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Acta Clinica Belgica Aug 2021: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent, self-limited attacks of fever with serositis. Acute recurrent...
: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent, self-limited attacks of fever with serositis. Acute recurrent arthritis is the most common form of musculoskeletal involvement in FMF; however, ≤5% of FMF patients can develop chronic arthritis, including sacroiliitis. It is difficult to determine if sacroiliitis is a musculoskeletal finding of FMF or if they are concomitant diseases-FMF and juvenile spondyloarthropathy (JSpA). The present study aimed to compare clinical and laboratory findings in FMF patients with concomitant sacroiliitis and JSpA patients with concomitant sacroiliitis.: The medical files of patients diagnosed with FMF and JSpA with concomitant sacroiliitis were retrospectively evaluated. All patients had MRI findings consistent with sacroiliitis. Patient demographic data, clinical features, and laboratory findings were compared between the patients with FMF and concomitant sacroiliitis, and those with JSpA and concomitant sacroiliitis.: The study included 18 patients with FMF and sacroiliitis, and 38 patients with JSpA and sacroiliitis. The median (range) age at diagnosis of FMF accompanied by sacroiliitis and JSpA accompanied by sacroiliitis was 12.0 years (3.5-18 years) and 13 years (4-18 years), respectively. There weren't any significant differences in HLA-B27 positivity, family history of ankylosing spondylitis, presenting complaints, arthritis, enthesitis, or treatment between the 2 patient groups.: The present findings show that pediatric patients with FMF and sacroiliitis, and those with JSpA and sacroiliitis have the same clinical and laboratory findings.
Topics: Child; Familial Mediterranean Fever; Humans; Magnetic Resonance Imaging; Retrospective Studies; Sacroiliitis; Spondylitis, Ankylosing
PubMed: 32009575
DOI: 10.1080/17843286.2020.1724450 -
Clash of the titans: Current CT and CT-like imaging modalities in sacroiliitis in spondyloarthritis.Best Practice & Research. Clinical... Sep 2023Sacroiliitis is characterised by active and structural changes of the joint. While the Assessment of Spondyloarthritis international Society (ASAS) classification... (Review)
Review
Sacroiliitis is characterised by active and structural changes of the joint. While the Assessment of Spondyloarthritis international Society (ASAS) classification criteria stress the importance of bone marrow inflammation, recent reports suggest that osteitis can occur in various diseases, mechanical conditions and healthy individuals. Thus, structural lesions such as joint surface erosion and ankylosis are important factors for differential diagnosis. Various imaging modalities are available to examine these changes. However, computed tomography (CT) is generally considered the reference standard. Nonetheless, recent advances in magnetic resonance imaging (MRI) allow for direct bone imaging and the reconstruction of CT-like images that can provide similar information. This way, the ability of MRI to detect and measure structural lesions is strengthened. The aim of this review is to provide an overview of the pros and cons of CT and CT-like imaging modalities in sacroiliitis.
Topics: Humans; Sacroiliitis; Sacroiliac Joint; Spondylarthritis; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 37953120
DOI: 10.1016/j.berh.2023.101876 -
Zhonghua Er Ke Za Zhi = Chinese Journal... Dec 2023To summarize the clinical, radiological characteristics, and prognosis of infectious sacroiliitis in children. A case-control study was conducted, including 12 cases...
