imaging and monitoring as part of the diagnostic work-up for axSpA. Disclosures S. Chatterjee None. H. Marzo-Ortega None. D. McGonagle None. A. Bennett None. R. Sengupta None.

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis

BackgroundDiffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of vertebral bodies and peripheral entheses. However, variations in sacroiliac (SI) joint change in patients with DISH have not been fully clarified. The purpose of this study was to evaluate SI joint variation in patients with DISH in comparison with a non-DISH population.MethodsA total of 342 SI joints in 171 patients (DISH+, n = 86; DISH-, n = 85) who had undergone lumbar spine surgery were analyzed by computed tomography examination. SI joint variations were classified into four types: Type 1, normal or tiny peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophytes formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. The type of bridging osteophyte in SI joints and the prevalence of ossification in each spinal segment from C1 to SI joint were also examined.ResultsThe most common SI joint variation in the DISH+ group was bony fusion (Type 4), with 71.6% exhibiting anterior paraarticular bridging. On the other hand, SI joint vacuum phenomenon (Type 3) was the most frequent change (57.1%) in the DISH- group. The middle to lower thoracic spine and SI joints were highly affected in DISH and caused bony ankylosis.ConclusionsAnterior paraarticular bridging was the most common type of SI joint change in patients with DISH who underwent lumbar spine surgery. The present results regarding variations of SI joint changes in DISH should help understand the etiology of DISH.

MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

ObjectivesTo compare the performance of conventional radiography, ldCT, and MRI in the diagnosis of sacroiliitis in suspected axial spondyloarthritis (axSpA).MethodsPatients presenting with > 3 months chronic back pain were assessed by axSpA-experienced rheumatologists and diagnosed as axSpA or not; axSpA patients were then considered nr-axSpA or AS using plain radiography. Non-axSpA patients were recruited as controls, and divided into non-inflammatory and inflammatory groups on the basis of inflammatory back pain and/or CRP/ESR elevation. Clinical variables, pelvic radiography, sacroiliac joint (SIJ) ldCT, and SIJ MRI were obtained.ResultsA total of 121 patients were included and had SIJ radiography and ldCT, of whom 71 additionally had an SIJ MRI. These included 23 non-inflammatory controls, 21 inflammatory controls, 32 nr-axSpA cases, and 45 AS cases. Fourteen of 32 (44%) nr-axSpA patients had positive ldCT scans, 21/24 (88%) had MRI-BMO, and 11/24 (46%) had MRI-structural lesions. ldCT had high specificity with only 1/23 (4%) non-inflammatory controls being positive. MRI-BMO had the highest sensitivity for nr-axSpA, but compared with ldCT lower specificity, with 5/15 (33%) of non-inflammatory controls being positive, and similar sensitivity for AS (20/22 (91%) vs 44/44 for ldCT).ConclusionsldCT identifies evidence of radiographic change in a significant proportion of nr-axSpA cases and is highly specific for axSpA. MRI-BMO lesions are more sensitive than either conventional radiography or MRI-structural assessment for axSpA. The relative position of these imaging modalities in screening for axSpA needs to be reconsidered, also taking into account the costs involved.Key Points• ldCT is more sensitive for erosions or sclerosis in axSpA than plain radiography, with 44% of patients with nr-axSpA having evidence of AS-related sacroiliac joint changes on ldCT.• MRI-structural lesions are no more sensitive but are less specific for AS than ldCT.• MRI-BMO is the most sensitive test for nr-axSpA of the modalities tested but is less specific for axSpA than for ldCT.

Radiographic Prevalence of Sacroiliac Joint Abnormalities and Clinical Outcomes in Patients With Femoroacetabular Impingement Syndrome

