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Arthritis & Rheumatology (Hoboken, N.J.) Jan 2016
Topics: Contrast Media; Female; Gadolinium; Humans; Male; Sacroiliitis; Spondylarthropathies; Synovitis
PubMed: 26474419
DOI: 10.1002/art.39456 -
Advances in Rheumatology (London,... Jun 2021Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent episodes of fever and serositis. Sacroiliitis can be observed in some FMF...
BACKGROUND
Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent episodes of fever and serositis. Sacroiliitis can be observed in some FMF patients. This study aimed to compare the demographic, clinical, and laboratory findings, and treatment in children with FMF and sacroiliitis, and children with juvenile spondyloarthropathy (JSpA).
METHODS
In total, 1687 pediatric FMF patients that were followed-up between May 2010 and June 2020 were evaluated retrospectively. Among them, those with sacroiliitis (n = 63) were included in the study and compared to patients with JSpA (n = 102).
RESULTS
The study included 63 FMF patients with sacroiliitis (38 males [60.3%] and 25 females [39.7%]) with a mean age of 15.2 ± 4.1 years. Mean age at symptom onset was 7.2 ± 5.05 years and mean age at diagnosis was 9.74 ± 4.67 years. The most common mutation in the FMF patients was M694V/M694V (n = 22). Patients were diagnosed with sacroiliitis with a mean of 12 months (range: 6-36 months) after the diagnosis of FMF. Among the FMF patients, 28 (44.4%) had enthesitis, 23 (36.5%) had heel pain, and 11 (17.4%) had low back pain. The study also included 102 JSpA patients (90 males [88.2%] and 12 females [11.8%]). Mean age of patients with JSpA was 16.1 ± 2.8 years. As compared to 102 JSpA patients, patients with FMF and sacroiliitis had higher acute phase reactants, whereas HLA-B27 positivity rate was lower. In addition, axial involvement rate was higher in the JSpA patients.
CONCLUSION
Sacroiliitis is a common co-morbidity in FMF patients. The phenotypic features of these patients are different from patients with JSpA.
Topics: Adolescent; Arthritis, Juvenile; Child; Familial Mediterranean Fever; Female; Humans; Male; Pyrin; Retrospective Studies; Sacroiliitis; Spondylitis, Ankylosing; Young Adult
PubMed: 34090528
DOI: 10.1186/s42358-021-00188-2 -
Pediatric Radiology Jul 2023MRI is used for early detection of inflammation of sacroiliac joints as it shows active lesions of sacroiliitis long before radiographs show damage to the sacroiliac... (Review)
Review
MRI is used for early detection of inflammation of sacroiliac joints as it shows active lesions of sacroiliitis long before radiographs show damage to the sacroiliac joints. Early diagnosis of arthritis allows early treatment of inflammation and can help delay disease progression and prevent irreversible damage. Also, early identification of axial involvement in juvenile spondyloarthropathy is crucial, as treatment options are different than for peripheral juvenile spondyloarthropathy. In general, standard sequences used in adults are also applied to children. However, interpreting MR images of pediatric sacroiliac joints is more challenging than in adults, because of normal physiological changes during skeletal maturation, which can simulate disease on MR images. Furthermore, classical definitions of sacroiliitis used in adults, for both active inflammatory and structural lesions, can be difficult to extrapolate to children. The development of reliable pediatric-specific definitions for sacroiliitis is still in active study. Understanding both normal and pathological signal changes in children is important to distinguish physiologic findings from disease and to make a correct diagnosis. In this review, the main imaging characteristics of sacroiliitis on MRI in children and its frequent pitfalls will be illustrated, while also citing some discussion points regarding the scan protocol.