To summarize the clinical, radiological characteristics, and prognosis of infectious sacroiliitis in children. A case-control study was conducted, including 12 cases of infectious sacroiliitis diagnosed in the Rheumatology and Immunology Department of the Children's Hospital affiliated with the Capital Institute of Pediatrics from June 2018 to June 2023. These cases comprised the case group. Concurrently, 28 cases of pediatric idiopathic arthritis involving the sacroiliac joint in the same department served as the control group. Basic patient information, clinical features, laboratory parameters, and clinical treatment outcomes for both groups were collected and analyzed. Independent sample -tests and chi-squared tests were used for inter-group comparisons. Among the 12 cases in the case group, there were 5 males and 7 females, with a disease duration of 0.8 (0.5, 1.2) months. Nine patients presented with fever, and 1 patient had limping gait. Human leukocyte antigen (HLA)-B27 positivity was observed in 1 case, and there was no family history of ankylosing spondylitis. In the control group of 28 cases, there were 19 males and 9 females, with a disease duration of 7.0 (3.0, 17.0) months. One patient (4%) had fever, and 14 cases (50%) exhibited limping gait. HLA-B27 positivity was found in 18 cases (64%), and 18 cases (64%) had a family history of ankylosing spondylitis. The case group had higher white blood cell count (WBC), neutrophil ratio, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, as well as a higher proportion of unilateral involvement on magnetic resonance imaging and bone destruction on CT compared to the control group ((11.1±6.2)×10 (7.3±2.3)×10/L, 0.64±0.10 0.55±0.12, 72 (34, 86) 18 (5, 41) mm/1 h, 24.6 (10.1, 67.3) mg/L 3.6 (0.8, 15.0) mg/L, 11/12 36% (10/28), 9/12 11% (3/28), =2.90, 3.07, =-2.94, -3.28, =10.55, 16.53, all <0.05). Pediatric infectious sacroiliitis often presents as unilateral involvement with a short disease history. Elevated WBC, CRP, and ESR, as well as a high rate of bone destruction, are also common characteristics.
Topics: Male; Female; Humans; Child; Sacroiliitis; Spondylitis, Ankylosing; Case-Control Studies; Sacroiliac Joint; Radiography; Magnetic Resonance Imaging; Fever
PubMed: 38018046
DOI: 10.3760/cma.j.cn112140-20230825-00131 -
Rheumatology (Oxford, England) Jan 2021The aim was to investigate the reliability and validity of radiographic sacroiliitis assessment in anteroposterior (AP) lumbar radiographs compared with conventional...
OBJECTIVE
The aim was to investigate the reliability and validity of radiographic sacroiliitis assessment in anteroposterior (AP) lumbar radiographs compared with conventional pelvic radiographs in patients with axial spondyloarthritis (axSpA).
METHODS
Patients from the German Spondyloarthritis Inception Cohort were selected based on the availability of pelvic and AP lumbar radiographs with visible SI joints at baseline and year 2. Two readers scored the images independently in a random order according to the modified New York criteria. The sacroiliitis sum score was calculated as the mean of both readers. Patients were classified as radiographic (r-)axSpA if radiographic sacroiliitis of grade ≥2 bilaterally or grade ≥3 unilaterally was present in the opinion of both readers and as non-radiographic (nr-)axSpA otherwise. The reliability and validity of sacroiliitis assessment in AP lumbar radiographs was assessed using intraclass correlation coefficients (ICCs), absolute agreement and κ statistics.
RESULTS
A total of 226 sets of radiographs were scored from 113 patients included in the study. The ICC for the sacroiliitis sum score was 0.91 at both baseline and year 2. A total of 62 (54.9%) and 55 (48.7%) patients were classified as r-axSpA at baseline and 65 (57.5%) and 60 (53.1%) patients at year 2 based on evaluation of pelvic and AP lumbar radiographs, respectively. The absolute agreement between the methods on the classification was 84.9 and 85.0% at baseline and year 2, respectively, with the κ of 0.70 at both time points.
CONCLUSION
Radiographic sacroiliitis can be assessed in AP lumbar radiographs with a similar reliability to conventional pelvic radiographs.
Topics: Adult; Cohort Studies; Correlation of Data; Disease Progression; Female; Humans; Lumbosacral Region; Male; Observer Variation; Pelvic Bones; Radiography; Reproducibility of Results; Sacroiliac Joint; Sacroiliitis; Spondylarthritis
PubMed: 32710108
DOI: 10.1093/rheumatology/keaa260 -
Current Rheumatology Reviews 2023The purpose of this study was to assess the performance of computed tomography (CT) scan and magnetic resonance imaging (MRI) for detecting sacroiliitis in... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The purpose of this study was to assess the performance of computed tomography (CT) scan and magnetic resonance imaging (MRI) for detecting sacroiliitis in nonradiographic SpA (nr-SpA).
