Sacroiliac Joint Involvement Research Articles

Prevalence of Sacroiliac Joint Involvement in Patients with Sickle Cell Disease

Prevalence of Sacroiliac Joint Involvement in Patients with Sickle Cell Disease

Retrospective Evaluation of Pediatric Patients Hospitalized with Brucellosis: Single Center Study in Istanbul

Aim: Brucellosis is a zoonotic disease and mainly develops as a result of consuming products of infected animals such as cattle, sheep and pigs. Material-Methods: Pediatric patients under the age of 18 who were hospitalized with a diagnosis of brucellosis in a third-level city hospital were included in the study. Serology titer ≥1:160 and/or Brucella spp in blood culture growth was determined as the diagnostic criterion for the diagnosis of brucellosis. Results: Of the 35 pediatric patients diagnosed with brucellosis, 22 were boys and 13 were girls, and the average age was determined as 154.2 ± 53.1 months (25-214). Hospital admission complaints were determined in order of frequency as follows; joint pain (51.4%), fever (31.4%), headache (17.1%) and abdominal pain (5.2%). Eleven of the patients (31.4%) had polyarthralgia and 7 (20%) had monoarthralgia. The most common physical examination findings were hepatomegaly (48.6%) and splenomegaly (40%), respectively. Joint involvement was detected in 17.1% of the patients. Sacroiliac joint involvement was reported in 3 (8.6%) patients, ankle joint involvement in 2 (5.7%) patients, and knee joint involvement in 1 (2.9%) patient. Anemia (60%) was the most common hematological finding. The average hemoglobin value was determined as 12.5±1.44 (10.2-15.9) g/dl. When patients are compared in terms of joint involvement; neutrophil count and treatment duration were found to be statistically higher in patients with joint involvement (p<0.05). Conclusion: Brucellosis is a zoonotic disease that is endemic in our country, affects all age groups, and can cause complications and relapses, and continues to be a serious public health problem for our country.

Spine and Sacroiliac Joint Involvement in Newly Diagnosed Patients With Inflammatory Bowel Disease: Clinical and MRI Findings From a Population-Based Cohort.

In patients with inflammatory bowel disease (IBD), co-occurring spondyloarthritis (SpA) leads to poorer outcomes and impaired quality of life, highlighting the importance of early detection and effective treatment. This is the first study to assess the prevalence and distribution of axial symptoms and magnetic resonance imaging (MRI)-detected involvement of the spine and sacroiliac joints (SIJs) in early IBD. Newly diagnosed patients with IBD from a prospective, population-based cohort were consecutively recruited. Rheumatological interview, clinical, ultrasound, and MRI assessment for SIJ and spine inflammatory and structural lesions were made using validated scoring methods and consensus definitions of axial SpA (axSpA). Of 110 patients (ulcerative colitis: 70, Crohn's disease: 40, mean age of 42 years, and 40% male), 48 (44.9%) reported back and/or buttock pain, and 10 (9.1%) had inflammatory back pain. Seventeen (16.7%) patients had MRI findings indicative of axSpA; only 10 of these patients had axial symptoms. Inflammatory MRI lesions were present in SIJs and the spine of 27 (26.5%) and 30 (30.3%) patients, respectively. The Assessment of SpondyloArthritis International Society classification criteria for axSpA were met in 11 (10%) cases. MRI findings typical of axSpA were associated with peripheral joint and entheseal inflammation detected by ultrasound ( P = 0.04). No differences in clinical or imaging findings were found between patients with ulcerative colitis and Crohn's disease. One-in-6 newly diagnosed patients with IBD had MRI findings indicative of axSpA. As 40% of these patients were asymptomatic, this suggests that axSpA is underdiagnosed in early IBD. Multidisciplinary collaboration is essential to ensure early detection of axial inflammation and to enable optimal therapy preventing future structural damage and disability.

Sacroiliitis in familial Mediterranean fever: A rare joint involvement of the disease.

Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disease characterised by recurrent episodes of fever and polyserositis. Sacroiliac joint involvement is rare in FMF patients. The purpose of this study was to evaluate the demographic, clinical, laboratory and imaging findings of patients with FMF who developed sacroiliitis. The files of paediatric patients aged 0-18 years who were followed up with a diagnosis of FMF were retrospectively reviewed. FMF patients with evidence of sacroiliitis on magnetic resonance imaging (MRI) were included in the study. Among 1062 FMF patients, 22 (12 males; median age 8.5) (2.1%) of them were found to have sacroiliitis. FMF was diagnosed before sacroiliitis in nine (40.9%) patients and after in 13 (59.1%) patients. The most common symptom in patients with sacroiliitis was low back pain (n = 21, 95.5%). In MEFV gene analysis, M694V was found in 16 (72.7%) patients and was the most common mutation. MRI showed evidence of sacroiliitis in all patients. All patients were using colchicine. Patients with FMF-associated sacroiliitis, remission was achieved with non-steroidal anti-inflammatory drugs in 12 (54.5%), conventional disease-modifying antirheumatic drugs in six (27.3%) and tumour necrosis factor inhibitor treatment in four (31.8%). Four (31.8%) patients experienced sacroiliitis when colchicine incompatible and four (31.8%) patients experienced sacroiliitis while using biologic agents for colchicine-resistant FMF. FMF-associated sacroiliitis should be considered especially in patients with M694V mutation if they have symptoms such as low back pain. Colchicine-resistant FMF patients should be evaluated for sacroiliitis symptoms at each visit.

The relationship between sacroiliac joint MRI scores and central sensitization in axial spondyloarthritis: A cross-sectional study

ABSTRACT Objective: To investigate the relationship between sacroiliac joint (SIJ) involvement and central sensitization (CS) in patients with axial spondyloarthritis (axSpA). Patients and Methods: Twenty-four patients with axSpA were included in this study. CS was investigated via pressure pain threshold (PPT), temporal summation (TS), conditional pain modulation (CPM), and the central sensitization inventory (CSI). Sacroiliac joint involvement was assessed using the magnetic resonance imaging (MRI)-based Canadian Spondyloarthritis Research Consortium (SPARCC) scoring system. CS-related parameters and SPARCC score correlations were analyzed. Results: The median (IQR) sacroiliac PPT score for the right SIJ was calculated as 17.47 (4.43) and 17.67 (4.57) for the left SIJ. In the TS measurement, the right SIJ TS median (IQR) value was calculated as 4.0 (3.5) and 4.0 (2.75) for the left side. The median (IQR) value was 149.67 (107.5) for CPM and 45.0 (27.75) for CSI. The median (IQR) sacroiliac inflammation score was calculated as 3.0 (8.75), and the median (IQR) structural score was calculated as 7.0 (11.5). No correlation was found between SPARCC scores and PPT, TS, CPM, and CSI values. Conclusion: In axSpA patients, there was no association observed between pain sensitivity measures and sacroiliac involvement. Further comprehensive studies are required, taking into account the complex nature of CS.

Interventional diagnosis and treatment methods of discogenic and musculoskeletal low back pain

Low back pain (lumbar pain) is one of the most common causes of disability in the population. In cases where conservative treatment of discogenic or musculoskeletal low back pain does not have a positive effect, interventional methods of diagnosis and treatment are used, which are developing actively on the background of rapid technological progress. Being on the border of interdisciplinary interaction, interventional methods can significantly shorten the duration of conservative therapy and, in many cases, avoid surgical decompressive interventions, which are associated with a considerable risk of complications. The methods, efficacy and safety of epidural administration of glucocorticoids for discogenic radiculopathy and lumbar stenosis as well as the methods of radiofrequency denervation for musculoskeletal pain due to the facet joints and the sacroiliac joint involvement are discussed. The possibilities of drug therapy for musculoskeletal pain of the lumbar spine, and combination of non-steroidal anti-inflammatory drugs and a vitamin B complex, are discussed.

