Sacroiliac Joint Involvement Research Articles

A Worthwhile Measurement of Early Vigilance and Therapeutic Monitor in Axial Spondyloarthritis: A Literature Review of Quantitative Sacroiliac Scintigraphy

Background: Back pain a common cause for hospital visits. Nuclear skeletal scintigraphy, at a high sensitivity, provides a functional imaging for detecting bone diseases. Sacroiliitis is an inflammation of the sacroiliac joint. Bone scan with quantitative sacroiliac scintigraphy (QSS) has been a useful inflammation indicator for sacroiliac joints. However, QSS has been ignored in the rehabilitation practice. Objective: To present the background, mechanisms, and current clinical applications of bone scan with QSS in spondyloarthropathy (SpA). Methods: The authors performed a literature review of QSS through database searching of MEDLINE, Embase, CINAHL, HaPI, Cochrane Review, and citation mining. Studies were included if they had QSS in the methodology performed in adult patients with various diseases. Any articles, including the authors’, that can be performed in a clinical setting were enrolled. Articles explicitly referencing QSS were retained for screening. Results: QSS appearance of SpA, including ankylosing spondylitis, may give rise to early detection. The specificity of sacroiliitis based on QSS increases from 73% to 97%. After investigating the relationship between serum C-reactive protein and sacroiliac joint inflammation in patients with SpA, there appeared to be a significant difference between serum C-reactive protein in serum and in sacroiliac ratio (particularly the middle part of the both joints), indicating a systemic inflammatory response to flair-up of SpA, for example, serum C-reactive protein as an indicator of inflammation. Sacroiliitis also occurs in post-streptococcal reactive arthritis. The involvement of sacroiliac joints in the development of post-streptococcal reactive arthritis had been demonstrated a significant correlation between anti-streptolysin O titres and QSS in patients with post-streptococcal reactive arthritis. Lower extremity periostitis acts as a human model in the study of bottom-up processing for periostitis-induced sacroiliac pain. The use of QSS can also monitor sacroiliac joint dysfunction before and after laser therapy. Improvements of the sacroiliac joint after convalescing of foot periostitis have been reported. Conclusions: Bone scan using QSS is a good screening measurement in scintigraphy rehabilitation for early detection of SpA and raises awareness of physicians toward the next step of diagnosis.

Prevalence of sacroiliac joint dysfunction in college students

Introduction and Aim: Sacroiliac (SI) joint is considered as one of the pain generators in students. Sacroiliac joint dysfunction is one of the common sources of low back pain, and many times the SI joint dysfunction mis-lead as the lumbar problem. Students who sit for longer duration cause stress in the sacroiliac joint. So, this study intended to investigate the prevalence and the contributing risk factors amongst students’ population with work-related musculoskeletal problems and also to identify the percentage of SI joint involvement in them.Materials and Methods: The study was conducted with 590 students from a private paramedical college, involving full time college students, with age group of 17-27 years, no recent falls or those not on current medications related to any musculoskeletal problems, and students without any congenital problems. Evaluation was done using Nordic musculoskeletal questionnaire along with a self-developed demographic questionnaire. The involved students were assessed using questionnaire and sacroiliac joint tests to identify the SI Joint dysfunction. Provocation tests included i) Sacroiliac joint distraction test, ii) SI Compression test iii) Thigh thrust test iv) Faber’s test and v) Gaenslen’s Test. Inference considered was presence of pain in more than 3 test indicates Sacroiliac joint involvement. On completion of assessment, a thank you card was given to all the volunteer students participated in the study. The collected data was filled and analyzed.Results: The study results showed that students with lower back pain also had complaints of neck pain. It was also noted that about 30% of the individuals were positive to the sacroiliac joint tests, among them 93 participants complained of low back pain.Conclusion: This study concluded that 61% of individuals were suffering with musculoskeletal disorders in the selected population. Around 30% of the low back pain participants complained of sacroiliac joint dysfunctions.

