Unilateral Sacroiliitis Research Articles

Added Advantages of DWI MR Imaging and ADC Mapping in the Diagnosis of Active Sacroiliitis of Axial Seronegative SpA

Aim: To evaluate the effectiveness of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping in diagnosing active sacroiliitis in patients with axial seronegative spondyloarthropathy (SpA). Material and Methods: This prospective study comprised 26 patients with MR imaging detected active sacroiliitis categorised as a case group, and compared them with healthy controls. ADC value measurements were obtained from the sacral and iliac sides of the bilateral S.I. joints in each case and control group. Independent samples t-test, Chi-square test, and ROC curve analysis were used. Result: Twenty-six patients had active sacroiliitis in 45 S.I. joints, unilateral active sacroiliitis was observed in seven patients (26.9%), bilateral symmetrical in three patients (11.5%) and bilateral asymmetrical in 16 patients (61.5%). The mean ADC value was 1.447 ± 0.528 [SD] × 10–3 mm 2 /s in the right S.I. joint and 1.630 ± 0.441 [SD] × 10–3 mm 2 /s in the left S.I. joint in active sacroiliitis (case group). The mean ADC value of the right S.I. joint was 0.965 ± 0.123 [SD] × 10–3 mm 2 /s and the left S.I. joint was 0.967 ± 0.96 [SD] × 10–3 mm 2 /s in inactive sacroiliitis (control group). A significant difference was observed statistically between the active sacroiliitis and the inactive sacroiliitis with a P < .0005. A cut-off mean ADC value of 1.034 ×10–3 mm 2 /s was obtained for differentiating active sacroiliitis from inactive sacroiliitis with a sensitivity of 84.6% and specificity of 84.6% from the ROC curve analysis. Conclusion: Diffusion-weighted MRI imaging with ADC value mapping acts as a sensitive diagnostic technique in the detection of active sacroiliitis in axial seronegative spondyloarthropathies and also helps in assessing the treatment response.

Successful Radiofrequency Ablation of L4 and L5 Dorsal Rami for Unilateral Sacroiliitis: A Case Report

In this case report, we present the successful treatment of a 67-year-old man with chronic sacroiliac joint pain and left unilateral sacroiliitis observed on computed tomography using L4 and L5 dorsal rami radiofrequency ablation.

Ankylosing Spondylitis and Right Lower Limb Lymphoedema A Rare Association: A Case Report and Review of the Literature

Introduction: Ankylosing spondylitis or rheumatic pelvispondylitis is a chronic inflammatory rheumatism characterized by an axial localization predominantly in the spine and sacroiliac joints, an involvement of the entheses and a tendency to bone ankylosis by ossification of these entheses. We report an observation of right lower limb lymphedema associated with ankylosing spondylitis. Observation: This was a 63-year-old patient with a history of inflammatory rheumatism (his older sister) and osteoporosis (his mother), He was diagnosed with ankylosing spondylitis based on enthesis involvement (bilateral tilted gluteal pain and low inflammatory back pain) with a positive HLA-B27 antigen by the 8-point Amor criteria for spondyloarthritis (right unilateral sacroiliitis, low inflammatory back pain, bilateral tilted gluteal pain, HLA-B27+ and NSAID sensitivity). The unilateral lymphedema with positive Stemmer's sign affected the lower 2/3 of the right lower limb. It occurred one year after the onset of ankylosing spondylitis. The echo-Doppler scan showed no signs of thrombosis or venous infiltration of the lower limbs, and diffuse infiltration of the subcutaneous tissue of the right leg without inflammatory character. Treatment of ankylosing spondylitis gradually improved the lymphedema. Conclusion: Lymphedema is a rare complication of ankylosing spondylitis. Dermatologists should be alert to early swelling of the extremities in patients with ankylosing spondylitis so as not to delay specific multidisciplinary treatment and measures to avoid irreversible lymphatic damage.