Study of thyroid disorders in ankylosing spondylitis patients on anti-tumor necrosis factor treatment

Abstract: BACKGROUND: Ankylosing spondylitis (AS) is a systemic rheumatic disease characterized mainly by involvement of sacroiliac joints and axial skeleton. Tumor necrosis factor-alpha (TNF-α) inhibitors are biologic agents which are Food and Drug Administration approved to treat AS and also act as a key factor in the treatment of autoimmune thyroid disease. OBJECTIVE: This study aimed to evaluate the thyroid gland disorders (functions and thyroid autoantibodies) in AS patients on anti-TNF-α biologics and their relation to disease activity. PATIENTS AND METHODS: This comparative cross-sectional study included 75 AS patients classified into two groups: Group I: treated with NSAIDs (n = 30) and Group II: treated with anti-TNF-α biologics (n = 45). Thyroid function tests, thyroid autoantibodies, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and human leukocytic antigen B27 were measured. AS disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Metrology Index (BASMI) scores. Thyroid ultrasonography was used to detect any thyroid gland nodularity and echogenicity. RESULTS: There were significant differences between both groups regarding BASDAI (P = 0.005), CRP (P = 0.005), thyroid-stimulating hormone (TSH) (P = 0.001), and anti-thyroid peroxidase (anti-TPO) (P = 0.007). A significant difference was found regarding the thyroid status, with more normal thyroid and more hyperthyroid patients in the anti-TNF-treated group (P = 0.003). There were statistically significant positive correlations between BASDAI and CRP (P = 0.007), TSH (P = 0.004), and thyroid anti-TPO antibody (P = 0.008) in the anti-TNF-treated patients. By ultrasound examination of the thyroid gland, 75.6% of the anti-TNF group had normal thyroid gland compared to 56.6% of the other group, and the reported nodules were mostly of benign TIRADS classification. Comparing different subgroups of thyroid nodularity with different treatment regimens revealed significant differences in BASDAI and different laboratory investigations in favor of the anti-TNF-treated patients. CONCLUSION: From this cohort study, we can conclude that thyroid autoimmune disease and thyroid nodules in AS patients can be controlled by treatment with anti-TNF-α biologic drugs better than NSAIDs alone.

Total hip arthroplasty for neglected bed ridden case of ankylosing spondylitis - A case report

Ankylosing spondylitis (AS) is a disabling condition right from the involvement of spine and sacro-iliac (SI) joint. In severe form it involves hips, knees and other bigger joints which further compromises their posture and limits their mobility. Total Hip Arthroplasty (THA) is often a viable option in such cases to manage pain and restore function and mobility. We present a neglected bed ridden case of AS who underwent THA and after proper surgical and medical rehabilitation became mobile and independent.

Effectiveness of tumor necrosis factor inhibitors in children with enthesitis-related arthritis: a single-center retrospective analysis.

In children with enthesitis-related arthritis (ERA), the hip and sacroiliac joint function might be impaired if not properly treated. We sought to evaluate the effectiveness of anti-tumor necrosis factor-α (TNF-α) therapy using the inflammatory indicators, Juvenile Arthritis Disease Activity Score 27 (JADAS27) and magnetic resonance imaging (MRI). We conducted a single-center retrospective study of 134 patients with ERA. We evaluated the effect of anti-TNF therapy on the inflammatory indicators, active joint count, MRI quantitative score, and JADAS27 over 18 months. We used the Spondyloarthritis Research Consortium of Canada (SPARCC) and the Hip Inflammation MRI Scoring System (HIMRISS) scoring systems for hip and sacroiliac joints scoring. The average age of onset of children with ERA was 11.62 ± 1.95 years, and they were treated with disease-modifying antirheumatic drugs (DMARDs) combined with biologics (n = 87, 64.93%). There were no differences in HLA-B27 positivity between the biologics and non-biologics treatment groups [66 (49.25%) vs. 68 (50.75%), P > 0.05]. Children who received anti-TNF (71 received etanercept, 13 adalimumab, 2 golimumab, and 1 infliximab) therapy improved significantly. Children with ERA used DMARDs and biologics at baseline (Group A) were followed up to 18 months, and their active joint count (4.29 ± 1.99 vs. 0.76 ± 1.33, P = 0.000), JADAS27 (13.70 ± 4.80 vs. 4.53 ± 4.52, P = 0.000) and MRI quantitative scores (P = 0.001) were significantly lower than those at baseline. Some of the patients (n = 13, 9.70%) were treated with DMARDs at the onset of the disease, but did not show significant improvement (Group B). After 6-18 months of switching to anti-TNF therapy, related indicators of the children were significantly lower than at baseline and 1 month (P < 0.013). At 18 months, a total of 33 patients (n = 74, 44.59%) in Group A and 7 (n = 13, 53.85%) in Group B reached inactive state. Eighteen months after diagnosis, anti-TNF therapy was found to be effective in children diagnosed with ERA. MRI is important for the early diagnosis of juvenile idiopathic arthritis. TNF-α inhibitors can significantly improve the clinical manifestations of sacroiliac joint and hip involvement in patients with ERA. Overall, the real-world study provides more evidence for precision diagnosis and treatment for other hospitals, families and patients.