IMAGING OF ANKYLOSING SPONDYLITIS

Ankylosing spondylitis is among HLA-B27-associated diseases. Four common diseases of the HLA-B27- associated group include ankylosing spondylitis, inflammatory bowel disease, psoriatic arthritis and reactive arthritis. This group is characterized by ankylosis, new bone formation and is common in large joints. Ankylosing spondylitis often have bilaterally asymmetrical sacroiliac joint involvement. Diagnosis is based on clinical, HLA-B27 testing and imaging. Conventional radiography is the classic diagnostic criteria. Magnetic resonance has recently been included in the 2009 ASAS diagnostic criteria for early diagnosis.

Musculoskeletal Brucellosis in Adults in the United Arab Emirates: A Retrospective Study

Introduction: Brucellosis is a zoonotic infection caused by the aerobic Gram-negative bacteria coccobacilli, and is considered a public health problem in the Mediterranean region and Arabian Peninsula. This paper studied the clinical characteristics of musculoskeletal brucellosis and the outcomes of treatment in Al Ain City, United Arab Emirates. Method: A retrospective chart review study was conducted at Tawam Hospital over seven years: January 2009–January 2016. Risk factors for brucellosis, musculoskeletal (MSK) manifestations, duration of Brucella infection (acute, subacute, chronic), and treatment were studied. Results: A total of 99 patients were diagnosed with brucellosis during the study period; the mean age was 44 years, the majority were males (71%), and the male to female ratio was 3:1. The most common risk factor for Brucella infection in the cohort was drinking raw milk (43.4%). Fever was the most common presenting symptoms (93%), followed by arthralgia, fatigue, and loss of appetite in 35, 21, and 14%, respectively. The clinical manifestations of brucellosis in the cohort were MSK involvement (30%), hepatitis (17%), epididymo-orchitis (2%), and endocarditis (1%). Thirty percent of patients (n=30) had MSK-specific symptoms and only one-third (n=10) had confirmatory positive radiographic findings. The majority of patients had lumbar and sacroiliac joint involvement. Most of the patients received antibiotics for a 4–8-week duration and the overall relapse rate of Brucella infection was 10%. Conclusion: This study demonstrates that MSK involvement is a common manifestation in brucellosis, occurring in one-third of the cases. The index of suspicion should be high in brucellosis-endemic countries for early recognition and treatment.

POS1297 HOW HLA B27 PREVALENCE IN THE POPULATION INFLUENCE ON FEATURES OF JUVENILE IDIOPATHIC ARTHRITIS: DATA FROM SAKHA REPUBLIC (YAKUTIA)