Клинический случай дебюта гистиоцитоза из клеток Лагерганса под маской ревматологического заболевания

A pediatrician faces with the differential diagnosis of oncological, oncohematological diseases which could have rheumatological "masks". According to medical literature, the most important symptoms are the joint pain at night, diffuse bone pain and organomegaly. Among the laboratory markers of oncological/oncohematological diseases the most important are bi-/trilineage cytopenia, high level of ESR, LDH, uric acid; including in the differential diagnosis of the neoplastic process in the detection of unilateral sacroiliitis without damage of other joints is necessary. The clinical case of a patient with Lagerhans cell histiocytosis is presented for differential diagnosis with the debut of spondyloarthritis for increasing the alertness of pediatricians and rheumatologists in children with musculoskeletal pain. Key words: Lagerhans cell histiocytosis, juvenile idiopathic arthritis, juvenile ankylosing spondylitis

Long‐term outcome of infectious sacroiliitis due to Pasteurella multocida in a dog

AbstractA 6‐month‐old, male German shepherd dog was presented with a 2‐week history of left pelvic limb lameness. Physical examination revealed severe left pelvic limb lameness, lumbosacral and left pelvic limb pain. Magnetic resonance imaging showed heterogeneous T2‐weighted hyperintensity, T1‐weighted hypointense with marked contrast enhancement in the left sacroiliac joint, consistent with unilateral sacroiliitis. Computed tomography was used to perform image‐guided arthrocentesis and also revealed an irregular left sacroiliac joint. Infectious sacroiliitis, caused by Pasteurella multocida, was confirmed by culture of the synovial fluid of the sacroiliac joint. Infectious sacroiliitis should be considered as a differential diagnosis for young dogs presented with pelvic limb lameness and pain.

Clinical aspects of HLA-B27 positive enthesitis-related arthritis in childhood

Introduction: Enthesitis-related arthritis (ERA) is a form of juvenile idiopathic arthritis (JIA) according to the International League Against Rheumatism (ILAR) classification. Enthesitis-related arthritis accounts for 8.6 to 18.9% of all children with JIA. The first clinical sign of ERA is usually asymmetrical arthritis of large joints, especially of the lower extremities. Axial involvement is typically presented by unilateral or bilateral sacroiliitis. Enthesopathy is a unique feature of ERA. Aim: The aim of this study is to determine the most common clinical characteristics in children with HLA-B27 positive ERA. Materials and Methods: We performed a retrospective analysis of 55 patients up to 16 years of age, diagnosed with HLA-B27 positive ERA. We used physical and laboratory tests as well as imaging techniques to assess various clinical aspects of ERA in every patient. Results: Demographic characteristics showed prevalence of male gender—44 boys vs. 11 girls (4:1 ratio). The mean age of onset was 13.3 years for boys and 9.9 years for girls. The most commonly affected joints were as follows: knees in 49% of the cases, ankles—in 43.6%, hip joints—in 36.3%, intertarsal/metatarsophalangeal joints—in 20%. Physical examination found enthesitis in 24 of the patients (43.6%). The most commonly affected entheses were: the site of attachment of the Achilles tendon in 66.6% of the cases, the site of attachment of the plantar fascia in 45.8%, the site of attachment of the patellar tendon in 12.5%. Plain X-ray of the sacroiliac joints detected sacroiliitis in 34 of the patients (61.8%). In over 90% of the cases, the sacroiliitis was bilateral. Conclusion: HLA-B27 positive ERA is a rare pathology in childhood. This study confirms typical epidemiological and clinical characteristics of the disease among Bulgarian children.

Brucellosis sacroiliitis masquerading as inflammatory spondyloarthropathy

Brucellosis is the most common zoonosis globally, and it is endemic to the Indian subcontinent. It can mimic a number of febrile illnesses and inflammatory disease conditions. An 18-year-old boy presented with low back pain and a fever of three-month duration. Magnetic resonance imaging revealed a unilateral sacroiliitis, which was being treated as an inflammatory spondyloarthropathy. Because of non-resolving symptoms, a biopsy was performed, which showed a granulomatous inflammation that was consistent with tuberculosis or brucellosis infection. A history of exposure to livestock and consumption of unpasteurized milk led to a clinical suspicion of brucellosis, which was confirmed on a positive serology. He was treated with antibiotics with improvement in symptoms and complete resolution of the sacroiliitis. A high index of suspicion must be maintained for brucellosis, especially in patients with a rural residence, exposure to livestock, and febrile illness with a clinically suspected unilateral sacroiliitis.

