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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 -
Skeletal Radiology Dec 2023To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications MATERIALS AND METHODS: This retrospective study...
OBJECTIVE
To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications MATERIALS AND METHODS: This retrospective study included patients with ISI who were evaluated between 2008 and 2021 in a single center. Two radiologists reviewed MRI and CT images to determine the anatomical distribution (unilateral/bilateral, iliac/sacral bone, proximal/middle/distal), severity (bone marrow edema [BME]/periostitis/erosions), concurrent infection (vertebral/nonvertebral), and complications (abscess/probable adjacent osteomyelitis/cavitation/devitalized areas/sequestrum/pelvic venous thrombosis) of ISI. Interobserver reproducibility was assessed. Correlation analysis evaluated the effect of the causative microorganism on severity. Two human bodies were dissected to outline possible ways that ISI can spread.
RESULTS
Forty patients with ISI (40 years ± 22; 26 women) were evaluated. Ten patients had bilateral ISI. Concurrent vertebral infection was associated in 15% of cases. Reproducibility of sacral BME, periostitis, and reactive locoregional abnormalities was perfect (κ = 1). Reproducibility was low for erosion count (κ = 0.52[0.52-0.82]) and periarticular osteopenia (κ = 0.50[0.18-0.82]). Inflammatory changes were BME (42/42 joints), muscle edema (38/42), and severe periostitis along the ilium (33/37). Destructive structural changes occurred with confluent erosions (iliac, 20/48; sacral, 13/48), sequestrum (20/48), and cavitation (12/48). Complications occurred in 75% of cases, including periarticular abscesses (n = 30/47), probable adjacent osteomyelitis (n = 16/37), and pelvic thrombophlebitis (n = 3). Tuberculous ISI (6/40) correlated with sclerosis (rs = 0.45[0.16; 0.67]; p < 10) and bone devitalization (rs = 0.38[0.16; 0.67]; p = .02). The anatomical study highlighted the shared venous vascularization of sacroiliac joints, pelvic organs, and mobile spine.
CONCLUSION
Complications of ISI are frequent, including abscesses, adjacent osteomyelitis, and periostitis. ISI had bilateral involvement nonrarely and is commonly associated with another spinal infection.
PubMed: 38110777
DOI: 10.1007/s00256-023-04535-w -
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 -
Clinics and Practice Jan 2024Sacroiliitis is the inflammation of the sacroiliac joint, the largest axial joint in the human body, contributing to 25% of lower back pain cases. It can be detected... (Review)
Review
Sacroiliitis is the inflammation of the sacroiliac joint, the largest axial joint in the human body, contributing to 25% of lower back pain cases. It can be detected using various imaging techniques like radiography, MRI, and CT scans. Treatments range from conservative methods to invasive procedures. Recent advancements in artificial intelligence offer precise detection of this condition through imaging. Treatment options range from physical therapy and medications to invasive methods like joint injections and surgery. Future management looks promising with advanced imaging, regenerative medicine, and biologic therapies, especially for conditions like ankylosing spondylitis. We conducted a review on sacroiliitis using imaging data from sources like PubMed and Scopus. Only English studies focusing on sacroiliitis's radiological aspects were included. The findings were organized and presented narratively.
PubMed: 38248433
DOI: 10.3390/clinpract14010009 -
Clinical Case Reports Jan 2020OO of the acetabulum can clinically and radiologically mimic an ankylosing spondylitis (with coxitis and sacroiliitis). Management of OO include multidisciplinary...
OO of the acetabulum can clinically and radiologically mimic an ankylosing spondylitis (with coxitis and sacroiliitis). Management of OO include multidisciplinary approach including radiologist, rheumatologist, and orthopedist.
PubMed: 31998520
DOI: 10.1002/ccr3.2578 -
Skeletal Radiology Aug 2022To evaluate the frequency of sacroiliitis in older subjects.
OBJECTIVE
To evaluate the frequency of sacroiliitis in older subjects.