Background:Sakha Republic (Yakutia) - SR(Y) is a bid arctic region of Russia with high proportion of aboriginals - Yakutians (50%), intra-national marriages, increased level of inbreeding and high distribution of HLAB27 among aboriginals – 33%, according the epidemiological studies. The main type of arthritis is ankylosing spondylitis in adults and enthesytis-related arthritis (ERA) of juvenile idiopathic arthritis (JIA) in children. The pattern of arthritis distribution in adults and children in SR(Y) is differ from Caucasians and similar to Native Americans.Objectives:Our study aimed to evaluate the features of JIA in aboriginals of SR(Y), associated with high prevalence of HLAB27 antigen.Methods:In the retrospective study we included 144 Yakutians who were admitted in the rheumatology department of Yakutsk in 2007-2016 years and 753 JIA patients Caucasian origin in Saint-Petersburg in the same years. We evaluated routine clinical and laboratorial features. HLA B27 was evaluated according the clinical judgement of the attending physicians.Results:ERA is a main JIA category in Yakutians. The main features the male predominance, higher onset age, high inflammatory activity, lower number of active joints, high incidence of hip and sacroiliac joints involvement, lower levels of psoriasis and uveitis. Yakutians have rare the involvement of cervical spine (6% vs 14%, p=0.0000001), TMJ (1% vs 6%, p=0.027), elbow (8% vs 16%, p=0.012), wrist (18% vs 28%, p=0.017), MCP (7% vs 21%, p=0.00005), PIP (8% vs 25%, p=0.00005). The treatment rates of methotrexate and biologics were similar between groups, but in Yakutians the biologics were administered earlier, because methotrexate failed and often was ineffective. The cumulative probability to receive biologics was higher in Yakutians compare to Caucasians: HR=3.4 [2.6; 4.4], p=0.000001 (Figure 1). The main biologic in Yakutians was etanercept (49/70; 70%). Yakutians received corticosteroids and cyclosporine A rarely, due to low incidence of systemic onset JIA and oligoarthritis with uveitis. It was observed, that the HLA B27 as a risk factors had different significance in Yakutians and Caucasians. HLA B27 presence increased the risk of ERA OR=2.72 (1.3; 5.6) p=0.01 in Yakutians and OR=69.2 (29.5; 162.3), p=0.00001 for Caucasians; for biologic administration: 0,86 (0,4; 1,8), p=0.529 and 2,45 (1,5; 4,0), p=0.0003, respectively.Figure 1.Cumulative probability to leave without biologics between Yakutian and Caucasian JIA patients.Conclusion:High distribution of HLA B27 antigene in Yakutians, lead to different pattern of JIA categories distributions and patient’s management.This work was supported by the Project of the Ministry of Science and Higher Education of the Russian Federation (basic part of funding to M.K. Ammosov North-Eastern Federal University #FSRG-2020-0016) and by the RFBR grant #18-05-600035_Arctika.Table 1.Differences between Yakutian and Caucasian JIA patients.JIA featuresYakutians, n=144 (%)Caucasians, n=723 (%)рGender, boys, n (%)85 (59.0)279 (38.6)0.000006Onset age, years10.6 (6.0; 13.4)6.0 (3.0; 10.3)0.0000001JIA categories, n (%)Oligoarthritis36 (25.0)188 (26.0)0.0000001Poly, RF (-)21 (14.6)248 (34.3)Poly, RF (+)1 (0.7)22 (3.0)Systemic onset4 (2.8)53 (7.3)ERA76 (52.8)171 (23.7)Psoriatic arthritis6 (4.2)41 (5.7)Active joints4.0 (3.0; 6.0)6.0 (3.0; 12.0)0.0000001Uveitis, n (%)16 (11.1)114/503 (22.7)0.002Psoriasis, n(%)3/143 (2.1)46/719 (6.4)0.043Hip involvement50 (34.7)146 (20.2)0.0001Sacroiliitis46 (31.9)69 (9.6)0.0000001HLA B27, n (%)76/131 (58.0)105/301 (34.8)0.00001ANA, n (%)4/46 (8.7)204/444 (46.0)0.00001RF, n (%)3/141 (2.1)22/403 (5.5)0.104Biologics, primary, n (%)70/144 (48.6)347 (48.0)0.892Time before first biologics, years0.6 (0.3; 1.4)2.6 (1.0; 5.4)0.0000001Disclosure of Interests:None declared

Sacroiliac joint involvement in ochronotic arthropathy.

Sacroiliac joint involvement in ochronotic arthropathy.

Magnetic resonance evaluation of sacroiliac joint involvement in Behçet’s disease: A cross-sectional study

Magnetic resonance evaluation of sacroiliac joint involvement in Behçet’s disease: A cross-sectional study

Comparative analysis and differentiation between SAPHO syndrome and spondyloarthropathies using whole-spine MRI

To determine the imaging characteristics of SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome and seronegative spondyloarthropathies (SpAs) on whole-spine magnetic resonance imaging (WS-MRI) and evaluate the role of WS-MRI in the diagnosis and differentiation of the two diseases. Twenty-eight patients with SAPHO and 44 with SpAs were included. All patients were symptomatic and clinically diagnosed with SAPHO or SpAs, and all underwent WS-MRI for comparison of imaging characteristics. The mean age of the SAPHO patients was 48.7±12.7 years, while that of the SpA patients was 34.7±12.3 years (p<0.001). WS-MRI showed that the frequency of cervical, thoracic, and lumbar spine involvement was 53.6% versus 52.3%, 75% versus 88.6%, and 60.7% versus 63.6%, respectively (p=0.70, 0.13, and 0.80). The frequency of sacroiliac joint involvement was 7.1% and 100% (p<0.001). Continuous spinal involvement accounted for 50% versus 43.2%, 60.7% versus 84.1%, and 39.3% versus 40.9% in the cervical, thoracic, and lumbar vertebrae, respectively (p=0.03). WS-MRI showed that bone marrow oedema of spinal anterior corner was observed in 50% versus 75% (p=0.03). Vertebral body and posterior attachment involvement accounted for 85.7% versus 93.2% and 14.3% versus 34.1% (p=0.3, 0.06). The frequency of bone erosion in mobile spine was 75% and 36.4%, respectively (p=0.02). The frequency of intervertebral disc, endplate, anterior thoracic wall, and paraspinal soft-tissue swelling was 42.9% versus 18.2%, 53.6% versus 22.7%, 85.7% versus 42.2%, and 50% versus 11.4% (p=0.02, 0.00). Factors differentiating the two groups at WS-MRI were bone marrow oedema of the spinal anterior corner, bone erosion, and swelling of the intervertebral disc, endplate, anterior thoracic wall, and paraspinal soft-tissue.

