Imaging Of Sacroiliac Joints Research Articles

Clinical significance of bone mineral density in Ankylosing Spondylitis patients: Relation to disease activity and physical function

Aim of the workThe aim of this work was to assess the bone mineral density (BMD) in Ankylosing Spondylitis (AS) patients and to investigate its relation with clinical and laboratory parameters, imaging of sacroiliac joints, disease activity and physical function. Patients and methods44 patients were recruited from the Rheumatology outpatient clinic of the Kasr El-Aini Hospital, their mean age was 33±8.7years. Twenty age and sex matched subjects were included as controls. Dual energy X-ray absorptiometry (DEXA) was performed for the patients and control. Disease activity and physical function were assessed using the Bath AS Disease Activity Index (BASDAI) and Bath AS Functional Index (BASFI), respectively. ResultsThe T-scores of the spine, hip and forearm were lower in patients compared to controls. Low BMD was more found among patients with chronic sacroiliitis. There were significant negative correlations between chin to chest and occiput to wall distance and BMD at the hip and forearm (both p<0.05). The BMD at the spine showed a significant correlation with the BASDAI (p=0.008) and BASFI (p=0.03). There was no correlation between BMD at any site and patients’ age, disease duration, inflammatory back pain duration, modified Schöber’s test, finger-to-floor test and laboratory parameters. ConclusionThe BMD was remarkably decreased at all measurement sites in AS patients. The BMD at the spine significantly negatively correlated with the disease activity and physical function. Bone loss in AS can be explained partly by the role of inflammatory mediators and partly as a consequence of reduced physical activity.

SAT0390 Axial Involvement in Early Psoriatic Arthritis: Magnetic Resonance Imaging and X-RAY of Sacroiliac Joints, Inflammation Back Pain and Hla-B27

BackgroundEarly psoriatic arthritis (EPsA) is predominantly peripheral spondyloarthritis (SpA), but certain patients (pts) may have axial involvement with inflammatory back pain (IBP) and sacroiliitis (SI). Active inflammation of sacroiliac joints...

THU0401 The Frequency of Sacroiliitis and Spondylarthritis in Patients with Sarcoidosis

BackgroundSarcoidosis is a chronic granulomatous disease, which can involve different organs and systems. It can mimic or co-exist with various primary rheumatic diseases. Coexistence of sarcoidosis and spondyloarthritis has been...

Leukocytoclastic Vasculitis in a Patient with Ankylosing Spondylitis

A 26-year-old male patient presented to our rheumatology clinic with pain, swelling and limitation of movement in his right ankle, and also purpuric skin lesions in the lower extremity pretibial region. He was asked questions, and he said that he had been having chronic low back pain and morning stiffness for the last few years. His physical examination revealed that he had arthritis in his right ankle, purpuric skin lesions in pretibial regions of both legs, and bilateral FABERE/FADIR positivity. The sacroiliac joint imaging and MRI revealed bilateral sacroiliitis findings, and the lateral heel imaging revealed enthesitis. HLA-B27 was positive. Skin biopsy from lower skin lesions was reported to be consistent with leukocytoclastic vasculitis. Based on clinical, laboratory, radiological, and pathological examinations, the patient was diagnosed with ankylosing spondylitis and leukocytoclastic vasculitis. Administration of corticosteroid, salazopyrin, and nonsteroid anti-inflammatory medications was started. Notable clinical and laboratory regression was observed during his checks 3 months later.

The prevalence of sacroiliitis and spondyloarthritis in patients with sarcoidosis.

Introduction. Sarcoidosis is a chronic granulomatous disease, which can involve different organs and systems. Coexistence of sarcoidosis and spondyloarthritis has been reported in numerous case reports. Purpose. To determine the prevalence of sacroiliitis and spondyloarthritis in patients previously diagnosed with sarcoidosis and to investigate any possible relation with clinical findings. Materials and Methods. Forty-two patients with sarcoidosis were enrolled in the study. Any signs and symptoms in regard to spondyloarthritis (i.e., existence of inflammatory back pain, gluteal pain, uveitis, enthesitis, dactylitis, inflammatory bowel disease, and psoriasis) were questioned in detail and biochemical tests were evaluated. Sacroiliac joint imaging and lateral heel imaging were performed in all patients. Results. Sacroiliitis was found in 6 of the 42 (14.3%) sarcoidosis patients and all of these patients were female. Common features of the disease in these six patients were inflammatory back pain as the major clinical complaint, stage 2 sacroiliitis as revealed by radiological staging, and the negativity of HLA B-27 test. These six patients with sacroiliitis were diagnosed with spondyloarthritis according to the criteria of ASAS and of ESSG. Conclusion. We found spondyloarthritis in patients with sarcoidosis at a higher percentage rate than in the general population (1–1.9%). Controlled trials involving large series of patients are required for the confirmation of the data.