Topics: Adult; Humans; Child; Sacroiliitis; Arthritis, Juvenile; Magnetic Resonance Imaging; Inflammation; Radiologists; Spondylarthropathies
PubMed: 36856758
DOI: 10.1007/s00247-023-05602-z -
Zeitschrift Fur Rheumatologie Feb 2019The classification of axial spondyloarthritis (axSpA) comprises the classical ankylosing spondylitis (AS), which is characterized by already existing structural changes... (Review)
Review
The classification of axial spondyloarthritis (axSpA) comprises the classical ankylosing spondylitis (AS), which is characterized by already existing structural changes in the sacroiliac joints, and the so-called non-radiographic axSpA (nr-axSpA), in which by definition such changes are not present. This distinction is based on the ASAS classification criteria for axSpA, which are however not suitable for a diagnosis. According to the current classification, spondyloarthritis (SpA) includes axSpA, which can be associated with psoriasis and/or chronic inflammatory bowel diseases (CED), such as Crohn's disease and ulcerative colitis, and peripheral SpA, which is further divided into SpA associated with psoriasis, partially synonymous with psoriatic arthritis (PsA), reactive SpA, partially synonymous with reactive arthritis (ReA) and SpA associated with CED, partially synonymous with arthritis associated with CED (e.g. Crohn's disease, ulcerative colitis) and peripheral undifferentiated SpA, which by definition is not associated with any of the above. In this article only the most important differential diagnoses are discussed, i. e. diffuse idiopathic skeletal hyperostosis (DISH), fractures and infections in the axial skeleton. In addition, the frequency of certain musculoskeletal findings in the normal population examined by magnetic resonance imaging (MRI) are also discussed.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Prohibitins; Sacroiliac Joint; Sacroiliitis; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 30377767
DOI: 10.1007/s00393-018-0557-8 -
Pain Management Mar 2020The sacroiliac (SI) joint can be directly jeopardized by malignancy and indirectly by ergonomic changes of pelvic obliquity that introduces uneven weight distribution.... (Review)
Review
The sacroiliac (SI) joint can be directly jeopardized by malignancy and indirectly by ergonomic changes of pelvic obliquity that introduces uneven weight distribution. Cancer treatment can exacerbate preexisting arthritis and cause diffuse arthropathies, but these are unlikely to be isolated to the SI joint. The cancer population is exposed to unique stressors that might facilitate development of SI joint pain that includes cancer itself and therapy-related complications. Like the general population, cancer patients are subject to aging and BMI and musculoskeletal structural changes that affect symmetric body functioning and posturing. No frank association between sacroiliitis and cancer has been identified. Therefore, we believe there is a need to characterize any relationship between cancer and SI joint dysfunction and pain.
Topics: Arthralgia; Comorbidity; Humans; Neoplasms; Sacroiliitis
PubMed: 32162600
DOI: 10.2217/pmt-2019-0046 -
The Journal of Emergency Medicine Sep 2014
Topics: Arthritis, Infectious; Humans; Magnetic Resonance Imaging; Male; Sacroiliitis; Tomography, X-Ray Computed; Young Adult
PubMed: 24950942
DOI: 10.1016/j.jemermed.2014.05.001 -
Journal of Cosmetic Dermatology Oct 2022Isotretinoin has been reported to induce inflammatory back pain (IBP) and sacroiliitis in the patients with acne vulgaris. The aim of this study is to investigate the...
INTRODUCTION
Isotretinoin has been reported to induce inflammatory back pain (IBP) and sacroiliitis in the patients with acne vulgaris. The aim of this study is to investigate the incidence of IBP and sacroiliitis in patients receiving isotretinoin treatment compared with oral antibiotics for acne vulgaris.
MATERIALS AND METHODS
A total of 201 patients with moderate-to-severe acne vulgaris who received isotretinoin (n = 100) or oral antibiotics (n = 101) were included in the study. All patients were monthly questioned for IBP symptoms during their treatment. Patients described IBP were also evaluated for sacroiliitis by c-reactive protein, sedimentation rate, HLAB27, and sacroiliac magnetic resonance imaging (MRI). Isotretinoin was discontinued in all patients diagnosed as sacroiliitis, and these patients were reevaluated after 3 months.
RESULTS
IBP was observed in 21 (10.4%), and sacroiliitis was detected in 11 (11%) patients on isotretinoin treatment; in oral antibiotic group, we did not observe IBP or sacroiliitis. The incidence of IBP and sacroiliitis differed significantly between the isotretinoin and oral antibiotic groups (p < 0.0001, p = 0.02). Complete regression was observed in the great majority of patients following cessation of isotretinoin.
CONCLUSIONS
Our study is the largest prospective controlled study that investigated the incidence of sacroiliitis in patients receiving isotretinoin and compared with patients using oral antibiotics.