Sacroiliac joint involvement in ochronotic spondylosis

Sacroiliac joint involvement in ochronotic spondylosis

Osteoarticular Involvement in Childhood Brucellosis: Evaluation of Clinical, Laboratory and Radiologic Features of 185 Cases.

Brucellosis is a systemic zoonotic disease. Osteoarticular (OA) system involvement is a common complication and the predominant manifestation of brucellosis in children. We aimed to evaluate the epidemiologic, demographic, clinical characteristics, and laboratory and radiologic findings of children with brucellosis and how these related to OA involvement. This retrospective cohort study consisted of all consecutive children and adolescents diagnosed as having brucellosis who were admitted to the pediatric infectious disease department of University of Health Sciences Van Research and Training Hospital between August 1, 2017, and December 31, 2018, in Turkey. A total of 185 patients diagnosed as having brucellosis were evaluated, 50.8% had OA involvement (n = 94). Seventy-two patients (76.6%) exhibited peripheral arthritis involvement, among of them, hip arthritis (63.9%; n = 46) was the most common manifestation, followed by arthritis of knee (30.6%; n = 22), shoulder (4.2%; n = 3) and elbow (4.2%; n = 3). A total of 31 patients (33.0%) had sacroiliac joint involvement. Seven patients (7.4%) had spinal brucellosis. Erythrocyte sedimentation rate level above 20 mm/h at admission and age were independent predictor of OA involvement (respectively odds ratio [OR] = 2.82; 95% confidential interval [CI] = 1.41-5.64, OR peryear = 1.10; 95% CI: 1.01-1.19). Increasing age was associated types of OA involvement. A half of brucellosis cases had OA involvement. These results can help physicians to make early identification and diagnosis of childhood OA brucellosis who present with arthritis and arthralgia to enable the disease to be treated in time.

Sacroiliac joint involvement in osteochondromatosis: identifying its prevalence and characteristics from cross-sectional imaging

Apart from a few case reports, sacroiliac joint (SIJ) involvement in osteochondromatosis has not been studied. We aimed to determine the prevalence and characteristics of such involvement using cross-sectional imaging. In this retrospective study, three observers (one junior radiologist and two musculoskeletal radiologists) independently reviewed computed tomography (CT) or magnetic resonance imaging (MRI) of patients in our database who had osteochondromatosis (≥2 osteochondromas across the skeleton) for SIJ involvement. The final decision was reached by the consensus of the two musculoskeletal radiologists in a later joint session. Of the 36 patients with osteochondromatosis in our database, 22 (61%) had cross-sectional imaging covering SIJs (14 females, 8 males; age range 7-66 years; mean age 23 years; 13 MRI, 9 CT). Of these, 16 (73%) had intra-articular osteochondromas. For identifying SIJ osteochondromas on cross-sectional imaging, interobserver agreement was substantial [κ = 0.67; 95% confidence interval (CI): 0.34, 1.00] between the musculoskeletal radiologists and moderate (κ = 0.59; 95% CI: 0.23, 0.94) between the junior radiologist and the final consensus decision of the two musculoskeletal radiologists. In the cohort with cross-sectional imaging, the anatomical variations of the accessory SIJ (n = 6, 27%) and iliosacral complex (n = 2, 9%) were identified in six different patients with (n = 2) and without (n = 4) sacroiliac osteochondromas. Cross-sectional imaging shows frequent (73%) SIJ involvement in osteochondromatosis, which, although a rare disorder, nevertheless needs to be considered in the differential diagnosis of such SIJ anatomical variants as the accessory SIJ and iliosacral complex. Differentiating these variants from osteochondromas is challenging in patients with osteochondromatosis.

Does Late Axial Spondyloarthropathy Diagnosis Cause Extra Anti-TNF Therapy?

