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Modern Rheumatology Mar 2024In our study, we investigated the presence of subclinical enthesitis by ultrasonography (US) in asymptomatic patients with enthesitis-related arthritis (ERA) and...
OBJECTIVES
In our study, we investigated the presence of subclinical enthesitis by ultrasonography (US) in asymptomatic patients with enthesitis-related arthritis (ERA) and sacroiliitis associated with familial Mediterranean fever (FMF).
METHODS
A total of 50 patients, including 35 patients with ERA and 15 with sacroiliitis associated with FMF, were included in the study. All patients were evaluated with US by a paediatric radiologist. Enthesis of seven tendons (common extensor and flexor tendons, quadriceps tendon, proximal and distal patellar tendon, Achilles tendon, and plantar fascia) was examined on both sides.
RESULTS
Subclinical enthesitis was detected in 10 ERA (28.5%) and three FMF (20%) patients. Enthesitis was radiologically diagnosed in 16 (2.3%) out of 700 evaluated entheseal sites. The most frequent sites of enthesitis were Achilles (37.5%) and quadriceps (31.3%) tendons. All patients were in clinical remission and had no active complaints, and acute phase reactants were within normal limits. Therefore, the patients were followed up without treatment change. However, disease flare-up was observed in three of these patients (23.1%) during the follow-up, and their treatments were intensified.
CONCLUSIONS
Our results showed that the US can be particularly helpful in detecting subclinical enthesitis and predicting disease flare-ups.
Topics: Child; Humans; Sacroiliitis; Familial Mediterranean Fever; Symptom Flare Up; Enthesopathy; Arthritis, Juvenile; Achilles Tendon
PubMed: 37267199
DOI: 10.1093/mr/road053 -
Joint Bone Spine Jan 2024Axial psoriatic arthritis (axPsA) has considerable overlap with axial spondyloarthritis (axSpA) but has some unique features that sometimes preclude classification into...
Axial psoriatic arthritis (axPsA) has considerable overlap with axial spondyloarthritis (axSpA) but has some unique features that sometimes preclude classification into axSpA. It has some clinical and radiographic differences compared to axSpA. Imaging typically shows asymmetric syndesmophytes, mainly in the cervical spine, with less frequent sacroiliitis. It more commonly presents later in life and is associated with less severe inflammatory back pain than axSpA. The interleukin (IL) IL-23/IL-17 axis is central to the pathogenesis of both diseases. However, the response to therapies targeting these cytokines has been different. IL-23 inhibitors are ineffective in axSpA but may be effective in psoriatic arthritis (PsA). Recent post hoc analyses of clinical trial data with IL-23 inhibitors in PsA have raised the possibility of their efficacy in axPsA and need evaluation in future clinical trials. Moreover, there is a need for classification criteria for axPsA and better tools to assess therapeutic response.
Topics: Humans; Arthritis, Psoriatic; Spondylitis, Ankylosing; Sacroiliitis; Back Pain; Interleukin-23; Spondylarthritis
PubMed: 37495073
DOI: 10.1016/j.jbspin.2023.105625 -
Indian Journal of Orthopaedics Mar 2022
PubMed: 35251517
DOI: 10.1007/s43465-021-00483-6 -
Annals of the Rheumatic Diseases Oct 2023
Topics: Humans; Sacroiliitis; Sacroiliac Joint; Spondylitis, Ankylosing
PubMed: 37072153
DOI: 10.1136/ard-2023-224164 -
The Journal of Rheumatology Oct 2023Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that primarily affects the axial skeleton, including the spine and sacroiliac joints. It encompasses...
Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that primarily affects the axial skeleton, including the spine and sacroiliac joints. It encompasses both nonradiographic axSpA (nr-axSpA) and radiographic axSpA (also known as ankylosing spondylitis [AS]), the latter characterized by radiographic evidence of sacroiliitis..