To quantify the prevalence of sacroiliac joint (SIJ) abnormalities in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) by use of various imaging modalities and to compare outcomes based on SIJ abnormalities. Plain radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans of patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. The exclusion criteria included patients undergoing bilateral or revision surgery, those with a history of dysplasia, and those with less than 2years' follow-up. On radiographs, the SIJs were graded using modified New York criteria for spondyloarthropathy. CT and MRI scans were reviewed for joint surface erosion, subchondral sclerosis, joint space narrowing, pseudo-widening, bone marrow edema, and ankylosis. Patients with SIJ abnormalities were matched to patients without SIJ abnormalities in a 1:2 ratio by age and body mass index. Outcomes included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain, and VAS for satisfaction. Of 1,009 consecutive patients, 743 (73.6%) were included; 187 (25.2%) showed SIJ changes. Of these 187 patients, 164 (87.7%) had changes on plain radiographs, 88 (47.1%) had changes on CT, and 125 (66.8%) had changes on MRI. SIJ changes on any imaging modality were weakly correlated with pain to palpation of the SIJ (r= 0.11, P=.004) on physical examination. Pain to palpation of the SIJ on physical examination (odds ratio [OR], 1.12; P= .031) and a history of SIJ pain (OR, 1.93; P= .018) increased the odds of having an SIJ abnormality on any imaging modality. After matching, patients without SIJ abnormalities had a significantly greater HOS-ADL (95.4 vs 90.6, P= .001), HOS-SS (91.1 vs 77.5, P < .001), and mHHS (91.3 vs 84.5, P < .001) and a significantly lower VAS pain score (10.9 vs 25.7, P < .001) than patients with abnormalities at a mean follow-up of 34.1 ± 9.7months (range, 24-54months). Patients without SIJ abnormalities had greater odds of achieving the minimal clinically important difference for the HOS-ADL (OR, 2.91; P= .001) and for the HOS-SS (OR, 2.83; P < .001) but not for the mHHS (OR, 1.73; P= .081). A high prevalence of SIJ abnormalities (25.2%) is seen on imaging in FAIS patients. These patients may show significantly inferior clinical outcomes and persistent postoperative pain after FAIS treatment. The results of this study may allow treating orthopaedic surgeons to better inform patients with SIJ abnormalities that they may not achieve clinically significant outcome improvement after hip arthroscopy. Level III, retrospective comparative study.

Radiographic Prevalence Of Sacroiliac Joint Abnormalities And Clinical Outcomes In Patients With Femoroacetabular Impingement Syndrome

Objectives:Patients with femoroacetabular impingement syndrome (FAIS) typically present with a gradual onset of groin pain. They may also presentwith gluteal pain, which can be related to posterior acetabular impingement or posterior joint degeneration secondary to FAIS or more commonly aberrant gait mechanics secondary to abnormal hip morphology. Gluteal pain is also a common presenting symptom in patients with sacroiliac joint (SIJ) problems. The date, the literature on the correlation between SIJ pathology and FAIS has been limited. As such, the purpose of the current study id to quantify the prevalenceof SIJ abnormalities FAIS patients using imaging modalities and to compare outcomes based on SIJ abnormalities.Methods:Radiographs, CT and MRI scans of 1,009 consecutive patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. Exclusion criteria included patients undergoing bilateral or revision surgery, history of dysplasia, and less than two-year follow-up. On radiographs, SIJ joints were graded using modified New York criteria for spondyloarthropathy. CT scans and MRIs were reviewed for joint surface erosions, subchondral sclerosis, joint-space narrowing, pseudo-widening, bone marrow edema, and ankylosis. Patients with SIJ abnormalities were matched 1:2 to patients without SIJ abnormalities by age and BMI. Outcomes included the hip outcome score- activities of daily living (HOS-ADL), sports-subscale (HOS-SS), modified Harris hip score (mHHS), and visual analog scales (VAS) for pain and satisfaction.Results:743 patients were included; 187 (25.2%) demonstrated SIJ changes. 164 (87.7%) had radiographic changes, 88 (63.3%) on CT, and 125 (66.8%) on MRI. SI changes on any imaging modality were correlated with pain to palpation (PTP) of the SI joint (r=0.11; p=0.004) on physical exam. History of SI pain was correlated with PTP of the SI joint (r=0.21; p<0.001). After matching, patients without SIJ abnormalities had significantly greater HOS-ADL (95.4 vs. 90.6;p=0.001), HOS-SS (91.1 vs. 77.5;p<0.001), and mHHS (91.3 vs. 84.5;p<0.001) scores and significantly less VAS pain (10.9 vs. 25.7;p<0.001) than those with abnormalities. Patients without SIJ abnormalities had greater odds of achieving the MCID for the HOS-ADL (Odds ratio [OR]=2.91, 95%confidence interval [95% CI]=1.5-5.5;p=0.001) and for the HOS-SS (OR=2.83, 95% CI = 1.6-4.9;p<0.001), but not for the mHHS (OR=1.73, 95% CI = 0.93-3.2; p=0.081).Conclusion:There is a high prevalence of SIJ abnormalities in patients with FAIS. Patients with abnormalities may expect inferior outcomes and persistent post-operative pain.Table 1.2-year patient reported outcome scores compared by presence of SIJ changesSIJ changesNo SIJ ChangesP-ValueAge32.3 ± 12.532.1 ± 12.00.91BMI24.3 ± 4.224.1 ± 4.30.61HOS-ADL90.6 ± 10.095.4 ± 8.7 0.001 HOS-SS77.5 ± 21.491.1 ± 12.4 <0.001 mHHS84.5 ± 16.491.3 ± 9.6 <0.001 VAS Pain25.7 ± 24.310.9 ± 12.4 <0.001 SIJ = Sacroiliac joint; BMI = Body Mass Index; HOS-ADL = Hip outcome score – activities of daily living; HOS-SS = HOS-sport specific subscale; mHHS = modified Harris hip score; VAS = visual analog scale.