Comparison of the effects of rituximab, tumor necrosis factor alpha inhibitors and non-steroidal antiinflammatory drugs on ankylosing spondylitis clinical activity and sacroileitis intensity on magnetic resonance imaging

Aim. To investigate the effect of rituximab in ankylosing spondylitits on disease activity and on intensity of sacroileitis detected by magnetic resonance imagigng compared to tumor necrosis factor alpha inhibitors and non-steroidal anti-inflammatory drugs. Methods. The study included 91 patient [14 (15.4%) females, 77 (84.6%) males, mean age - 34.4±9.13 years, disease duration - 6.6±3.8 years] with established diagnosis of ankylosing spondylitits. The main group included 20 patients (17 males, mean age 36.9±9.9 years) who were treated with rituximab. The comparison group included 36 patients (30 males, mean age 34.3±8.6 years) treated with tumor necrosis factor alpha inhibitors. The control group consisted of 35 patients (30 males, mean age 33.4±9.3 years) treated with non-steroidal anti-inflammatory drugs and sulfasalazine. Disease activity was measured by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDASESR (Ankylosing Spondylitis Disease Activity Score) scores before the treatment initiation, at the 2nd, 8th, 16th and 24th weeks of treatment. Magnetic resonance imaging of sacroiliac joints was performed before the treatment initiation and at the 24th week of treatment, T1 and STIR sequences were analyzed. Results were processed using the SPARCC (Spondyloarthritis Research Consortium of Canada) scoring methodology. Results. There was a significant reduction of the disease clinical activity measured by BASDAI score (from 6.19±1.48 to 3.70±0.91, p 0.01) and ASDASESR score (form 3.43±0.72 tо 2.11±0.46, p 0.01) in patients treated with rituximab at the week 24. Mean SPARCC score reduced from 15.9±7.2 to 4.6±8.2 (p 0.01). The influence of rituximab on clinical activity of the disease was superior over the effect of the standard treatment (BASDAI and SPARCC scores 5.22±1.14 and 7.8±7.1 accordingly at the week 24, p 0.05), but inferior over the effect of tumor necrosis factor alpha inhibitors (BASDAI and SPARCC scores 2.03±0.64 и 4.9±7.0 accordingly at the week 24, p 0.01). Conclusion. Anti B-cell therapy is effective in treating active ankylosing spondylitis and leads to the decrease of the clinical symptoms intensity and disease activity measured by BASDAI и ASDASESR scores. The effect of rituximab was superior over the effect of non-steroidal anti-inflammatory drugs and sulfasalazine and inferior over the effect of tumor necrosis factor alpha inhibitors.

Association of biomarkers of inflammation, cartilage and bone turnover with gender, disease activity, radiological damage and sacroiliitis by magnetic resonance imaging in patients with early spondyloarthritis

To assess the association between biomarkers of inflammation, cartilage and bone turnover with gender, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Spondylitis Disease Activity Score (ASDAS) and bone marrow oedema in resonance magnetic imaging (MRI) of sacroiliac joints (SIJs) and radiological damage in early spondyloarthritis (SpA). Cross-sectional study of 60 patients (56.7 % females; mean age, 32.4 years) with early SpA. Sociodemographic data, clinical features, serum matrix metalloproteinase 3 (MMP-3), high sensitivity C-reactive protein (hsCRP), C-terminal cross-linking telopeptides of type I collagen (CTX-I) and urinary deoxypyridinoline, ASDAS, BASDAI, BASFI, BASRI and MRI of the SIJs were collected. The mean (SD) disease duration was 12.4 (6.8 months). Twenty-two (68.7 %) of the 32 patients had active sacroiliitis by MRI. MMP-3 and CTX I correlated with swollen joint (r = 0.515, r = 0.386, p = 0.01). hsCRP correlated with ESR (r = 0.303, p = 0.05), with CRP (r = 0.455, p = 0.01) and with total BASRI (r = 0.95, p = 0.05). Biomarkers were unrelated with the rest of variables. Levels of MMP-3 (44.3 ± 52.4 vs 24.7 ± 33.4, p < 0.05) and CTX-I (0.53 ± 0.45 vs 0.24 ± 0.38; p < 0.05) were higher in men. Our study shows that CTX-I and MMP-3 are a marker of peripheral disease activity in early SpA. Male gender had higher levels of CTX-I and MMP-3, which may indicate higher disease activity. Higher hsCRP levels trended towards correlation with more baseline radiographic damage. Therefore, these biomarkers may help identify a subgroup of patients who will need closer monitoring and more intensive treatment.