Magnetic resonance imaging (MRI) evidence of sacroiliitis in skin psoriasis patients: Relation to disease severity

BackgroundPsoriasis is a disease of autoimmune imbalance in a genetically susceptible individual. It has a wide range of mild to severe cases. On the contrary to cutaneous affection which attracts the patient attention to seek medical help, articular affection can have a delayed diagnosis. Aim of the workThis study aimed to detect radiologic evidence of sacroiliitis in psoriasis patient not under treatment for articular disease. Patients and methodsTwenty skin psoriasis patients participated in the study. None had been previously diagnosed with articular manifestations related to psoriasis. Imaging of the sacroiliac joint by magnetic resonance imaging- Short TI inversion recovery technique (MRI- STIR technique) was ordered for all patients. The presence of bone marrow edema in T2 weighted image was considered diagnostic of active sacroiliitis. Psoriasis areas and severity index (PASI) score was used to assess skin psoriasis severity. ResultsPatients were 11 female and 9 males with mean age of 31 ± 5.7 years and mean disease duration of 6.9 ± 3.1 years. The mean PASI score was 19.5 ± 5.2. Clinical sacroiliitis was detected in 25% of patients, plantar fasciitis in 35% and Achilles tendinitis in one patient (5%). MRI with STIR technique was positive for unilateral sacroiliitis showing bone marrow edema in 3 (15%) patients; one male and two females. There was no association between PASI score and presence of radiologic sacroiliitis. ConclusionRadiologic sacroiliitis is not uncommon in skin psoriasis patients not known to have articular involvement and was not related to the skin disease severity.

POS0037 DOES IMAGING OF THE SACROILIAC JOINT DIFFER IN PATIENTS PRESENTING WITH UNDIAGNOSED BACK PAIN AND PSORIASIS, ACUTE ANTERIOR UVEITIS, AND COLITIS: AN INCEPTION COHORT STUDY