MR distribution of active inflammatory and chronic structural sacroiliac joint changes in axial spondyloarthropathy: Challenging conventional wisdom

ObjectiveEvaluate the MR distribution of inflammatory sacroiliac joint changes in axial spondyloarthritis phenotypes, including Ankylosing Spondylitis (AS) and non-radiographic Axial Spondyloarthritis (nrAxSpA). MethodsA retrospective review of 94 patients seen for treatment of axial spondyloarthritis (SpA) who underwent sacroiliac joint MRI between January 2011 and December 2015 was performed. MR images from 68 patients (20 with AS and 48 with nrAxSpA) were reviewed independently by two radiologists. Images were scored on presence of active inflammatory and chronic structural lesions. These lesions were further categorized as unilateral, bilateral and asymmetric, or bilateral and symmetric. ResultsNo statistically significant difference was found in the distribution (laterality or symmetry) of bone marrow edema or sclerosis between the AS and nr-axSpA groups. Osseous erosions were more commonly bilateral symmetric in AS than nr-axSpA (11/20 vs. 8/48, p = 0.01). No statistically significant difference was noted between bone marrow edema scores in the AS and nr-axSpA subgroups (2.6 vs 3.3, p = 0.514). Patients with AS had a significantly higher fat metaplasia score compared to patients with nr-axSpA (7.3 vs 1.1, p = 0.001). Patients with nr-axSpA had a higher mean score for erosions (11.6 vs 4.2, p = 0.001). Only patients classified as AS were found to have bony ankylosis. Inter-observer reliability was strong to excellent. ConclusionAnkylosing spondylitis findings at the sacroiliac joints are classically described as bilateral and symmetric on radiographs. Our study demonstrates that distribution on MRI at an individual time point is variable. The variable distribution should be considered when radiologists evaluate MRI exams of AS patients.

Disease activity and two-year sacroiliac joint changes according to instrumental study findings in a CoRSAr cohort of patients with early axial spondyloarthritis

The evolution of axial spondyloarthritis (axSpA) and the transition of its nonradiographic to radiographic stage, when ankylosing spondylitis (AS) can be diagnosed, concern many researchers. To clarify this issue, an active search for predictors of the progression of this disease is underway; special cohort studies are being conducted.Objective: to analyze two-year changes in the magnetic resonance imaging (MRI) signs of sacroiliac joint (SIJ) inflammation and disease activity in patients with axSpA who form a Moscow CoRSAr cohort (a Cohort of early SpondylArthritis) and the role of these indicators in the progression of sacroiliitis.Subjects and methods. The investigation enrolled 68 CoRSAr cohort patients followed up for two years. All the patients underwent pelvic radiography and SIJ MRI at inclusion in the cohort and then every year. At inclusion in the cohort, nonradiographic axSpA was present in 28 patients, and AS was in 40. Disease activity was determined by BASDAI and ASDAS-CRP. The progression of sacroiliitis was assessed by the total scores of radiographic sacroiliitis.Results and discussion. The patients' age at inclusion in the cohort averaged 28.5±5.8 years, with a mean disease duration of 24.1±15.4 months and a male proportion of 51.5%; the HLA-B27-positive patients were 92.6%. At two years, 39% of the patients with nonradiographic axSpA went to the AS group. 24-month sacroiliitis progression was observed in 40% of the patients. Disease activity had little impact on the progression of sacroiliitis.Conclusion. Over two years, almost 40% of patients with axSpA showed an increase in the radiographic stage of sacroiliitis in the CoRSar cohort; this progression was primarily associated with the foci of osteitis according to MRI and correlated little with the activity of the disease.

Degenerative changes of sacro-iliac joint in patients with lumbar LV–S1 spine fusion

Degenerative changes of sacro-iliac joint in patients with lumbar LV–S1 spine fusion

Radial MR Screen of the Sacroiliac Joints in the Lumbar Spine of Patients with Chronic Lower Back Pain

Magnetic resonance imaging (MRI) can reliably detect inflammation and structural changes in sacroiliac joints (SIJs) in patients with lower back pain (LBP). However, patients with LBP are usually referred for MRI of the lower back (e.g. lumbar spine LS), and imaging of the SIJs is rarely requested for these patients. The aim of this work is to use radial MRI as an additional screening technique for SIJ pathology presenting in lumbar spine patients with chronic LBP.