Introduction: Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease that mainly characterized by sacroiliac joint and spine involvement. Although there is no clear evidence that any of these agent prevent the radiologic progression, anti-TNF drugs provide significant improvements in the disease activity score, functional index and quality of life. In AS patients, knowledge of the factors that determine the need for anti-TNF treatment will be associated with fewer complication sand better treatment. The purpose of this study is to investigate the possible factors which willmark the transition to the anti-TNF therapy in AS patients. Materials and Methods: This study was conducted in the Rheumatology division of the Internal medicine department of the Ondokuz Mayis University of Medicine hospital between January 2012- June 2015. The study protocol was approved by the Ethics Committee of Ondokuz Mayis University. A total of 165 patients, who were diagnosed as AS according to the ASAS classification criteria, were enrolled in this study. There were 85 women (51.5%) and 80 men (48.5%), aged between 15-69. Patients were divided into two groups according to their use of anti-TNF drug. Results: A total of 165 Ax-SpA patients (85 women and 80 men) were included in the study. The mean age was 37.82±11.24 years. The mean duration of the disease was 4.59±5.35 years. male gender, uveitis, delay in diagnosis, elevations in sedimentation CRP levels, increase in disease activity and functional indexes such as BASDAI and BASFI scores shows the more frequent need for anti-TNF drug use. Conclusion: In our study, patients who needed anti-TNF treatment had a longer time between symptom onset and diagnosis than patients who did not hear. The delay in diagnosing these patients leads to a delay in treatment so that the focus of inflammation increases and these patients need more anti-TNF as this window of opportunity escapes.

Evaluation of Respiratory Rehabilitation in Patients with Ankylosing Spondylitis

Abstract Ankylosing spondylitis (AS) (spondylos = vertebra, ankylos = curved) is an inflammatory disease with predominant axial skeletal involvement and obligatory sacroiliac joint involvement, capable of affecting, with varying frequency and severity, peripheral joints and may also have extra-articular determinations. The main motivation of this study is the desire to demonstrate that there is a close relationship between respiratory muscle performance and exercise capacity in patients with ankylosing spondylitis. The methodological approach of the study consisted of a group of 21 patients. Statistical analysis was based on patient characteristics such as age, weight, height, body mass index, and thoracic expansion was measured. For the correct individualization of rehabilitation programs, the clinical form (with thoracic hyperkyphosis or straight spine), the age of the disease, the peripheral joints affected, the stage of injury, the degree of reducibility of the vicious attitudes, the impairment of thoracic breathing, the type of occupational spinal demands, the general condition and associated diseases will be taken into account. The results obtained proved that the application of respiratory physiotherapy procedures, based on the diagnosis, needs and limitations of the patients, correlated with tests to evaluate the quality and effectiveness of the recovery process, shows an increase in abdominal muscle strength that is not statistically significant. The 2-week rehabilitation cure is insufficient to modulate respiratory function and increase respiratory muscle strength. The subjective appreciation given by patients to the cure is due to other physiological changes produced by the rehabilitation cure such as: softening of connective and muscle structures, muscle relaxation.

Results of ELBRUS clinical non-interventional study

Objective: non-interventional study ELBRUS (Etoricoxib in the Treatment of Back Pain) was conducted to investigate the efficacy and safety of daily administration of Rixia® (Etoricoxib) 60 mg per day in patients with chronic non-specific low back pain (CNSLBP).Patients and methods. The study included 50 patients (31 women and 19 men, mean age 54.3±16.8 years) with CNSLBP. Educational conversation, cognitive therapy, regular therapeutic exercises, identification and treatment of comorbidities were conducted. Patients received etoricoxib 60 mg once daily. Pain intensity was assessed on a 10-point numerical rating scale (NRS), pain-related disability was assessed on the Oswestry Scale (ODS), and emotional state was assessed on the Hospital Anxiety and Depression Scale (HADS).Results and discussion. The causes of CNSLBP were: in 5 (10%) patients – sacroiliac joint involvement, in 14 (28%) – lower lumbar facet joints involvement, in 3 (6%) – myofascial pain, the remaining 28 (56%) patients had a combination of several reasons. As a result of complex treatment, the intensity of pain at rest decreased on average from 4.0±2.5 to 1.4±1.3 points, while moving – from 6.6±1.9 to 2.8±1.8 points, at night – from 2.7±2 to 0.7±0.9 points according to the NRS, disability – from 39±18.9 to 19.9±14.6% according to the ODS, the severity of anxiety – from 6.5±3.9 to 3.3±2.4 points and depression from 5.0±3.7 to 3.1±2.9 points according to HADS (p&lt;0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib. Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted. Keywords: chronic nonspecific low back pain, non-steroidal anti-inflammatory drugs, etoricoxib, Rixia®&gt;˂0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib.Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted.