METHODS
This cross-sectional monocentric double-blind study included 63 patients consulting for symptoms suggestive of SpA between February 2014 and February 2017. Patients with conventional radiographs showing a confirmed sacroiliitis (grade 3 or 4) were not included. Eligible patients underwent CT and MRI of sacroiliac joints (SIJ). CT and MR images were interpreted by 2 experienced musculoskeletal radiologists blinded to clinical and laboratory data. Two professors in rheumatology blinded to radiologists' conclusions analyzed clinical data, laboratory tests, HLA typing, X-rays, CT and MRI images, and divided the patients into 2 groups: confirmed nr-SpA or no SpA. This classification was considered the gold standard when analyzing the results.
RESULTS
46 women and 17 men were included in this study. 47 patients were classified as confirmed nr-SpA (74.6%) and 16 patients as no SpA (25.4%). Sensitivity, specificity, and positive and negative predictive values of CT and MRI for detecting sacroiliitis were, respectively, estimated at 71.7%, 71.4%, 89.2%, 43.5%, and 51.2%, 100%, 100%, and 40%. CT and MRI findings were found to be statistically associated (p<0.001).
CONCLUSION
SIJ MRI is a highly specific method in the detection of sacroiliitis, but with a moderate sensitivity. SIJ CT scan, usually known as the third option after radiography and MRI, has much greater diagnostic utility than it has been documented previously.
Topics: Female; Humans; Male; Cross-Sectional Studies; Sacroiliac Joint; Sacroiliitis; Sensitivity and Specificity; Spondylarthritis; Double-Blind Method
PubMed: 37254543
DOI: 10.2174/1573397119666230529105122 -
Archives of Gynecology and Obstetrics Dec 2022We performed this research to report the clinical characteristics and clinical therapeutic strategies of acute postpartum inflammatory sacroiliitis.
PURPOSE
We performed this research to report the clinical characteristics and clinical therapeutic strategies of acute postpartum inflammatory sacroiliitis.
METHODS
We retrospectively analyzed the data of patients diagnosed with acute postpartum inflammatory sacroiliitis from 2014 to 2020. All their clinical details including clinical symptoms and signs, laboratory tests, radiologic examination, diagnosis and treatment process and clinical outcomes were obtained and analyzed in this retrospective analysis.
RESULTS
Eleven patients diagnosed with acute postpartum inflammatory sacroiliitis complain of low back pain. Magnetic resonance imaging (MRI) is useful in diagnosing acute postpartum inflammatory sacroiliitis. The systemic non-steroidal anti-inflammatory drugs (NSAIDs) administration, sacroiliac joint injection, and physical therapy effectively alleviated the pain with symptoms disappearing, and the abnormal signal reduced in MRI.
CONCLUSION
Acute postpartum inflammatory sacroiliitis is an uncommon disease with atypical symptoms. MRI examination may be the best diagnostic method. General NSAIDs and sacroiliac joint injections of local anesthetic plus corticosteroid under the guidance of fluoroscopy or ultrasound can achieve safe and effective treatment. This retrospective study was approved by the Committee on the Ethics of our hospital (No. 202101023).
TRIAL REGISTRY
Trial registration was performed in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , No. ChiCTR2100045656).
Topics: Female; Humans; Sacroiliitis; Retrospective Studies; Sacroiliac Joint; Magnetic Resonance Imaging; Postpartum Period; Anti-Inflammatory Agents, Non-Steroidal; Treatment Outcome
PubMed: 35396619
DOI: 10.1007/s00404-022-06534-z -
HSS Journal : the Musculoskeletal... Feb 2022Sacroiliac (SI) joint subchondral resorption on high-resolution magnetic resonance imaging (MRI) may be an early sign of the development of sacroiliitis. At our...