All that glitters is not gold: sacroiliitis.

ObjectivesThe aim of this study was to determine the prevalence of „rheumatic” and „non-rheumatic” changes of the sacro-iliac joints (SIJ).Material and methodsWe performed MRI in 210 patients with suspected inflammatory low back pain. We sorted and analysed the characteristics of sacroiliac bone lesions in „rheumatic” and „non-rheumatic” patients and assessed the diagnostic values of their extent and location. SIJ lesions were classified on the basis of their location into two categories: unilateral and bilateral. Their extent was then measured and assigned to one of two groups: <1 cm or ≥ 1 cm.ResultsIn 45 cases (21%), the MRI findings matched the clinical diagnosis of „rheumatic” sacroiliitis. Interestingly, in 99 cases (47%) the SIJ changes were classified as „non-rheumatic”. L5–S1 degenerative changes, scoliosis and pelvic asymmetry were most frequently encountered as concomitant phenomena in our study.ConclusionsMRI of the sacroiliac joints in patients suspected of inflammatory low back pain demonstrated more often “non-rheumatic” changes.

SACROILIAC JOINT PATHOLOGY IN ELDERLY PATIENTS WITH LOW BACK PAIN (OBSERVATION PROGRAM “IOLANTA”)

Pain in the lower back is one of the frequent reasons for seeking medical help among people over 60 years of age. The study of this problem is of interest to specialists of various profiles, including neurologists, rheumatologists, orthopedic surgeons and therapists. Purpose — to determine prevalence rate of sacroiliac joint pathology in elderly patients with low back pain (LBP) in conjunction with evaluation of clinical significance of bone resorption and cytokines markers. Materials and Methods.The study was conducted with consecutive inclusion of patients (n = 259) with mean age of 65.5 year old [62.5; 69.5] who addressed the hospital for the first time in calendar year with complaints for low back pain. The authors performed MRI examination of lumbar-sacral spine and sacroiliac joint, assessed transforming growth factor β1 (TGF β1), interleukin (IL) 1β and IL-6, Beta-Crosslaps (β-CrossLaps) criteria, P1NP (N-terminal propeptide of procollagen type I) concentration and deoxypyridinoline (DPD) level. Results. 39.4% of patients older 60 years with low back pain on MRI demonstrated changes in sacroiliac joints with statistically significant higher (p = 0.037) pain level as compared to patients without pathology of sacroiliac joint, as well as higher values of TGF-β1 (p = 0.033), IL-1β (p = 0.028), IL-6 (p = 0.041), β-CrossLaps (p = 0.028), P1NP (p = 0.037) and DPD (p = 0.002). Conclusion. Reported alterations in sacroiliac joint conditioned by degenerative and dystrophic processes are associated with distinctive signs of osteoarthrosis and confirm non-specific inflammation active with bone resorption in patients with low back pain.

Degenerative changes in sacroiliac joint in patients with its disfunction

Objective: to study the correlation of radiologic parameters of sacrum and pelvis in frontal plane, this can influence on the function of joint with degenerative changes in it.Methods: we examined 50 patients (age 20–71 years old) with sacroiliac disfunc­tion. Criteria of inclusion were: pain in the area of spinae iliaca superior, with irradiation to groin, gluteus region or hip, its duration more than 3 months; no effective conservative treatment; positive 4 of 6 provocative tests. On X-rays we measured angles of sacrum cranial plate tilt, pelvic tilt, sacrum rotation around axial plane, the width of joint space in the ventral, dorsal and medial parts. We assessed joint surfaces, subhondral sclerosis, osteophytes, ligaments ossification, bone spots. Obtained results were statistically calculated.Results: in all patients we revealed degenerative changes. For the patients of the 1st claster — they all had the highest degree of asymmetry in ventral part, average — in medial and dorsal parts, large tilt of sacrum and pelvis, significant rotation of sacrum. In the 2nd claster — almost symmetric joint space in all three parts, tilt of pelvis and sacrum, large rotation of sacrum. In the 3rd claster — significant asymmetry of joint space in the medial part and small in dorsal, large tilt of pelvis and sacrum, significant rotation of sacrum. In the 4th claster — large asymmetry of joint space in the dorsal part and minimal in the ventral and medial parts, small tilt of sacrum and pelvis, small rotation of sacrum. Widespread combination of degenerative changes were infringement of articulation surface, subhondral sclerosis and osteophytes in articular space.Conclusions: all patients with sacroiliac disfunction had degenerative changes. For diagnostics and forecasting of results we must take into consideration such factors which can lead to the disfunction of sacroiliac joint.