Significance of human leukocyte antigen-B27 expression in cases of reactive arthritis: A study in rural central India

Background: Reactive arthritis (RA), apart from presenting as an immune reaction to certain microorganisms, had also shown to have a genetic predisposition. Human leukocyte antigen (HLA-B27) is an allele of the HLA Class I molecules and its positivity in a person is shown to be a strong predictor of RA. The present study was aimed to study the significance of HLA-B27 positivity in clinical presentation and progress of RA in rural central India. Materials and Methods: One hundred rheumatoid arthritis factor seronegative patients of symptomatic RA were enrolled in the study. HLA-B27 was detected by flow cytometry method and patients were divided into two groups, each of 50 depending on HLA-B27 positivity and negativity as case and control groups. The patients were contacted on their follow-up visits and the clinical information and progress of the disease was assessed and correlated with HLA-B27 status. Results: About 74% in study group and 62% in control groups were males in RA (P = 0.001 and 0.0007, respectively). Study cases with HLA-B27 positivity showed many significant differences in their clinical presentation and disease severity and progression over the control cases (HLA-B27 negative). The mean duration of symptoms in the study group was 22.7 ± 31.26 and 12.98 ± 6.94 in control group. Severity of arthritic pain was more in study group as compared to control group (P = 0.0007). Study cases showed more axial skeletal involvement (P = 0.0002), enthesitis (P = 0.0001), and sacroiliac joint involvement (P = 0.0005). Clinical evaluation of back pain with different clinical tests in study cases showed more morning spinal stiffness (P = 0.0001), low Schober index (P = 0.001), higher lateral flexion (P = 0.0001), and lower chest expansion (P = 0.0001). The severity of disease in follow-up period increased significantly in 92% of patients in the study group despite initiation of clinical management of arthritis, while decreased in 60% of patients in the control group (P = 0.0001). Conclusion: HLA-B27-associated RA presents with significantly more severe primary disease and a rapid course of disease. Thus, HLA-B27 association should be done in all patients of RS and positive patients must be followed more rigorously to prevent many possible complications. To the best of our knowledge, this is the first study in central India to report the importance of HLA-B27 in patients of RA with regard to its management and prognosis.

Sacroiliac joint involvement in children with inflammatory bowel diseases.

Objective:Sacroiliitis (SI), an inflammatory arthropathy, may accompany pediatric inflammatory bowel diseases (IBDs), present with non- specific back pain, hence might be unnoticed. The aims of this study were to assess the frequency of the SI in children with IBD and determine the characteristics of the association of SI with the clinical hallmarks of the IBD.Methods:In this prospective, cross sectional study, twenty-seven children with IBD, 7–18 years of age were evaluated. Patients with low back pain or stiffness, alternating buttock pain, or hip pain were examined for the presence of SI. The radiologic manifestations on X-ray suggesting sacroilitis were confirmed with Magnetic resonance imaging (MRI).Results:Twenty-seven children (16 girls, female/male=1.45), with mean age of 12.55±3.6 years, of which 52% had ulcerative colitis (UC), 41% had Crohn’s disease (CD), and two had indeterminate colitis (IC). The median time from IBD diagnosis was 6.0 (18.0) months for patients with SI and 12.0 (13.5) months for patients without SI. Low back pain or stiffness was observed in 13 patients (48%). SI was present in eight (30%) of the children with IBD. The patients with CD were more prone to SI (45% of CD vs. 21% of UC patients). All patients with SI were negative for HLA-B27 genotyping. The disease activity and gender were not associated with increased risk for SI. MRI was remarkable for bone marrow edema in all of the patient, followed by erosions in six of them (75%), synovial enhancement observed in five (63%), and erosion associated enthesitis of the pelvic region was observed in two (25%) of the patients.Conclusion:SI may remain obscured in children with IBD. Children with CD are more prone to SI than those with UC. Pediatric rheumatology-pediatric gastroenterology collaboration might augment screening in at-risk patients.