Sacroiliac (SI) joint subchondral resorption on high-resolution magnetic resonance imaging (MRI) may be an early sign of the development of sacroiliitis. At our institution, high-resolution intermediate-weighted (proton density) MRI sequences are used in the workup of suspected spondyloarthritis (SpA). : We sought to test the hypothesis that SI joint subchondral resorption might be a useful MRI feature in the diagnosis of sacroiliitis. : We retrospectively reviewed the records of patients with suspected SpA from a single rheumatologist's practice from January 1, 2010, to December 31, 2017. Patients had an MRI of the SI joints, using our institution's specialized protocol, and underwent standard physical examination and laboratory evaluation. The sensitivity and specificity of SI joint subchondral resorption in the identification of sacroiliitis were estimated using the clinical diagnosis as the reference standard and from a Bayesian latent class model with conditional dependence. : SI joint subchondral resorption on SI joint MRI was highly correlated with a positive diagnosis in patients worked up for axial SpA. It demonstrated superior sensitivity when compared with other MRI features used in the MRI diagnosis of sacroiliitis, such as bone marrow edema pattern, erosion, and ankylosis. Interobserver reliability was high for subchondral resorption. : This retrospective study found that subchondral resorption on MRI evaluation of the SI joints appeared to be a sensitive indicator of SpA, potentially of early disease. This imaging feature warrants evaluation in other cohorts of patients suspected of having axial SpA to validate diagnostic performance in diverse populations.
PubMed: 35087338
DOI: 10.1177/15563316211006710 -
European Radiology Mar 2024Sacroiliitis is commonly seen in patients with axial spondyloarthritis, in whom timely diagnosis and treatment are crucial to prevent irreversible structural damage.... (Review)
Review
Sacroiliitis is commonly seen in patients with axial spondyloarthritis, in whom timely diagnosis and treatment are crucial to prevent irreversible structural damage. Imaging has a prominent place in the diagnostic process and several new imaging techniques have been examined for this purpose. We present a summary of updated evidence-based practice recommendations for imaging of sacroiliitis. MRI remains the imaging modality of choice for patients with suspected sacroiliitis, using at least four sequences: coronal oblique T1-weighted and fluid-sensitive sequences, a perpendicular axial oblique sequence, and a sequence for optimal evaluation of the bone-cartilage interface. Both active inflammatory and structural lesions should be described in the report, indicating location and extent. Radiography and CT, especially low-dose CT, are reasonable alternatives when MRI is unavailable, as patients are often young. This is particularly true to evaluate structural lesions, at which CT excels. Dual-energy CT with virtual non-calcium images can be used to depict bone marrow edema. Knowledge of normal imaging features in children (e.g., flaring, blurring, or irregular appearance of the articular surface) is essential for interpreting sacroiliac joint MRI in children because these normal processes can simulate disease. CLINICAL RELEVANCE STATEMENT: Sacroiliitis is a potentially debilitating disease if not diagnosed and treated promptly, before structural damage to the sacroiliac joints occurs. Imaging has a prominent place in the diagnostic process. We present a summary of practice recommendations for imaging of sacroiliitis, including several new imaging techniques. KEY POINTS: • MRI is the modality of choice for suspected inflammatory sacroiliitis, including a joint-line-specific sequence for optimal evaluation of the bone-cartilage interface to improve detection of erosions. • Radiography and CT (especially low-dose CT) are reasonable alternatives when MRI is unavailable. • Knowledge of normal imaging features in children is mandatory for interpretation of MRI of pediatric sacroiliac joints.
PubMed: 38459347
DOI: 10.1007/s00330-024-10653-3 -
PloS One 2023Recently, several inflammatory markers, including the uric acid to HDL cholesterol ratio (UHR), triglyceride/HDL cholesterol ratio (THR), systemic inflammatory index...