PC0007 Inflammatory low back pain features at primary care

BackgroundLow back pain is among the most frequent reasons for seeking medical care. Low back pain (LBP) of inflammatory origin deserves special interest as it can be a manifestation of...

AB0721 Magnetic resonance imaging of sacroiliac joints in early polyarthicular peripheral psoriatic and rheumatoid arthritis (remarca investigation)

BackgroundActive sacroiliitis (SI) by magnetic resonance imaging (MRI) has been proposed as an important symptom of early spondyloarthritis (SpA) and would be helpful for the distinction between perhypheral polyarthicular psoriatic...

Diagnostic imaging of sacroiliac joints and the spine in the course of spondyloarthropathies.

SummarySpondyloarthropathies belong to a group of rheumatic diseases, in which inflammatory changes affect mainly the sacroiliac joints, spine, peripheral joints, tendon, ligaments and capsule attachments (entheses). This group includes 6 entities: ankylosing spondylitis, arthritis associated with inflammatory bowel disease, reactive arthritis, undifferentiated spondyloarthropathy, psoriatic arthritis and juvenile spondyloarthropathy.In 2009, ASAS (Assessment in SpondyloArthritis international Society) association, published classification criteria for spondyloarthropathies, which propose standardization of clinical-diagnostic approach in the case of sacroiliitis, spondylitis and arthritis.Radiological diagnosis of inflammatory changes of sacroiliac joints is based on a 4 step radiographic grading method from 1966. According to modified New York criteria, the diagnosis of ankylosing spondylitis is made based on the presence of advanced lesions, sacroiliitis of at least 2 grade bilaterally or 3–4 unilaterally. In case of other types of spondyloarthropathies diagnosis is made based on presence of at least grade 1 changes.In MRI, active inflammation of sacroiliac joints is indicated by the presence of subchondral bone marrow edema, synovitis, bursitis, or enthesitis.ASAS discusses only the classic form of axial spondyloarthropathies, which is ankylosing spondylitis. To quantify radiological inflammatory changes in the course of the disease, Stoke Ankylosing spondylitis classification Spinal Score (SASSS) is recommended. The signs of inflammation and scarrying of the spinal cord in the course of ankylosing spondylitis, present in MRI include: bone marrow edema, sclerosis, fat metaplasia, formation of syndesmophytes, and ankylosis.

Erosions Are the Most Relevant Magnetic Resonance Imaging Features in Quantification of Sacroiliac Joints in Ankylosing Spondylitis

To determine the most relevant radiological features in quantitative magnetic resonance imaging (MRI) of sacroiliac (SI) joints in patients with recent-onset ankylosing spondylitis (AS) versus patients with SI involvement due to other rheumatic diseases, or to degenerative SI pain. We retrospectively analyzed laboratory values, clinical data, and MRI of the SI joints of 179 patients admitted for evaluation of AS-suspicious SI pain. Standardized MRI sequences were performed at time of first presentation, then archived, and retrospectively quantitatively assessed using a modified SPARCC method for formal statistical comparisons. Of all patients, 27 (15%) were diagnosed with definite AS. The remainder had SI involvement in other rheumatic diseases, HLA-B27- spondyloarthropathy, or nonspecific degenerative changes. While joint space irregularities, bone marrow edema, subcortical cysts, and contrast medium enhancement were found in MRI of all patients, these features were inconsistent, and only erosions were statistically significantly (p < 0.02) in patients diagnosed with AS. Only in AS, the presence of erosions and the quantitative SPARCC erosion subscore correlated to a statistically significant degree (p < 0.02) with laboratory levels of inflammation. Erosions alone, not bone marrow edema or contrast medium enhancement, are the most disease-specific measurable imaging findings in SI MRI of patients with AS.

Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group

Background:Magnetic resonance imaging (MRI) of sacroiliac joints has evolved as the most relevant imaging modality for diagnosis and classification of early axial spondyloarthritis (SpA) including early ankylosing spondylitis.Objectives:To identify and...

Magnetic resonance imaging of sacroiliac joints in patients with seronegative spondyloarthritides