Study of musculoskeletal manifestations in patients with inflammatory bowel diseases

ObjectiveThe aim was to study the involvement of sacroiliac joints, lower limb joints, and enthesis and to detect osteoporosis in patients with inflammatory bowel disease (IBD), and then to correlate them with disease activity in patients with ulcerative colitis (UC).BackgroundIBDs are systemic diseases that commonly display extraintestinal manifestations. Musculoskeletal involvement is one of the most common extraintestinal manifestations.Patients and methodsThis cross-sectional study included 50 patients with IBD who were evaluated for rheumatologic manifestations by clinical examination, laboratory, and radiologic studies such as musculoskeletal ultrasonography of lower limb entheses, digital radiographs of both sacroiliac and hip joints, and dual-energy X-ray absorptiometry scan for evaluation of osteoporosis.ResultsIn this study, we found that most patients had tenderness rather than swelling of joints (knee tenderness in 66% and swelling in 34%). Bilateral sacroiliitis was present in 78% of patients. The proximal patellar entheses were the most inflamed site followed by Achilles tendon entheses. UC disease activity was significantly related to knee, ankle, and entheseal swelling and sacroiliac tenderness. There was a highly significant positive correlation between UC disease activity and fecal calprotectin level and a nonsignificant negative correlation with dual-energy X-ray absorptiometry scan T-score.ConclusionMusculoskeletal manifestations are common in patients with IBD and should be studied clinically and radiologically by expert rheumatologist for early detection and management.

Sacroiliitis in systemic lupus erythematosus

Although musculoskeletal system involvement is awell-known manifestation in systemic lupus erythematosus (SLE), the probability of sacroiliac joint involvement and its effect on patients might be ignored. The aim of the study was to investigate the association between SLE and sacroiliitis and to evaluate the relationship between clinical parameters and sacroiliitis in SLE. The study was designed as acase-control study. A total of 63 patients with SLE and 31 age- and sex-matched healthy controls were included in the study. The clinical and demographic variables of the study population were documented. The sacroiliac joints of patients and controls were evaluated with sacroiliac magnetic resonance imaging. Human leukocyte antigen (HLA) B27 was assessed using flow cytometry (Beckman Coulter Navios-model 3, Beckman Coulter Inc., Brea, CA, USA). Multinomial logistic regression analysis was used to determine the clinical risk factors related to sacroiliitis. Among the 63patients, acute sacroiliitis was found in 25patients (39.7%) and chronic sacroiliitis was found in 21patients (33.3%). Sacroiliitis was higher in patients than in controls (p = 0.001). Acute sacroiliitis was more frequently observed in patients when compared with the control group (p = 0.001). Higher C‑reactive protein (CRP) concentrations (odds ratio = 1.75, 95% confidence interval: 1.30-2.35; p < 0.001) were found to be arisk factor for acute sacroiliitis. The ratio of sacroiliitis was higher in patients with SLE than in controls. Increased CRP concentrations were determined as arisk factor for acute sacroiliitis. Thus, one should keep in mind that patients with SLE and higher CRP concentrations may have sacroiliitis.