PubMed: 37778760
DOI: 10.3899/jrheum.2023-0744 -
The Journal of Rheumatology Jul 2021To establish the prevalence of nonradiographic sacroiliitis within a real-life sample of patients with psoriatic arthritis (PsA), using pelvic radiographs and magnetic... (Observational Study)
Observational Study
OBJECTIVE
To establish the prevalence of nonradiographic sacroiliitis within a real-life sample of patients with psoriatic arthritis (PsA), using pelvic radiographs and magnetic resonance imaging (MRI) of sacroiliac joints (SIJs).
METHODS
This cross-sectional study included 107 consecutive adults with PsA (Classification Criteria for Psoriatic Arthritis criteria). Participants completed clinical and laboratory evaluation, pelvic radiographs scored for radiographic sacroiliitis according to the modified New York (mNY) criteria, and noncontrast MRI of SIJs, scored by the Berlin score and categorized into active sacroiliitis using the 2016 Assessment of Spondyloarthritis international Society (ASAS) criteria and the presence of structural sacroiliitis.
RESULTS
Radiographic sacroiliitis/mNY criteria were detected in 28.7% (n = 29), confirmed by MRI-detected structural lesions in 72.4% (n = 21). Active sacroiliitis was detected by MRI in 26% (n = 28) of patients, with 11% (n = 11) qualifying for nonradiographic sacroiliitis. Patients with radiographic and nonradiographic sacroiliitis had similar clinical characteristics, except for a longer duration of psoriasis (PsO) and PsA in the radiographic subgroup (PsO: 23.8 ± 12.5 vs 14.1 ± 11.7 yrs, = 0.03; PsA: 12.3 ± 9.8 vs 4.7 ± 4.5 yrs, = 0.02, respectively). Inflammatory back pain (IBP) was reported in 46.4% (n = 13) with active sacroiliitis and 27% (n = 3) with nonradiographic sacroiliitis. The sensitivity of IBP for detection of nonradiographic sacroiliitis was low (27%) and moderate for radiographic sacroiliitis (52%), whereas specificity ranged from 72% to 79% for radiographic and nonradiographic sacroiliitis, respectively.
CONCLUSION
The prevalence of active sacroiliitis among a real-life population of patients with PsA was 26%. However, the prevalence of nonradiographic sacroiliitis was low (11%) compared to the radiographic sacroiliitis (28.7%) seen in patients with longer disease duration. IBP was not a sensitive indicator for the presence of early-stage sacroiliitis that was commonly asymptomatic.
Topics: Arthritis, Psoriatic; Cross-Sectional Studies; Humans; Magnetic Resonance Imaging; Prevalence; Sacroiliac Joint; Sacroiliitis; Spondylarthritis
PubMed: 33452174
DOI: 10.3899/jrheum.200961 -
Case Reports in Medicine 2022Pregnancy-associated sacroiliitis is infrequent during the peripartum period. Although pregnancy-associated pyogenic sacroiliitis rarely occurs, it is associated with...
Pregnancy-associated sacroiliitis is infrequent during the peripartum period. Although pregnancy-associated pyogenic sacroiliitis rarely occurs, it is associated with significant morbidity and mortality. A timely diagnosis of the disease is challenging due to its nonspecific clinical symptoms. We reviewed a case that experienced an acute illness during pregnancy. The illness was manifested by localized pain in the hips or buttocks, sacroiliac joint tenderness, and debilitating hip pain during ambulation. Magnetic resonance imaging revealed little joint involvement, and the patient was treated with antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids. The patient responded well to the therapy with marked improvement in her ambulation. Septic sacroiliitis should be considered in peripartum patients presenting with increased inflammatory markers and severe localized pain. Medical management is usually curative and without an adverse effect on pregnancy. Although we could not perform a biopsy to verify the cause of the disease, the patient's excellent response to the treatment confirmed our diagnosis.
PubMed: 35573053
DOI: 10.1155/2022/3596672 -
JACC. Case Reports Aug 2021A 65-year-old immunocompromised woman presented with progressive dyspnea and sacroiliac joint pain. Cardiac magnetic resonance showed abnormal right ventricular filling...
