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The Turkish Journal of Pediatrics 2020Familial Mediterranean fever (FMF) is an autosomal-recessive auto-inflammatory disorder characterized by recurrent episodes of fever with serositis. Sacroiliitis... (Review)
Review
BACKGROUND AND OBJECTIVES
Familial Mediterranean fever (FMF) is an autosomal-recessive auto-inflammatory disorder characterized by recurrent episodes of fever with serositis. Sacroiliitis associated with FMF is very rare, especially in children. We aimed to describe the demographic, clinical, laboratory features, and treatment responses of pediatric patients with FMF -related sacroiliitis.
METHODS
The study consisted of seven pediatric patients younger than 16 years, diagnosed with sacroiliitis associated with FMF between 2010 and 2017. Medical records of patients were retrospectively evaluated. Sacroiliitis was diagnosed based on magnetic resonance imaging. We also reviewed previous studies of FMF related sacroiliitis.
RESULTS
Five of the seven patients (male:female ratio of 5:2) had a M694V (homozygous) mutation, one patient had a M694V (heterozygous) mutation, and one patient had a V726A (heterozygous) mutation. All patients were HLA-B27 negative. One of the cases achieved remission with colchicine plus non-steroidal anti-inflammatory drug treatment, and one patient`s symptoms were managed by the addition of sulfasalazine. Four patients responded to etanercept treatment, and one patient`s symptoms were suppressed with canakinumab.
CONCLUSION
Sacroiliitis can be seen in pediatric FMF patients suffering with inflammatory back pain. This manifestation generally occurs in FMF patients who have M694V mutation. Etanercept could likely show a beneficial effect in patients who are resistant to disease modifying anti-rheumatic drugs and non-steroidal anti-inflammatory drugs. In addition, canakinumab treatment should be considered as a successful alternative therapy in this rare group of patients.
Topics: Child; Colchicine; Familial Mediterranean Fever; Female; Homozygote; Humans; Male; Mutation; Pyrin; Retrospective Studies; Sacroiliitis
PubMed: 32419408
DOI: 10.24953/turkjped.2020.02.002 -
Clinical and Experimental Rheumatology Jul 2022Axial involvement affects 25-70% of psoriatic arthritis (PsA) patients, depending on the criteria used for its definition. Efforts are underway to clarify the...
OBJECTIVES
Axial involvement affects 25-70% of psoriatic arthritis (PsA) patients, depending on the criteria used for its definition. Efforts are underway to clarify the similarities and differences between axial-PsA and ankylosing spondylitis (AS). We aimed to compare, in a real-world setting, axial-PsA and AS, in terms of demographic, radiologic and clinical (musculoskeletal and extra-articular) characteristics, with a focus on comorbidities.
METHODS
All AS (New York criteria, n=128) and PsA patients (CASPAR criteria, n=78) with axial involvement who were regularly followed-up in the outpatients' rheumatology clinics from two tertiary hospitals (December 2018-July 2020) were included. Demographic, radiologic and clinical characteristics were recorded and compared between the two groups. For comorbidities (coronary disease, cerebrovascular accidents, hypertension, diabetes mellitus, dyslipidaemia, depression, osteoporosis, and malignancies), adjustments were made for relevant confounders.
RESULTS
AS patients were younger (p=0.05) and were diagnosed at a younger age (p=0.002), more frequently of male gender (p=0.04), had lower BMI (p=0.006) and they were more frequently HLA-B27-positive (p=0.006). In AS patients, peripheral arthritis, dactylitis and nail involvement were less common (p=0.001 for all), in contrast to eye (p=0.001) and bowel involvement (p=0.004). Frequency of radiologic abnormalities in the spine was similar between the two groups while sacroiliitis was more often bilateral in AS and unilateral in axial-PsA. Comorbidities, including cardiovascular-related ones, were comparable between AS and axial-PsA, apart from depression which was more frequent in axial-PsA (p=0.07 in logistic regression).
CONCLUSIONS
AS and axial-PsA have certain clinical and radiologic differences. Comorbidities were comparable, while depression was more common in axial-PsA.
Topics: Arthritis, Psoriatic; Humans; Male; Sacroiliitis; Spine; Spondylitis, Ankylosing
PubMed: 34369366
DOI: 10.55563/clinexprheumatol/8zn9z8 -
Physics in Medicine and Biology Feb 2024Sacroiliitis is an early pathological manifestation of ankylosing spondylitis (AS), and a positive sacroiliitis test on imaging may help clinical practitioners diagnose...