Juvenile Spondyloarthritis: focus on uveitis

BackgroundJuvenile spondyloarthritis (JSpA) represents a group of inflammatory arthritides with several distinctive features (enthesitis, involvement of spine and sacroiliac joint, HLA-B27 association and development of uveitis). There are limited data on the course of uveitis in children with JSpA.This study aims to estimate the prevalence of uveitis and to look at the presence of HLA-B27 in relation to uveitis occurrence and ocular symptoms in a cohort of JSpA patients.FindingsThis is a cross sectional/retrospective study involving patients with JSpA followed in a tertiary referral hospital.Two hundred twenty-three patients were enrolled in the study. The prevalent diagnosis was enthesitis-related arthritis (ERA) (62%) followed by juvenile psoriatic arthritis (PsA), undifferentiated arthritis (UA), and the arthropathies associated with inflammatory bowel disease (IBD-A) (18, 14, 6%, respectively).Uveitis was reported in twenty-four patients (11%) of the JSpA cohort (JSpA-U). ERA patients had the highest uveitis prevalence (ERA-U) (13%) with similar prevalences in UA, PsA and in IBD-A (7% each).The prevalence of HLA-B27 positivity was similar amongst the entire JSpA-U cohort (N = 22, 45%) and those with ERA-U (N = 8, 44%). The overall prevalence of symptomatic uveitis was 79%. Neither the likelihood of uveitis, nor of symptomatic uveitis, varied by HLA-B27 status either in the entire cohort nor in those with ERA.ConclusionsAbout one-tenth of patients developed uveitis, the majority of which was symptomatic. Fewer than half of the patients with uveitis were HLA-B27 positive. HLA-B27 status was not statistically associated with either the development of uveitis or symptomaticity of uveitis.

Prevalence of sacroiliitis and acute and structural changes on MRI in patients with psoriatic arthritis

Sacroiliac joint involvement is one of the earliest manifestations of psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) is a useful tool in the early diagnosis of axial disease due to its sensitivity for detecting acute and chronic changes associated with sacroiliitis. In this study, we evaluated the prevalence of sacroiliitis, acute and structural image changes on MRI in PsA patients and identified predictive clinical, laboratory and disease activity factors. Cross-sectional study on PsA patients submitted to MRI of the sacroiliac joints. The scans were evaluated by two blinded radiologists and the level of agreement was calculated (kappa). Clinical, disease activity and quality-of-life indices (DAS28, BASDAI, PASI, MASES, HAQ, CRP, ESR) were estimated. The sample consisted of 45 PsA patients with a mean age of 50.1 ± 11.5 years. The prevalence of sacroiliitis was 37.8% (n = 17), 47% of which was unilateral. The kappa coefficient was 0.64. Only 5 (29.4%) of the 17 patients with sacroiliitis on MRI had back pain. The most prevalent acute and chronic changes on MRI were, respectively, subchondral bone edema (26.7%) and enthesitis (20%), periarticular erosions (26.7%) and fat metaplasia (13.3%). CRP levels were higher among sacroiliitis patients (p = 0.028), and time of psoriasis was positively associated with chronic lesions (p = 0.006). Sacroiliitis on MRI was highly prevalent in our sample of PsA patients. Raised CRP levels were significantly associated with sacroiliitis, and longer time of psoriasis was predictive of chronic sacroiliitis lesions. Most sacroiliitis patients displayed no clinical symptoms.

Is axial magnetic resonance imaging useful in early juvenile spondyloarthritis-preliminary report.

Magnetic resonance imaging (MRI) is recommended for evaluation of changes in juvenile spondyloarthropathies (JSpA). To our knowledge, there is no previous prospective study analysing early changes on axial MRI. The objective is to investigate incidence of reparable changes on axial MRI in patients with established JSpA, lasting for less than 6months. The pilot study included 27 patients with confirmed diagnosis of JSpA examined within 2years. Prior to imaging, basic demographic and laboratory data and HLA-B27 were collected. Patients filled out a visual analogue scale for pain and a childhood health assessment questionnaire. A paediatric rheumatologist and a paediatric physiatrist examined patients and measured indices of flexion, extension and sagittal flexibility. Contrast-enhanced axial MRI examination and cervical x-ray were performed. Three experienced paediatric radiologists independently reviewed x-ray and MRI images of all patients. There was no significant correlation between early changes detected on MRI and other parameters. The study revealed early changes of the cervical spine to be the most common finding. More patients had positive cervical MRI than positive sacroiliac joint (SIJ) MRI. Cervical x-ray and MRI were equally useful for diagnosis regardless of other parameters. Study showed new information on axial involvement, striking cervical spine as the most involved part. The biggest study limitation is the small number of patients. Establishing early JSpA diagnosis is of utmost importance, especially in the light of novel therapy introduced in every day practice. It seems that cervical spine involvement is more represented than previously described in literature, especially in comparison with SIJ. Key Points • Contrast-enhanced MRI is considered the gold standard for detection early changes in JSpA. • Standardization of diagnostic criteria and better classification of changes using the unique scoring system for children are necessary. • It seems that cervical spine involvement is more represented than previously described in the literature, especially in comparison with SIJ involvement.