Background:Axial spondyloarthritis (axSpA) presents diagnostic challenges incurring a delay of up to a decade and relies considerably on radiographic and MRI evidence of sacroiliitis which has led to the development of classification criteria which also rely on imaging. However, it has been suggested that such criteria may not be appropriate for axSpA patients presenting with other forms of SpA, especially psoriatic, because imaging features may vary in frequency and/or may be atypical. This hypothesis has never been tested in a prospective inception cohort of patients presenting with undiagnosed back pain.Objectives:We aimed to compare the spectrum of radiographic and MRI abnormalities in the sacroiliac joint (SIJ) of an inception cohort of patients presenting with undiagnosed back pain and psoriasis, iritis, and colitis.Methods:We used data from the prospective multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study, which is aimed at early detection of axial SpA in patients referred by the respective specialist after first presenting with these disorders. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, AAU, or colitis undergo routine clinical evaluation by a rheumatologist for axial SpA followed by imaging. In SASPIC I, MRI evaluation of the SIJ was ordered per rheumatologist decision. In SASPIC II, MRI evaluation was ordered for all patients. Radiographs and MRI scans were assessed by two central readers and comparisons of the three groups were based on concordant assessments of imaging features. Evaluation of MRI scans included both global assessment for presence/absence of axSpA with confidence scale (-10 to +10), active and structural lesions typical of axSpA per recent ASAS definitions, and granular assessment of individual lesions according to SIJ quadrants and halves in consecutive semicoronal slices through the SIJ. Groups were compared by ANOVA and the chi-square test.Results:A total of 240 patients were recruited, 143 from SASPIC I and 97 from SASPIC II, 101 (42.1%) being diagnosed with axSpA (65.3% male, mean age 34.4 years, mean symptom duration 8.7 years, B27 positive 55.4%). Mean age of colitis (N=101), psoriasis (N=61), iritis (N=78) patients were 33.4, 36.6, 34.3 years, respectively, mean symptom duration was 6.8, 7.2, 9.4 years, respectively, and % males were 45.5%, 52.5%, 51.3%, respectively. There were no significant group differences for unilateral versus bilateral radiographic sacroiliitis and no significant differences in the frequencies, type, or distribution of MRI lesions (Table 1).Conclusion:Data from the SASPIC prospective inception cohort does not support the view that imaging of the SIJ differs in psoriatic axSpA, which appears similar to axSpA associated with iritis or colitis. These data support the umbrella concept of axSpA.Imaging FeatureColitis (n=30)Psoriasis (n=19)Iritis (n=52)P valueUnilateral sacroiliitis (grade ≥2), N(%)1 (3.3%)0 (0%)2 (3.8%)0.69mNY criteria +, N(%)5 (16.7%)6 (31.2%)15 (28.8%)0.39Grade of sacroiliitis, mean(SD)1.8 (2.2)2.1 (2.7)2.2 (2.4)0.76MRI indicative of axSpA, N(%)15 (50.0%)11 (57.9%)32 (61.5%)0.60MRI indicative of axSpA (confidence ≥5/10), N(%)14 (46.7%)10 (52.6%)30 (57.7%)0.63MRI active lesion typical of axSpA, N(%)6 (20.0%)6 (31.6%)18 (34.6%)0.37MRI structural lesion typical of axSpA, N(%)11 (36.7%)7 (36.8%)18 (34.6%)0.98MRI with unilateral lesion (any)2 (6.7%)3 (15.8%)11 (21.2%)0.22MRI with unilateral lesion (BME)1 (3.3%)2 (10.5%)5 (9.6%)0.54MRI with unilateral lesion (Erosion)0 (0%)0 (0%)3 (5.8%)0.23MRI with unilateral lesion (Sclerosis)1 (3.3%)1 (5.3%)3 (5.8%)0.89MRI with unilateral lesion (Fat)0 (0%)0 (0%)0 (0%)NAMRI with iliac lesion17 (56.7%)12 (63.2%)32 (61.5%)0.88MRI with sacral lesion12 (40.0%)11 (57.9%)31 (59.6%)0.21Disclosure of Interests:Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, BMS, Boehringer, Galapagos, Gilead, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, Ulrich Weber: None declared, Jon Chan: None declared, Raj Carmona: None declared, James Yeung: None declared, Sibel Aydin: None declared, Jodie Reis: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Olga Ziouzina: None declared, Dianne Mosher: None declared, Stephanie Keeling: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert: None declared.

Effect of tofacitinib treatment on active MRI sacroiliitis in psoriatic arthritis patients