Recently, several inflammatory markers, including the uric acid to HDL cholesterol ratio (UHR), triglyceride/HDL cholesterol ratio (THR), systemic inflammatory index (SII), and C-reactive protein to albumin ratio (CAR), have been reported to be associated with inflammatory conditions. However, their collective role in sacroiliitis has not been extensively studied. This study aims to investigate the general characteristics and inflammatory markers in patients with and without sacroiliitis, and to observe any differences in these parameters in subjects with active and chronic sacroiliitis. Patient with sacroiliitis who showed up in the Radiology Department of Abant Izzet Baysal University Hospital were enrolled. Patients diagnosed with sacroiliitis based on clinical symptoms, physical examination, and conventional radiography or MRI findings were included in the sacroiliitis group. Patients without sacroiliitis who present with back pain or hip pain but have normal radiographic findings were included in the control group. General characteristics, including age, sex, body mass index (BMI), medical history, and disease duration, were collected from all participants. Blood samples were collected to measure inflammatory markers, including UHR, THR, SII, and CAR. The collected data were compared between sacroiliitis and control groups. Subgroup analysis was also performed to compare the inflammatory markers between subjects with active and chronic sacroiliitis. The median UHR of the sacroiliitis and control subjects were 11% (3-20%) and 7% (3-13%), respectively (p<0.001). Serum UHR was significantly and positively correlated with CRP (r: 0.4, p = 0.001) and ferritin (r: 0.17, p = 0.045) levels. In ROC analysis, a UHR level higher than 8% has an 81% sensitivity and 64% specificity in detecting sacroiliitis (AUC: 0.8, p<0.001, 95% CI: 0.72-0.84). In conclusion, we suggest that UHR could provide useful data as an additional diagnostic tool in patients with sacroiliitis.
Topics: Humans; Sacroiliitis; Uric Acid; Cholesterol, HDL; Magnetic Resonance Imaging; Radiography; Biomarkers
PubMed: 37871023
DOI: 10.1371/journal.pone.0289624 -
Clinical Rheumatology Aug 2022Patients with Crohn's disease (CD) usually undergo magnetic resonance enterography (MRE) for evaluating small bowel involvement. Musculoskeletal symptoms are the most...
Asymptomatic sacroiliitis detected by magnetic resonance enterography in patients with Crohn's disease: prevalence, association with clinical data, and reliability among radiologists in a multicenter study of adult and pediatric population.
OBJECTIVES
Patients with Crohn's disease (CD) usually undergo magnetic resonance enterography (MRE) for evaluating small bowel involvement. Musculoskeletal symptoms are the most frequent extraintestinal manifestation in inflammatory bowel diseases, especially in CD, with sacroiliitis at imaging occurring in about 6-46% of patients and possibly correlating with axial spondyloarthritis. The primary study aim was to assess the prevalence of sacroiliitis in adult and pediatric patients with CD performing an MRE. We also evaluated the inter-rater agreement for MRE sacroiliitis and the association between sacroiliitis and patients' clinical data.
METHOD
We retrospectively identified 100 adult and 30 pediatric patients diagnosed with CD who performed an MRE between December 2012 and May 2020 in three inflammatory bowel disease centers. Two radiologists assessed the prevalence of sacroiliitis at MRE. We evaluated the inter-rater agreement for sacroiliitis with Cohen's kappa and intraclass correlation coefficient statistics and assessed the correlation between sacroiliitis and demographic, clinical, and endoscopic data (Chi-square and Fisher's tests).
RESULTS
The prevalence of sacroiliitis at MRE was 20% in adults and 6.7% in pediatric patients. The inter-rater agreement for sacroiliitis was substantial (k = 0.62, p < 0.001) in the adults and moderate (k = 0.46, p = 0.011) in the pediatric cohort. Age ≥ 50 years and the time between CD diagnosis and MRE (≥ 86.5 months) were significantly associated with sacroiliitis in adult patients (p = 0.049 and p = 0.038, respectively).
CONCLUSIONS
Sacroiliitis is a frequent and reliable abnormality at MRE in adult patients with CD, associated with the age of the patients ≥ 50 years and CD duration.
Topics: Adult; Child; Child, Preschool; Crohn Disease; Humans; Inflammatory Bowel Diseases; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Middle Aged; Prevalence; Radiologists; Reproducibility of Results; Retrospective Studies; Sacroiliitis
PubMed: 35389115
DOI: 10.1007/s10067-022-06143-w