Post-traumatic arthritis of the sacroiliac joints mimicking inflammatory sacroiliitis: analysis of consecutive computed tomography examinations

To assess the presence, prevalence and characteristics of post-traumatic, inflammatory-like changes of the sacroiliac joint (SIJ) on pelvic computed tomography (CT). Sequential CT examinations from the acute (index) and follow-up post-traumatic periods of 24 patients that underwent pelvic trauma with SIJ involvement were evaluated and compared to 32 control patients with pelvic fractures that did not involve the SIJs. Index CT was evaluated for the presence of fracture, intra-articular step, and diastasis, whereas follow-up CT was scored for periarticular sclerosis, erosions, ankylosis, and backfill. Clinical follow-up was performed by pain provocation SIJ tests and a questionnaire (study representative subgroup, n=11, 46%) and from clinical files (control group, n=26, 31%). Pearson correlation coefficient was assessed between the index and follow-up CT variables. Linear regression was used to predict the influence of trauma variables on the development of inflammatory-like structural changes. Total "structural, arthritis-like lesions' score from the follow-up CT examination was significantly higher in the study compared to the control group (3.25 versus 0.05 respectively, p<0.001). The presence of intra-articular diastasis and fracture were significant risk factors for the development of structural inflammatory-like lesions in the SIJ (1.19 and 2.1 respectively, p<0.001). Painful SIJs by physical examination were found in 50% of the clinically evaluated subgroup which was mechanical by nature in 81.8%. Traumatic SIJ fracture or diastasis is associated with the development of post-traumatic SIJ structural inflammatory-like lesions on pelvic CT, mimicking sacroiliitis. These findings may be the result of focal, post-traumatic joint inflammation, which leads to mechanical rather than inflammatory symptoms.

Clinical and imaging characteristics of 110 patients with infectious sacroiliitis

Objective: To investigate the clinical and imaging characteristics of infectious sacroiliitis. Methods: A total of 110 patients diagnosed with infectious sacroiliitis were retrospectively analyzed between 2008 and 2017.Clinical manifestations and therapeutic responses, laboratory tests such as HLA-B(27), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), T cell spot test for tuberculosis infection(TB-SPOT), Brucella agglutination test ect., blood culture of pathogens, pathological findings as well as magnetic resonance imaging were all recorded and analyzed. Results: Among the 110 patients, the male to female ratio was 44 to 66 with an average age 15-58(29.4±10.8) years and the course of disease 0.3-60 (5.7±13.2) months. As to the pathogens, 71 cases were pyogenic, 24 cases with tuberculous sacroiliitis, and 15 cases were brucellosis infections. The majority of patients (97.3%) had unilateral sacroiliac joint involvement. Ten (9.1%) patients suffered infectious sacroiliac arthritis after delivery. Hip pain was the main clinical manifestation (83/110,75.5%) and fever as the second (77/110,70.0%). HLA-B(27) was positive in 11 patients (10.0%). Both ESR and CRP were elevated in the majority. There were 103 patients receiving sacroiliac joint puncture biopsy. Seven patients were diagnosed through blood culture or brucellosis agglutination test. Bone marrow edema and osteolytic lesions in magnetic resonance imaging (MRI) were more common in pyogenic or tuberculous sacroiliitis than in brucellosis infections. Conclusion: Infectious sacroiliitis should be differentiated from spondyloarthritis, which develops more in female patients, with short disease duration and fever, mostlynegative HLA-B(27). The majority patients present unilateral sacroiliitis. Active inflammatory lesions are usually beyond sacroiliac joints with osteolytic changes in MRI examinations.