Axial involvement in psoriatic arthritis is quite common. There is no data on the use of tofacitinib, an oral Janus kinase inhibitor, in psoriatic arthritis patients with axial involvement, nor is there any data on its effect on active MRI sacroiliitis.The aim of the study was to assess the effect of tofacitinib therapy on the dynamics of active MRI sacroiliitis in psoriatic arthritis patients.Materials and methods. 41 patients with active psoriatic arthritis fulfilling the CASPAR criteria were included. Median age was 41.0 [34; 50] years old, median disease duration was 6.0 [3; 10] years. Apart from a standard clinical examination, 40 patients underwent sacroiliac joint MRI on scanner Siemens General Electric 1.5 TESLA. Bone marrow edema on MRI (STIR) with one lesion on two consecutive slices or at least two lesions on a single slice, was considered active MRI sacroiliitis. Tofacitinib was given in 5 mg tablets twice a day with a possible dose increase up to 10 mg twice a day after 12 weeks of therapy. At the end of study, over a period of 24 weeks, sacroiliac joint MRI examination was repeated in 35 patients.Results. Prior to tofacitinib therapy, active MRI sacroiliitis was detected in 14 of 40 (35%) patients: bilateral – in 9 patients, unilateral – in 5 patients. At the end of 24 weeks therapy, active MRI sacroiliitis was detected in 4 of 35 (11.4%) patients observed: in 1 patient with baseline bilateral MRI sacroiliitis and in 2 patients with unilateral MRI sacroiliitis. 1 patient showed negative dynamics, that is, development of active MRI sacroiliitis (absent at baseline). The decrease in number of active MRI sacroiliitis patients is statistically significant (p=0.017). At baseline, inflammatory changes were detected in 23 of 80 (28.8%) sacroiliac joints, after 24 weeks of therapy they were found in 5 of 70 (7.1%; p=0.001) sacroiliac joints observed. During the treatment period, there was a significant decrease in the initially high activity of spondylitis. After 24 weeks of treatment, median BASDAI decreased from 6.0 [4.2; 7.0] to 1.4 [0.6; 3.2], median ASDAS-CRP from 3.8 [2.8; 4.4] to 1.5 [1.0; 2.1] (p=0.001 for both comparisons). Prior to tofacitinib therapy, high activity according to BASDAI was observed in 90.2% of patients, low activity – in 9.8%; at the end of study – in 13.5% and 86.5% of patients, respectively (p=0.001). At baseline, very high activity by ASDAS-CRP was detected in 61% of patients, high activity – in 29.2%, low activity – in 9.8% of patients. At the end of study there weren’t any patients with very high activity by ASDAS-CRP (p=0.001), high activity remained in 23.1%, moderate and low activity – in 30.7% and 46.2% of patients, respectively (p=0.001 for both comparisons). Significant differences between baseline symptoms in patients with MRI sacroiliitis and without it were defined by number of digits with dactylitis – 2 [0; 4] and 0 [0; 2] (p=0.04) and by ESR values – 47 [26; 76] and 20 [6; 37] mm/h (p=0.02). These parameters were higher in MRI sacroiliitis subgroup. By the end of study, these differences leveled out: the number of digits with dactylitis decreased to 0 [0; 0] and 0 [0; 0] (р=0.48), ESR – to 12 [6; 16] and 8 [6; 16] mm/h, respectively (p=0.78).Conclusion. Tofacitinib therapy shows high efficacy in reducing active MRI sacroiliitis and decreasing activity of axial involvement in psoriatic arthritis patients. The use of tofacitinib in patients with active MRI sacroiliitis as well as dactylitis and increased ESR levels demonstrated its high efficacy.

Pure peripheral spondyloarthritis, is it exceedingly rare? A real-world experience from an Indian tertiary care hospital

Background: Peripheral spondyloarthritis (pSpA) is usually associated with psoriasis, inflammatory bowel disease, or preceding infection (called reactive arthritis). Pure pSpA is a clinical entity wherein there are enthesitis, dactylitis, or arthritis, without any of the above-associated conditions. We aimed to describe the clinical, laboratory, radiological, and management profile of pure pSpA, among patients with pSpA presenting to the rheumatology outpatient department. Materials and Methods: In this retrospective, observational study, medical records of all the patients diagnosed as pSpA by a rheumatologist, between January 1, 2016, and December 31, 2018, were included. Among these, thirty patients qualified to be called pure pSpA, and we reported their demographic characteristics (age and sex), clinical features (onset of disease, clinical signs, and symptoms), laboratory parameters (erythrocyte sedimentation rate, hemoglobin, and C-reactive protein), radiological findings, and treatment pattern. Results: Thirty patients fulfilled the criteria for pure pSpA. The mean age (standard deviation) of the patients at onset was 32 ± 5.8 years. The mean disease duration before diagnosis was 9.7 months. Arthritis, enthesitis, and dactylitis were present in 29 (96.7%), 8 (26.7%), and 9 (30%) patients, respectively. Eighteen (60%) patients had monoarthritis, while 11/30 (36.7%) had oligoarthritis, at presentation. HLA B27 was positive in 24/30 (80%) patients. Seven patients (23.3%) had bilateral sacroiliitis on imaging and two (6.7%) had unilateral sacroiliitis. Twenty patients (66.7%) required conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), while two (6.7%) required biological DMARDs in the form of anti-tumor necrosis factor-alpha inhibitors. Conclusion: Pure pSpA is a relatively rare clinical disease which presents with either a mono or oligoarthritis and shows good treatment response to csDMARDs.