Utility of selected sequence MRI imaging of the axial skeleton in the diagnosis of axial spondyloarthritis

BackgroundWhole body MRI has been used to evaluate inflammatory lesions associated with axial spondyloarthritis (SpA). These sequences are extensive, time consuming and add to the cost of the investigation. We aimed to determine the utility of selected sequence MRI imaging of the axial skeleton including spine, pelvis and sacroiliac (SI) joints to identify features of (SpA). MethodsA retrospective study was conducted on 76 patients diagnosed with SpA that underwent a selective sequence MRI imaging of the axial skeleton. The MRI were reported by two musculoskeletal trained radiologists were reviewed. The MRI sequences included whole spine sequences of sagittal STIR (short tau inversion recovery), T1 weighted and T2 weighted sequences. Coronal STIR and T1 weighted images were studied for SI joints and pelvis. The MRI were assessed based on the guidelines outlined by the Assessment of SpondyloArthritis International Society (ASAS) for features of spondylitis, spondylodiscitis, enthesitis, synovitis, capsulitis, bone marrow edema, fatty marrow replacement, erosions and bony ankylosis. Inflammatory lesions were documented in the spine, sacroiliac, facet, hip and costovertebral joints. ResultsThe mean scan duration was 28 min. SI joint involvement was noted in 74 (97.3%) of patients. The other most prevalent findings were spondylitis in 44 (57.8%) patients, costovertebral joint involvement in 31 (40.7%), facet joint lesions in 32 (42.1%), spondylodiscitis in 21 (27.6%), enthesitis in 13 (17.1%), hip lesions in 16 (21%) and ankylosis in 10 (13.1%). ConclusionsThis selective sequence imaging of the pelvis and spine was able to identify typical lesions of SpA in a shorter time period. Fifty-five percent patients had lesions in the posterior elements including facet joints and costovertbral joints that would be missed on traditional SI joint imaging.

X-linked Rickets with Inflammatory Sacroiliitis-like Presentation: A Case Report and Literature Review

Background: Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presentations is sacroiliac joint involvement, which may be mistaken for inflammatory spondylitis. Discussion: Here, we report the case of a 31-year-old African American woman who presented with a 2-year history of lower back pain and morning stiffness initially suspected to be due to inflammatory spondyloarthritis. Laboratory tests revealed negative inflammatory markers, normal serum calcium, vitamin D3, and parathyroid hormone level: - However, alkaline phosphatase levels were elevated and serum phosphorus level was low. MRI of the lumbosacral spine revealed mild widening of the sacroiliac joint with periarticular sclerosis. Her condition was attributed to a known diagnosis of X-linked hypophosphatemic rickets affecting her sacroiliac joints. Her symptoms gradually improved after conservative treatment with physical therapy, NSAIDs, phosphate and vitamin D supplementations. Based on our literature review, we have come across only five rickets cases with similar presentations. Two paints previously undiagnosed hypophosphatemic rickets at 14 and 35 years, respectively. One case was related to vitamin D-deficient rickets, and the final two cases were adult-onset vitamin D-resistant rickets misdiagnosed as ankylosing spondylitis. Radiological signs of sacroiliac joint involvement in these cases include narrowing of the sacroiliac joints, fusion of the sacroiliac joints, subchondral hypointense signal changes, and chondral surface irregularities. Conclusion: Vitamin D supplementation significantly reduce the incidence of rickets; however, there are still cases of familial rickets that can present with a variety of symptoms, including signs and symptoms consistent with inflammatory spondylitis, which can be easily misdiagnosed or mistreated if this presentation is not recognized.

Parallel Line Sign-A New MRI Sign Associated With Chronic Sacroiliitis: Prevalence, Characteristics, and Associations.