MATERIALS AND METHODS
Consecutive MRI examinations of the sacroiliac joints (SIJs) performed for suspected sacroiliitis (2005-2019) in patients ≥ 18 years were retrospectively evaluated for the presence of active/structural lesions and were categorized for the presence/absence of sacroiliitis. Clinical and imaging parameters were compared between subjects with sacroiliitis according to age groups < 40 years, 40-55, and > 55 years. Clinical parameters including inflammatory back pain (IBP) and other spondyloarthritis (SpA) features were retrieved from the medical records.
RESULTS
A total of 431 patients with SIJs MRI were evaluated: median age, 44 [IQR 35-54]; female:male 267(62%):164(38%). Sacroiliitis was diagnosed in 89 (20.6%) subjects-median age, 41 years [IQR 32-54], 52% females- and was equally prevalent among the different age groups: > 40 years old, 23.6%; 40-55, 20%; and > 55 years old, 17%, p = 0.43, with active/structural lesions equally dispersed. Older patients (> 55) started suffering from back pain at an older age and had a longer delay in diagnosis. Gender distribution, the presence of IBP, and other SpA features were no different in patients < 45 and > 55 years of age.
CONCLUSIONS
The frequency of sacroiliitis on SIJs-MRI in subjects > 55 years is similar to its frequency in younger subjects and is associated with the same type and magnitude of active and structural MRI lesions. Clinical parameters such as IBP and additional SpA features are similarly prevalent in older and younger subjects suggesting they suffer from the same disease and differing only in age of presentation.
Topics: Adult; Aged; Back Pain; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sacroiliac Joint; Sacroiliitis; Spondylarthritis
PubMed: 35094157
DOI: 10.1007/s00256-022-04001-z -
The Journal of Rheumatology Sep 2023Radiography is still used worldwide for the detection of sacroiliitis in juvenile spondyloarthritis (JSpA), despite its low sensitivity and reliability. We aimed to...
OBJECTIVE
Radiography is still used worldwide for the detection of sacroiliitis in juvenile spondyloarthritis (JSpA), despite its low sensitivity and reliability. We aimed to define unequivocal evidence of sacroiliitis on pelvic radiography in skeletally immature youth for use in classification criteria when magnetic resonance imaging (MRI) is unavailable.
METHODS
Subjects were a retrospective cohort of juvenile patients with spondyloarthritis with a radiograph and MRI as part of a diagnostic evaluation for axial disease. Six musculoskeletal imaging experts underwent an iterative consensus process to define unequivocal sacroiliitis on radiography in skeletally immature youth. Radiographs were graded using the modified New York (mNY) criteria and the unequivocal sacroiliitis criteria. Interrater agreement was assessed with the Fleiss [Formula: see text] statistic. Specificity, area under the receiver operator characteristic curve (AUROC), and sensitivity of the 2 measures were tested using 2 MRI reference standards.
RESULTS
A total of 112 subjects, with a median age of 14.9 (range 6.7-20.1) years, were included. The Fleiss [Formula: see text] was fair for the mNY criteria (0.54, 95% CI 0.42-0.67) and the unequivocal sacroiliitis criteria (0.58, 95% CI 0.46-0.69). The unequivocal sacroiliitis criteria achieved > 90% specificity using both MRI reference standards. Sensitivity (59.26 and 57.14 vs 44.83 and 43.33) and AUROC (0.76 and 0.76 vs 0.71 and 0.71) were higher, for both reference standards, for the unequivocal sacroiliitis in youth definition than for the mNY criteria, respectively.
CONCLUSION
In this study, we propose the first consensus-derived definition to our knowledge of unequivocal sacroiliitis by radiography in skeletally immature youth. This definition achieved excellent specificity and had higher AUROC and sensitivity values than the mNY criteria using both MRI reference standards. This definition has applicability to the JSpA axial disease classification imaging criterion when MRI is unavailable.