Clinical and imaging characteristics of patients with different types of infectious sacroiliitis

To investigate the clinical manifestations and imaging characteristics of patients with different types of infectious sacroiliitis. Clinical data of 40 patients diagnosed with infectious sacroiliitis were retrospectively analyzed. Among the 40 patients, 16 patients were diagnosed as non-brucellar and non-tuberculous infectious sacroiliitis (ISI), 13 with tuberculous infectious sacroiliitis (TSI), and 11 with brucellar sacroiliitis (BSI). In the ISI and TSI group, female patients accounted for 11/16, 12/13, while the proportion of unilateral involvement was 15/16 and 12/13, respectively. Compared with ISI and TSI group, BSI patients were mainly male (8/11) and presented more bilateral involvement (6/11) (P<0.05). Bone erosion was more common in ISI and TSI groups than in BSI group (6/15, 7/11 and 2/10), as well as abscess formation (3/15, 4/11 and 1/10, respectively). Symptoms in all patients relieved 1-2 weeks after administration of antibiotics or anti-tuberculosis treatment, but the resolution of the magnetic resonance imaging findings delayed about 6 (3-9) months. ISI and TSI patients with infectious sacroiliitis should be differentiated from spondyloarthritis, with a characteristic of more female patients, unilateral sacroiliitis, bone erosion, soft tissue involvement and abscess formation. However, BSI patients are mainly male, more bilateral involvement and less bone destruction and abscess formation. Antibiotic therapy demonstrates significant therapeutic effects, but resolution of the magnetic resonance imaging findings responses late.

Radiological Spectrum of Active Sacroiliitis by Conventional Radiography and MRI

Introduction: The aim of the present study was to compare the role of Conventional Radiography and Magnetic Resonance Imaging (MRI), in diagnosis of active sacroiliitis and differentiation between inflammatory and infective sacroiliitis.Methods: Fifty two cases of active sacroiliitis diagnosed on MRI from August 2017 to August 2019 were included in study. All the patients were subjected to conventional radiology, MRI and findings were co-related with clinical and laboratory findings. Conventional radiography was used to evaluate structural changes. MR images were evaluated for bone lesions (extent and distribution of bone marrow edema and presence of bone erosions), soft-tissue lesions (capsulitis, extra capsular fluid collections, and peri-articular muscle edema) and joint space reduction for differentiation between infective and inflammatory etiology.Results: Conventional radiography showed sclerosis, erosion, partial and complete ankylosis. Thick capsulitis, extra capsular fluid collection, and peri-articular muscle edema were all more frequently observed in infective sacroiliitis (p&lt;0.001). Iliac-dominant bone marrow edema more common in spondyloarthritis (p&lt;0.001). When periarticular muscle edema was the sole predictor, unilateral sacroiliitis in spondyloarthritis was correctly identified in 79.16% of cases, and infectious sacroiliitis was correctly identified in 82.14% of cases.Conclusions: MRI is the optimum imaging modality to diagnose active sacroiliitis. MRI plays an essential role in better demonstrating early alterations and inflammatory activity and aid in differentiation of infective and inflammatory sacroiliitis. Conventional radiography with low sensitivity can be used as a screening tool and follow-up of patients with sacroiliitis.

Spondyloarthritis and sarcoidosis: Related or fake friends? A systematic literature review.

Sarcoidosis and spondyloarthritis (SpA) have been regularly associated. Bone iliac granulomas have also been described. We propose herein a systematic review of rheumatologic axial manifestations of sarcoidosis. PubMed and the Cochrane Library were used to conduct this systematic literature review. Case reports and cross-sectional studies were reviewed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A total of 41 articles were eligible. Three cross-sectional studies on the association between SpA and sarcoidosis showed a prevalence of sacroiliitis and SpA ranging from 12.9 to 44.8% and 12.9 to 48.3% in inflammatory back pain (IBP) subgroups, respectively. However, the IBP definitions and sacroiliac joint (SIJ) imaging modalities (X-rays or magnetic resonance imaging) were heterogeneous, and X-ray was mainly used for sacroiliitis diagnosis (in 78% of cases). Thirty-one case-report articles of the sarcoidosis-sacroiliitis association were identified, representing 35 patients. ASAS criteria for SpA were met in half of cases (16/32) and 46% (12/26) had HLA B27 positivity. Sarcoidosis occurred after sacroiliac symptoms in 47% of cases. In the seven case-report articles with granulomatous sacroiliac bone involvement, unilateral involvement seemed higher than in the sarcoidosis-sacroiliitis group. Literature analysis found a good evidence of the association between SpA and sarcoidosis, and special attention should be given to patients reporting IBP. Unilateral sacroiliitis may raise suspicion of granulomatous bone involvement, distinct from sacroiliitis. Imaging modalities used to study the SIJ in patients with sarcoidosis have been heterogeneous and further investigation is needed.