A 65-year-old immunocompromised woman presented with progressive dyspnea and sacroiliac joint pain. Cardiac magnetic resonance showed abnormal right ventricular filling with septal bounce and abnormal pericardial enhancement, suggestive of constrictive pericarditis. Cultures from pericardium following pericardiectomy grew . She was diagnosed with coccidioidomycosis and responded to pericardiectomy and amphotericin. ().
PubMed: 34471887
DOI: 10.1016/j.jaccas.2021.04.019 -
Best Practice & Research. Clinical... Dec 2020Imaging is often used at the time of diagnosis to exclude conditions other than arthritis, to confirm the physical examination if equivocal, and to assess the degree of... (Review)
Review
Imaging is often used at the time of diagnosis to exclude conditions other than arthritis, to confirm the physical examination if equivocal, and to assess the degree of inflammation and baseline damage. Plain radiography is helpful in the evaluation of damage from chronic inflammation, while ultrasound and magnetic resonance imaging (MRI) are helpful in the assessment of early disease and active inflammation. Multiple studies have shown that tenderness on physical examination of the sacroiliac joint is often discordant with imaging results, so MRI is increasingly relied upon to assess for objective evidence of inflammation. There are no widely accepted, validated tools for the pediatric population using ultrasound or MRI assessment of the peripheral joints. Validated tools exist for objective assessment of pediatric hip disease on radiographs and axial disease on MRI, but not on other imaging modalities. The utility of these scoring systems in clinical care and clinical trials remains untested.
Topics: Child; Humans; Magnetic Resonance Imaging; Radiography; Sacroiliac Joint; Sacroiliitis; Spondylarthritis
PubMed: 33036917
DOI: 10.1016/j.berh.2020.101596 -
Clinical Rheumatology May 2022Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease that can present with various forms of arthritis. This retrospective study aims...
INTRODUCTION
Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease that can present with various forms of arthritis. This retrospective study aims to evaluate the characteristics of patients with arthritis in a large pediatric cohort of FMF patients.
METHODS
The demographic and clinical data were extracted from electronic medical records. Patients with arthritis were grouped as arthritis of FMF and arthritis of FMF-associated diseases.
RESULTS
A total of 541 patients were followed with a diagnosis of FMF in the last 5 years. Acute arthritis of FMF (n: 138) was the most common cause. It showed a recurrent course in the majority with a longer duration than other attack symptoms. Significantly higher frequencies of biallelic exon 10 and M694V mutations, erysipelas-like erythema, and protracted febrile myalgia were detected in these patients, particularly in those older than 2 years of age. Sacroiliitis of FMF was the second most common cause (n: 19). Patients with acute arthritis and sacroiliitis of FMF needed higher doses of colchicine. One patient with neonatal-onset FMF and M694V homozygosity was diagnosed with protracted arthritis. Arthritides of FMF-associated diseases including IgA vasculitis (n: 10), juvenile idiopathic arthritis (n: 9), chronic nonbacterial osteomyelitis (n: 5), and inflammatory bowel disease (n: 2) were detected in 26 patients.
CONCLUSIONS
Arthritis is an important clinical finding of FMF mostly associated with M694V mutations. The frequency of protracted arthritis is declined, whereas sacroiliitis of FMF and arthritis of associated diseases expand the spectrum of arthritis. This study represents the changing face and current perspectives of arthritis in FMF. Key Points • Arthritis is an important clinical finding of familial Mediterranean fever (FMF) that can present in various forms • Arthritis is most likely associated with M694V mutations • The frequency of protracted arthritis is declined whereas sacroiliitis of FMF and arthritis of associated diseases expand the spectrum of arthritis in FMF.
Topics: Arthritis, Juvenile; Child; Familial Mediterranean Fever; Humans; Infant, Newborn; Mutation; Pyrin; Retrospective Studies; Sacroiliitis
PubMed: 35091781
DOI: 10.1007/s10067-022-06082-6