Topics: Adolescent; Humans; Child; Young Adult; Adult; Sacroiliitis; Sacroiliac Joint; Retrospective Studies; Reproducibility of Results; Consensus; Spondylarthritis; Spondylitis, Ankylosing; Radiography; Magnetic Resonance Imaging; Arthritis, Juvenile
PubMed: 37061228
DOI: 10.3899/jrheum.2022-0890 -
Inflammatory Bowel Diseases May 2021Sacroiliitis is an inflammatory arthritis of the sacroiliac joints and is associated with inflammatory bowel disease (IBD). Yet, sacroiliitis often goes undiagnosed in...
BACKGROUND
Sacroiliitis is an inflammatory arthritis of the sacroiliac joints and is associated with inflammatory bowel disease (IBD). Yet, sacroiliitis often goes undiagnosed in IBD, and the clinical association between IBD disease activity and sacroiliitis is not well established. Patients with Crohn's disease (CD) often receive magnetic resonance enterography (MRE) to assess disease activity, affording clinicians the opportunity to evaluate for the presence of sacroiliitis. We aimed to identify the prevalence and disease characteristics associated with sacroiliitis in CD patients undergoing MRE.
METHODS
All CD patients undergoing MRE for any indication between 2014 and 2018 at an IBD referral center were identified. The MREs were reviewed for the presence of sacroiliitis based on bone marrow edema (BME) and structural lesions. We analyzed demographics, IBD characteristics, clinical and endoscopic disease activity, and management between CD patients with and without sacroiliitis.
RESULTS
Two hundred fifty-eight patients with CD underwent MRE during the study period. Overall, 17% of patients had MR evidence of sacroiliitis, of whom 73% demonstrated bone marrow edema. Female gender, back pain, and later age of CD diagnosis were associated with sacroiliitis (P = 0.05, P < 0.001, P = 0.04, respectively). Disease location and CD therapy were not associated with sacroiliitis on MRE. Clinical, endoscopic, and radiographic disease activity were not associated with sacroiliitis on MRE.
CONCLUSION
Sacroiliitis is a common comorbid condition in CD. With limited clinical clues and disease characteristics to suggest sacroiliitis, physicians may utilize MRE to identify sacroiliitis, especially in CD patients with back pain.
Topics: Crohn Disease; Edema; Female; Humans; Prevalence; Sacroiliitis
PubMed: 32793977
DOI: 10.1093/ibd/izaa198 -
Rheumatology International Mar 2022Sacroiliitis and spondyloarthritis (SpA) have been associated to sarcoidosis. Sarcoidosis bone involvement of the sacral or iliac bones has been reported to mimic SpA....
Sacroiliitis and spondyloarthritis (SpA) have been associated to sarcoidosis. Sarcoidosis bone involvement of the sacral or iliac bones has been reported to mimic SpA. We aimed to evaluate the prevalence of structural sacroiliitis and structural changes of the sacroiliac joints (SIJ) in patients with sarcoidosis by abdominal-pelvic computed tomography (AP-CT). In this monocentric retrospective study, three blinded readers evaluated AP-CT that had already been performed on patients with sarcoidosis and classified them as normal, degenerative, or inflammatory. A consensus was reached for the divergent cases. Erosion, ankylosis, and sclerosis, classically associated with sacroiliitis, were noted. SpA was defined according to the ASAS 2009 classification criteria. We identified 217 patients with proven sarcoidosis who underwent AP-CT. Only three patients had sacroiliitis by CT and four had SpA, representing 1.38% and 1.85% of the patients, respectively. Degenerative SIJs represented 28.1% of patients and were significantly associated with age, at least one pregnancy, rural lifestyle, ankylosis, diffuse idiopathic skeletal hyperostosis, sclerosis, and the presence of osteophytes. Four patients had axial bone sarcoidosis. Sacroiliitis, SpA, and degenerative changes of the SIJ have been highlighted by AP-CT in patients with sarcoidosis. Osteoarthritis of the SIJ in sarcoidosis was associated with age, pregnancy, and rural lifestyle. Further studies are needed to assess the link between SpA and sarcoidosis.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Pregnancy; Prevalence; Retrospective Studies; Sacroiliac Joint; Sarcoidosis; Spondylarthritis; Tomography, X-Ray Computed
PubMed: 34636939
DOI: 10.1007/s00296-021-05021-z