Evaluation of the change in structural radiographic sacroiliac joint damage after 2 years of etanercept therapy (EMBARK trial) in comparison to a contemporary control cohort (DESIR cohort) in recent onset axial spondyloarthritis

ObjectiveTo compare 2 years of radiographic sacroiliac joint (SIJ) changes in patients with recent onset axial spondyloarthritis (axSpA) receiving etanercept in a clinical trial (EMBARK) to similar patients not receiving...

Diagnostic value of X-ray, CT and MRI for sacroiliac joint lesions in patients with early stage of ankylosing spondylitis

Objective To compare the diagnostic value of X-ray, CT or MRI in detection of abnormal sacroiliac joint changes in patients with early stage ankylosing spondylitis. Methods One hundred and twenty patients with early stage ankylosing spondylitis who admitted in our hospital underwent X-ray, CT and MRI subsequently were selected, and the diagnostic value was analyzed. Results There were no statistically significant differences in diagnostic accuracy of articular cartilage swelling, joint space narrowing, joint space widening, the articular surface of cystic mass, articular sclerosis by CT and MRI(all P>0.05), except for bone erosion and bone cyst lesion(χ2 =8.179, 6.289, all P 0.05). Conclusion X-ray associated with low accuracy rate and high rate of miss diagnosis.With the high accuracy rate in detection of abnormal sacroiliac joint changes in patients with early stage ankylosing spondylitis, both CT and MRI are candidate for commonly used diagnostic methods for early diagnosis. Key words: Spondylitis, Ankylosing; Sacroiliac joint; X-rays; Tomography, X-ray computed; Magnetic resonance imaging

Should axial spondyloarthritis without radiographic changes be treated with anti-TNF agents?

A spectrum of disease extends beyond the rigid confines of ankylosing spondylitis (AS). Axial spondyloarthritis (axSpA) encompasses non-radiographic axSpA (nr-axSpA) in individuals without established radiographic changes but with other clinical/imaging axSpA features and AS in those with definite sacroiliac joint changes on pelvic X-rays. A broad consensus about the management of nr-axSpA is emerging among clinicians, but the evidence base remains open to question. To explore whether nr-axSpA and AS should be treated similarly, we examined the literature on their prevalence, natural history, disease burden, and treatment. There is strong evidence that nr-axSpA and AS are expressions of the same disease. Approximately 10% of patients with nr-axSpA will develop radiographic disease over 2years; after >20years, the figure may exceed 80%. Nr-axSpA patients have lower CRP and less spinal inflammation on MRI than AS patients but similar disease activity, pain, and quality-of-life impairment. Most patients with nr-axSpA manage well with conservative treatment, but a minority has severe disabling symptoms. Anti-TNF therapy has demonstrated similar efficacy and safety in nr-axSpA and AS. Current evidence does not clearly indicate that anti-TNF treatment can inhibit or limit bony progression of AS, the basis of conservative and anti-TNF treatment is control of symptoms and function. For some patients with nr-axSpA, the need for powerful treatments is as great as in some with AS; thus, treatment of axSpA should be consistent across the axSpA spectrum with anti-TNF agents being available, irrespective of radiographic change, according to the same criteria as those applied to AS.

Discordant inflammatory changes in the apophyseal and sacroiliac joints: serial observations in enthesitis-related arthritis.

To determine the extent to which inflammation of the sacroiliac joints (SIJs) and apophyseal joints (AJs) changes concordantly after treatment in enthesitis-related arthritis (ERA). A retrospective study was performed with institutional review board approval. 31 young patients with ERA who had been scanned between March 2009 and November 2014 were included. All patients had post-contrast imaging of the SIJs and lumbar spine and short tau inversion-recovery (STIR) images of the SIJs. The severity of sacroiliitis was scored using a modification of an established technique, and inflammation of the AJs was evaluated using a recently described grading system. The changes in SIJ and AJ scores after treatment were classified as either concordant or discordant, and the proportion of scan pairs in these groups was recorded. In addition, the correlation between change in SIJ STIR score (Δnfla) and change in AJ score (ΔAJ) was assessed using Spearman's correlation coefficient. Of a total of 43 scan pairs, the changes in inflammation were concordant in 16 scan pairs and discordant in 27 scan pairs. There was no significant correlation between Δnfla and ΔAJ (R = 0.14, p = 0.37). Inflammatory changes in the SIJs and AJs are often discordant. This may be a reason why patients experience ongoing back pain despite apparent improvement in one or the other site. Inflammation may behave differently at different anatomical sites. The SIJs and AJs should both be imaged in patients with ERA with back pain.