Commentary: A rare co-occurrence of anti CCP-positive rheumatoid arthritis with sacroiliitis

Dear editor, I have read the case report titled, ‘A rare co-occurrence of anti CCP-positive rheumatoid arthritis with sacroiliitis’ written by Haridas et al. with great interest! 1 The authors have highlighted (though rare) the need to consider the involvement of sacroiliac joints (SIJs) in patients diagnosed with rheumatoid arthritis (RA), which can be considered as an atypical joint involvement of RA from their experience with this case. However, there certain clarifications are needed for the common readers, which I would like to highlight in this commentary.

Immunoglobulin G4-related disease, constitutional symptoms, human leukocyte antigen b27 positivity, and sacroiliitis

IgG4-related disease (IgG4-RD) is a relatively new clinical entity with protean manifestations that pose diagnostic difficulties especially so if the clinical features are atypical. Here we present a 55-year-old man with back-buttock pains, a knee and ankle arthritis with moderately severe constitutional symptoms. The acute phase reactants were high, and the test for HLA B27 was positive. Spondyloarthritis (SpA) was suspected but, because of the symptom-onset >45 years of age, infection and malignancy were also considered. Detailed investigations including a whole-body positron-emission tomography (PET) scan that showed hypermetabolic soft tissue thickening in the periaortic recess and at the base of the heart encasing root and ascending aorta. Fluorodeoxyglucose (FDG) uptake was also seen in the peripheral zones of the prostate, bilateral, parotid nodes, and in the right sacroiliac joint. A biopsy of the parotid gland nodule confirmed the diagnosis of IgG4-RD. The presence of features of inflammatory back-buttock pains, lower extremity oligoarthritis, good relief to non-steroidal anti-inflammatory drugs (NSAIDs), presence of HLA B27, and an acute involvement of the right sacroiliac joint were typical of spondyloarthritis. However, the moderately severe constitutional symptoms were not typical of SpA. Thus, this patient had both the IgG4-RD as well as SpA. Was the presence of HLA B27 incidental and the sacroiliitis was due to the infiltration of IgG4 cells or, he had true SpA with sacroiliitis and the IgG4 cell infiltration was incidental? This issue has been discussed in depth.

Spondyloarthropathy - Is sacroiliac joint imaging sufficient? A study of 431 patients.

Background:Sacroiliac (SI) joint involvement (sacroiliitis) is considered as major criteria for diagnosing Spondyloarthropathy (SpA), although involvement of spine and hip can also occur. The aim of our study was to assess the utility of including sagittal short-tau inversion recovery (STIR) sequence of dorsolumbar spine and coronal STIR/proton density (PD) fat saturated sequence through both hips, to routine SI joint magnetic resonance (MR) imaging protocol, in patients clinically suspected to have SpA.Material and Methods:A retrospective observational study was conducted between February 2013 and February 2018 on clinically suspected SpA patients referred to our department for imaging. The images obtained using this new SI joint protocol were evaluated for findings suggesting SpA diagnosis as per the Assessment of SpondyloArthritis international Society criteria. Other differentials for similar symptoms were also looked for.Results:Of the 431 patients (313 M and 118 F), 255 had features confirming the diagnosis of SpA and 176 had no radiological manifestations of SpA (56 were normal and 120 had other findings to suggest clinical symptoms; e.g., degenerative SpA, Pott's spine, skeletal metastases, early AVN of hip, cysticercus, iliofemoral impingement). 19/255 patients had normal SI joints but other findings to suggest diagnosis of SpA, e.g. romanus lesions, costovertebritis/costotransversitis, pubic symphysitis, inflammatory hip arthropathy, enthesitis, iliofemoral/trochanteric bursitis. 33/61 patients with chronic sacroiliitis had disease activity in spine or hip.Conclusion:Inclusion of sections through dorsolumbar spine and both hips to routine SI joint protocol, helped in identifying: (a) early disease in 19 patients, who had normal SI joints and may have otherwise been missed with routine only SI joint imaging, (b) additional findings in SpA-related sacroiliitis, (c) disease activity in chronic sacroiliitis, and (d) other causes of low back pain and thus helped in further patient management.