Клинические особенности синдрома Рейтера у детей

The clinical features of articular syndrome and extra-articular manifestations in children with Reiter’s syndrome (illness) were studied. Reiter’s syndrome in childhood has some features of the course and development of the disease. In childhood, asymmetry of lesions of the joints of the lower extremities with early involvement of small feet joints in the process, possible flushing of the skin over the affected joints, intense pain, rare involvement in the process of the hip joints, lumbar spine and unilateral sacroiliitis is characteristic. Extraarticular manifestations proceeded often erased, and sometimes were not determined at all. Relapses and a chronic course are not excluded.

Diagnostic protocol sequence to avoid radiation overdose in patients with sacroiliitis and suspected renal stones

Sacroiliitis is a type of spondyloarthropathy that appears early as a frequent pattern. In some patients, the source of pain in the region of the lower back is the sacroiliac joint (SIJ). This retrospective study aimed to determine the incidence of sacroiliitis to avoid radiation overdose in patients with loin pain who are suspected of having renal stones and who have undergone computed tomography (CT) of the kidneys, ureters, and bladder without contrast, CT KUB. MethodData was analyzed for four hundred and twenty patients with unilateral or bilateral flank pain underwent CT of the kidneys, ureters, and bladder without contrast. Both sexes of different ages were included in the sample. The general assumption in this study was that flank pain in patients is not an indicator of sacroiliitis. ResultsPatients with sacroiliitis and stones (46.7%) constituted the highest proportion, followed by patients who had sacroiliitis but no stones (39.30%). The proportion of patients with sacroiliitis without stones and a normal urine WBC level was significantly higher than that of patients who had unilateral sacroiliitis (94% and 6%, respectively). Among these patients, the proportion of patients with symmetrical sacroiliitis was significantly higher than that of patients with asymmetrical sacroiliitis (76% and 24%, respectively).\\ ConclusionBased on the total sample, sacroiliitis affected 86% of patients and was the predominant finding among the overall sample and 43.1% of the patients should not have undergone a CT scan. Therefore, to avoid unnecessary radiation overdose, patients with flank pain should undergo the following routine protocol: (1) X-ray imaging for a primary diagnosis; (2) ultrasound to determine whether renal stones exist; and (3) computed tomography, but only if further renal stone information is necessary.

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.

IgG4 related disease in a middle-aged male having HLA-B27 positive unilateral sacroiliitis

IgG4 related disease in a middle-aged male having HLA-B27 positive unilateral sacroiliitis

Unilateral sacroiliitis: differentiating infective and inflammatory etiology by magnetic resonance imaging and tissue studies.