Objective. To study diagnostic possibilities of magnetic resonance imaging (MRI) of sacroiliac joints (SIJ) in pts with seronegative spondyloarthritides (SS). Material and methods. MRI and radiological examination was performed in 15 pts: 10 with ankylosing spondylitis (AS) and 5 with undifferentiated SS. MRI was done with Magnetom Symphony apparatus (Siemens, Germany) with magnetic-field strength 1,5 tesla. Tl, T2 and T2-FS weighted were used. Tl-FS weighted performed in 3-4 minutes after intravenous infusion of gadolinium were additionally used in 5 pts. Inflammatory and structural (erosions, subchondral sclerosis) MRI changes of SIJ were studied. Inflammatory changes of SIJ were analyzed in subchondral bone, bone marrow, joint capsule, joint cavity, interosseous ligaments. SS activity was assessed with BASDAI. Results. Median age of pts was 24 years, median SS duration — 3 years. HLA-B27 was revealed in 13 from 15 pts. All pts had radiological signs of sacroiliitis: 13 - bilateral (12 - II or III stage and 1 — I and III stage according to Kellgren), 2 — unilateral (II stage). So radiological signs of inflammation were revealed in 28 from 30 examined SIJ. MRI signs of sacroiliitis were present in the same 28 SIJ. Subchondral edema of sacrum and/or huckle-bone was revealed in 23 SIJ of 13 pts, bone marrow edema — in 20 SIJ of 13 pts, joint cavity edema - in 21 SIJ of 14 pts, capsule edema — in 12 SIJ of 8 pts, interosseous ligaments inflammation signs — in 3 SIJ of 2 pts. Inflammatory changes of all 5 examined anatomic structures were present in 1, 4 — in 9, 3 — in 13 SIJ. In 1 SIJ inflammation was localized in capsule only. Structural changes were revealed in 22 (73%) SIJ of 14 pts. Structural MRI changes of SIJ at II radiological stage of sacroiliitis were noted in 67% and at III stage — in 83%. Combination of inflammatory and structural changes was present in 22 from 30 SIJ (73%). Frequency of such combination was similar at different radiological stages of sacroiliitis. Isolated inflammatory signs without structural changes were present in 3 SIJ of 3 pts. Gadolinium administration allowed to reveal 5 additional edema zones in SIJ region of 4 from 5 pts. Inflammatory changes of SIJ were revealed with similar frequency in presence (81%) or absence (88%) of pain in this region. Pts with high (BASDAI>40) or not high (BASDAK40) general activity of the disease had about the same mean number of SIJ inflammatory changes (7,6 and 7,8 respectively). Conclusion. MRI is highly sensitive method for revealing SIJ changes in pts with SS. Inflammatory MRI changes were present in all joints with radiological changes irrespectively from radiological stage.

Occurrence of sacroiliitis in patients with seronegative oligoarthritis

The aim of this study was to investigate sacroiliitis in patients with seronegative oligoarthritis. Thirty consecutive patients with seronegative oligoarthritis and no other signs of spondylarthropathy were included. Sacroiliac (SI) joints were investigated by both radiography and magnetic resonance imaging. HLA B27 antigen was studied and family history was reexamined in 2006. Five patients had sacroiliitis. Additionally, 15 patients had HLA B27 antigen or family history of either psoriasis or ankylosing spondylitis. Our conclusion is that during the first decade of seronegative oligoarthritis, HLA B27 antigen, family history, and especially imaging of SI joints reveal in two thirds of the patients the spondylarthritic nature of their disease.

Effect of imaging time on the values of the sacroiliac index.

Quantitative scintigraphy of the sacroiliac joints was performed in a group of normal subjects and a group of subjects with unilateral and bilateral sacroiliitis. The aim of the study was to determine whether the time intervals of imaging had any effect on the values of the sacroiliac index. Imaging was performed every 30 min up to 300 min and the indices were calculated at the time intervals mentioned. We found that the values of the sacroiliac index increased in the group of normal subjects until 150 min after the application of the radiopharmaceutical, and that in the group of subjects who had sacroiliitis they increased until 210 min. The results show that the time interval optimal to quantitative sacroiliac joint imaging is at least 3 1/2 h after administration of the radiopharmaceutical.

Influence of age on quantitative sacro-iliac joint imaging.

Computer processing of sacro-iliac (S-I) joint scintigrams represents a significant contribution to the diagnostic workup of this area. The S-I index is calculated as the ratio between the total number of counts in the region of interest placed on the S-I joint and an identical region placed on the sacrum. S-I indexes were determined in a group of 70 patients aged 13-77 years to establish the influence of age on normal index values. Our results indicate that S-I index values are age dependent. The study was performed 2 h post-injection but the possibility exists that this is not the optimal time interval.

An improved method for sacro-iliac joint imaging: A study of normal subjects, patients with sacro-iliitis and patients with low back pain

A new method is described for quantitative measurement of the uptake of 99mTc--methylene diphosphonate (MDP) by the sacro-iliac joints. The method uses 'regions of interest' providing advantages over the previously described 'slice' method; the two methods are compared in normal subjects, patients with known sacro-iliitis and patients with low back pain. Sacro-iliac activity, as calculated by the sacro-iliac index (SII) in normal patients, was shown to decrease with age in females but not in males. The SII was compared with radiographs of the sacro-iliac joints in the patients with known sacro-iliac joint disease and in those with low back pain. The method is useful for the exclusion of sacro-iliitis as a specific cause of back pain.