Purpose: The purpose is to demonstrate the existence of the parallel line sign (PLS), a dark line parallel to the sacroiliac joint (SIJ), and determine its prevalence, characteristics, and associations. Methods: 200 consecutive SIJ MRIs referred by rheumatologists were retrospectively reviewed for the presence of the PLS. Presence and extent of imaging features of sacroiliitis (bone marrow edema, fatty infiltration, erosions, sclerosis, and ankylosis) were evaluated. Results: Prevalence of PLS was 11.5% (23/200), with 9 subjects having bilateral PLS, resulting in 32 SIJs showing a PLS. Every PLS involved the synovial portion of the SIJ, and almost all (31/32, 96.9%) involved the iliac (rather than sacral) side of the SIJ. Every PLS occurred with at least one established imaging feature of sacroiliitis. Presence of a PLS was associated with higher prevalence of erosions (78.3% vs 36.7% in those without PLS, P < .001), greater extent of SIJ involvement by erosions (3.6 ± 1.3 vs 2.3 ± 1.1 quadrants of the SIJ involved, P < .001), and higher density of erosions per centimeter (88.9% vs 46.2% with >2 erosions/cm, P = .001). There was higher prevalence of bone marrow edema, fatty infiltration, and sclerosis in those with PLS compared to those without PLS (P = .001, P < .001, and P = .006, respectively). Extent of involvement by any of these features was not significantly different between the two groups (P = .22, P = .16, and P = .46, respectively). Conclusions: The PLS is associated with imaging features of chronic sacroiliitis, especially erosions. Knowledge of the existence of the PLS may help avoid misdiagnosis of an insufficiency fracture and increase confidence in the diagnosis of sacroiliitis.

Juvenile spondyloartropathies.

Juvenile spondyloarthropathies (JSpA) are defined as a heterogeneous group of diseases that start before the age of 16, which is associated with peripheral joint (especially large joints of the lower limbs) and axial skeletal (spine and sacroiliac joint) involvement, enthesitis, and human leukocyte antigen (HLA) B27 positivity. Juvenile spondyloarthropathies mainly cover juvenile ankylosing spondylitis (JAS), psoriatic arthritis, reactive arthritis, inflammatory bowel disease-associated arthritis, seronegative enthesopathy, arthropathy syndrome (SEA), and enthesitis-associated arthritis. Symptoms associated with spondyloarthropathies are enthesitis, inflammatory low back pain, dactylitis, nail changes, psoriasis, acute anterior uveitis, and inflammatory bowel disease-related symptoms. In JSpA, axial involvement is rarely seen in the early stages of the disease, in contrast to adult patients with ankylosing spondylitis (AS). The disease usually begins as asymmetric oligoarthritis of lower extremities in children, and axial skeletal involvement can occur in the course of the disease. Although the debate on the classification of juvenile spondyloarthropathies continues due to its initial nonspecific findings and the heterogeneity of the disease phenotype, the International League of Associations Rheumatology (ILAR) classification criteria are the most commonly used pediatric criteria. In that set of criteria, patients with JSpA are mainly classified under enthesitis-related arthritis or psoriatic arthritis group. Since juvenile spondyloarthropathies can cause severe loss of function and long-term sequelae, the main goal in treatment should be suppression of inflammation as early as possible and prevent sequelae.

High-Frequency Spinal Cord Stimulation for Pain Management in Refractory Ankylosing Spondylitis: A Case Report

Background: Ankylosing spondylitis (AS) affects men more than women and commonly results in chronic back pain with spine and sacroiliac joint involvement. Case Report: The patient is a 53-year-old man with a 25-year history of worsening AS. After not responding to available conservative therapies and not qualifying for back surgery, the patient underwent a 10-kHz high-frequency spinal cord stimulation (HF10 SCS) trial. After a successful trial without complications, permanent implantation was pursued with subsequent one-week postoperative outcomes demonstrating Visual Analog Scale score reductions of 87.5% in back pain and 50% in leg pain, an Oswestry Disability Index score decrease of 83%, and overall improvement in previously problematic health concepts on the EuroQol-5 Dimensions-3 Levels and 36-Item Short Form version 2 surveys. Conclusions: This report highlights the successful use of Senza’s SCS system applying Nevro’s HF10 therapy in a patient with refractory symptoms of AS, highlighting potential applications of this technique which have yet to be studied. Key words: Ankylosing spondylitis, high-frequency spinal cord stimulation, chronic pain, back pain, case report