Unilateral sacroiliitis (US) is an uncommon disease with varied etiology. The differentiation between infective and inflammatory causes for US based on MRI alone is often difficult. We studied the efficacy of MRI findings in comparison with tissue studies in the diagnosis of US. A retrospective analysis of patients who presented with US and evaluated with MRI, biopsy for histopathology and tissue cultures was performed. Patients with bilateral sacroiliitis, traumatic and postpartum sacroiliitis were excluded. Based on defined MRI criteria, the patients were divided into two groups-infective (group A) and inflammation (group B). In total, 33 patients (mean age-33.4 ± 17.2years) with MRI features of US had presented with unilateral gluteal pain (100%) and positive Patrick's test (91.9%). Based on the MRI features of severe subchondral marrow edema, widening of joint space, intra-articular abscess and periarticular muscle abscess, infective sacroiliitis (A) was diagnosed in 20/33 (60.6% cases). A total of 13/33 (39.3%) patients had features of inflammation (B), based on the following MRI criteria-subchondral sclerosis with minimal edema, erosions, maintained joint space without abscess/destruction. Tissue evidence of infection was positive in 13/20 (65%) patients in group A while it was negative in all group B patients. MRI had high sensitivity (71%) and 100% specificity in diagnosing inflammatory sacroiliitis while it had low specificity, but 100% sensitivity for diagnosing infective sacroiliitis. Hence, patients diagnosed as inflammatory sacroiliitis in MRI are unlikely to benefit from further tissue studies while percutaneous biopsy is recommended in patients diagnosed in MRI as infective sacroiliitis.

CLINICAL AND INSTRUMENTAL CHARACTERISTICS OF AXIAL LESION IN EARLY PERIPHERAL PSORIATIC ARTHRITIS (DATA OF A REMARCA STUDY)

Objective : to investigate the extent of axial skeleton lesion in a Russian cohort of patients with early peripheral psoriatic arthritis (epPsA). Subjects and methods. Examinations were made in 89 patients (42 men and 47 women) (mean age, 36.5±10.9 years) with epPsA (duration, 12.1±10.1 months), the diagnosis of which met the CASPAR criteria. In addition to the standard examination, all the patients underwent evaluation of inflammatory back pain (IBP) (ASAS criteria), pelvic radiography, and determination of HLA-B27; 79 patients had additionally magnetic resonance imaging (MRI) of the sacroiliac joints (AIJ). Active sacroiliitis (SI) detected on MRI (MRI SI) was defined as bone marrow edema (osteitis) on T2 STIR. SI on radiography (rSI) was recorded if there were changes in at least one AIJ of Kellgren grade 2 or higher; radiologically significant SI (rsSI) was diagnosed when there were changes in the AIJ, which corresponded to its lesion in ankylosing spondylitis (grade II and higher bilateral SI or grade III and higher unilateral SI). The results of radiography and MRI were assessed by an independent radiologist. The disease activity in patients with IBP was evaluated by BASDAI. Results and discussion . IBP was identified in 58 (65.1%) patients; it was episodic in 35 (60.3%) and permanent in 23 (39.7%) cases. There was MRI SI in 28 (35.4%) of the 79 patients, rSI in 42 (47.2%), rsSI in 27 (30.3%) cases. 34 (38.1%) of the 84 patients were HLA-B27 positive. The mean BASDAI value was 4.5±1.6. An association was found between the presence of MRI SI and IBP: IBP was present in 92.9% of the patients with MRI SI and in 54.9% of those without MRI SI (p=0.0002). There is a relationship of MRI SI to permanent IBP (p=0.003). An association was found between the presence of rSI and IBP (p=0.047), between rSI and permanent IBP (p=0.01) and between rsSI and IBP (p=0.01). At the same time, SI was asymptomatic in 23.8% of the patients: rSI developed without previous IBP. No association was found between MRI SI/rSI/rsSI and HLA-B27. There was an association between MRI SI and higher peripheral arthritis activity by the DAS28. The mean DAS28 value was 9.34±1.79 in patients with MRI SI and 8.57±1.63 in those without MRI SI (r=0.25; p=0.028). There was an association between the presence of MRI SI and the values of disease activity assessment by a patient (r=0.23; p=0.047) and those of pain assessment by a patient (r=0.31; p=0.0074). An association was found between MRI SI and the affected area of the skin. Conclusion. In epPsA, there is IBP in 65% of the patients (it was episodic in 60% of them), MRI SI in 35%, rSI in 47.2%, and rsSI in 30.3%. There is an association between IBP and SI detected by any of the imaging techniques (MRI and radiography). In 24% of patients, rSI developed without previous IBP, suggesting that there is latent axial lesion. MRI SI is more frequently detected in patients having higher arthritis activity by the DAS28, higher overall disease and pain assessments by the patient, and a large area of skin lesions.