Topics: Humans; Acne Vulgaris; Anti-Bacterial Agents; Back Pain; Dermatologic Agents; Isotretinoin; Prospective Studies; Sacroiliitis
PubMed: 35092165
DOI: 10.1111/jocd.14807 -
Scientific Reports Jul 2020Sacroiliac joint involvement is one of the earliest manifestations of psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) is a useful tool in the early diagnosis...
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.
Topics: Adult; Aged; Arthritis, Psoriatic; Early Diagnosis; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Sacroiliitis
PubMed: 32665619
DOI: 10.1038/s41598-020-68456-7 -
Journal of Digital Imaging Feb 2022Spondyloarthritis (SpA) is a group of diseases primarily involving chronic inflammation of the spine and peripheral joints, as evaluated by magnetic resonance imaging...
Spondyloarthritis (SpA) is a group of diseases primarily involving chronic inflammation of the spine and peripheral joints, as evaluated by magnetic resonance imaging (MRI). Considering the complexity of SpA, we performed a retrospective study to discover quantitative/radiomic MRI-based features correlated with SpA. We also investigated different fat-suppression MRI techniques to develop detection models for inflammatory sacroiliitis. Finally, these model results were compared with those of experienced musculoskeletal radiologists, and the concordance level was evaluated. Examinations of 46 consecutive patients were obtained using SPAIR (spectral attenuated inversion recovery) and STIR (short tau inversion recovery) MRI sequences. Musculoskeletal radiologists manually segmented the sacroiliac joints for further extraction of 230 MRI features from gray-level histogram/matrices and wavelet filters. These features were associated with sacroiliitis, SpA, and the current biomarkers of ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), BASDAI (Bath Ankylosing Spondylitis Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), and MASES (Maastricht Ankylosing Spondylitis Enthesis Score). The Mann-Whitney U test showed that the radiomic markers from both MRI sequences were associated with active sacroiliitis and with SpA and its axial and peripheral subtypes (p < 0.05). Spearman's coefficient also identified a correlation between MRI markers and data from clinical practice (p < 0.05). Fat-suppression MRI models yielded performances that were statistically equivalent to those of specialists and presented strong concordance in identifying inflammatory sacroiliitis. SPAIR and STIR acquisition protocols showed potential for the evaluation of sacroiliac joints and the composition of a radiomic model to support the clinical assessment of SpA.
Topics: Biomarkers; Humans; Magnetic Resonance Imaging; Retrospective Studies; Sacroiliac Joint; Sacroiliitis; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 34997373
DOI: 10.1007/s10278-021-00559-7 -
Current Opinion in Rheumatology Jul 2017The Assessment of Spondyloarthritis International Society (ASAS) axial spondyloarthritis (axSpA) classification criteria marked a major step forward in SpA research,... (Review)
Review
PURPOSE OF REVIEW
The Assessment of Spondyloarthritis International Society (ASAS) axial spondyloarthritis (axSpA) classification criteria marked a major step forward in SpA research, distinguishing axial from peripheral disease, and allowing earlier identification through MRI. This facilitated all aspects of research including epidemiology, therapeutics and patient outcomes.
RECENT FINDINGS
The ASAS axSpA classification criteria have been applied broadly in research, and were validated in a recent meta-analysis of international studies. Concerns arose because of clinical differences between the clinical and imaging arms, which imply different risk for radiographic progression, and perform differently in validation studies. Low specificity of the MRI finding of sacroiliac joint bone marrow edema may lead to misclassification in populations with low axSpA prevalence. We suggest methodology to improve upon the criteria, including rigorous assessment of potential candidate criteria sets, discrete choice experiments to allow consideration of feature weights, and validation. Separately, assessment of structural and inflammatory MRI abnormalities should be performed to refine the MRI definition of sacroiliitis.
SUMMARY
The debate regarding the validation and modification of the ASAS axSpA classification criteria should lead to international efforts to build upon the gains made by these criteria, to further refine the axSpA population definitions for research and ultimately improve patient outcomes.
Topics: Bone Marrow; Disease Progression; Edema; Humans; Magnetic Resonance Imaging; Prevalence; Sacroiliac Joint; Sacroiliitis; Sensitivity and Specificity; Societies, Medical; Spondylarthritis; Spondylarthropathies; Spondylitis, Ankylosing
PubMed: 28376062
DOI: 10.1097/BOR.0000000000000402