Sacroiliitis is an early pathological manifestation of ankylosing spondylitis (AS), and a positive sacroiliitis test on imaging may help clinical practitioners diagnose AS early. Deep learning based automatic diagnosis algorithms can deliver grading findings for sacroiliitis, however, it requires a large amount of data with precise labels to train the model and lacks grading features visualization. In this paper, we aimed to propose a radiomics and deep learning based deep feature visualization positive diagnosis algorithm for sacroiliitis on CT scans. Visualization of grading features can enhance clinical interpretability with visual grading features, which assist doctors in diagnosis and treatment more effectively.The region of interest (ROI) is identified by segmenting the sacroiliac joint (SIJ) 3D CT images using a combination of the U-net model and certain statistical approaches. Then, in addition to extracting spatial and frequency domain features from ROI according to the radiographic manifestations of sacroiliitis, the radiomics features have also been integrated into the proposed encoder module to obtain a powerful encoder and extract features effectively. Finally, a multi-task learning technique and five-class labels are utilized to help with performing positive tests to reduce discrepancies in the evaluation of several radiologists.On our private dataset, proposed methods have obtained an accuracy rate of 87.3%, which is 9.8% higher than the baseline and consistent with assessments made by qualified medical professionals.The results of the ablation experiment and interpreting analysis demonstrated that the proposed methods are applied in automatic CT scan sacroiliitis diagnosis due to their excellently interpretable and portable advantages.
Topics: Humans; Sacroiliitis; Sacroiliac Joint; Spondylitis, Ankylosing; Tomography, X-Ray Computed; Algorithms; Magnetic Resonance Imaging
PubMed: 38237177
DOI: 10.1088/1361-6560/ad2010 -
BMC Musculoskeletal Disorders Sep 2020Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit. Isotretinoin is an effective treatment option for severe acne. The aim of this study...
BACKGROUND/ OBJECTIVES
Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit. Isotretinoin is an effective treatment option for severe acne. The aim of this study was to evaluate musculoskeletal side effects of systemic isotretinoin treatment.
METHODS
Ninety-four patients with acne vulgaris and 100 sex- and age-matched controls were enrolled in this study. Only the patients who had musculoskeletal symptoms were evaluated in this study. All participants were firstly assessed by a dermatologist. The patients were asked whether they had any musculoskeletal symptoms after isotretinoin treatment, if so, the feature and duration of the symptoms were recorded. The dosage of the drug, treatment duration, incidence of arthralgia, myalgia, low back pain, sacroiliitis and tendinopathy and laboratory test results were noted. The severity of pain was assessed by visual analog scale (VAS). The severity of acne vulgaris was evaluated by Global Acne Grading Scale (GAGS). Sacroiliac radiography, magnetic resonance imaging (MRI) and rheumatologic blood tests were requested from the patients meeting Assessment of Spondyloarthritis International Society (ASAS) criteria.
RESULTS
Of the 94 patients, 71 were female and 23 were male. 47.9% of the patients had arthralgia, 53.2% had myalgia, 70.2% (66) had low back pain, 11.7% had sacroiliitis and 4.3% had tendinopathy. 37.8% of 66 patients with low back pain had inflammatory pain and 62.2% had mechanical pain. Bone marrow edema consistent with sacroiliitis was detected by sacroiliac MRI in 11 patients with inflammatory back pain. The median total cumulative dose of isotretinoin was significantly higher in patients with low back pain than in patients without low back pain (p = 0.014). There was no significant correlation between cumulative dose of drug, treatment duration and VAS with ESR and CRP (p > 0.05). Also no correlation was found between GAGS scores and musculoskeletal symptoms (p > 0.05).
CONCLUSION
Low back pain is one of the very common complications of isotretinoin. It can be mostly mechanical or inflammatory. Isotretinoin-induced low back pain is dose-related, and inflammatory back pain without sacroiliitis is also frequent. The clinicians should be aware of the back pain may be a reflective of sacroiliitis during isotretinoin usage.
Topics: Acne Vulgaris; Cross-Sectional Studies; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Sacroiliitis
PubMed: 32977793
DOI: 10.1186/s12891-020-03656-w -
Arthritis & Rheumatology (Hoboken, N.J.) Dec 2023We aimed to develop and validate a fully automated machine learning (ML) algorithm that predicts bone marrow edema (BME) on a quadrant level in sacroiliac (SI) joint...
OBJECTIVE
We aimed to develop and validate a fully automated machine learning (ML) algorithm that predicts bone marrow edema (BME) on a quadrant level in sacroiliac (SI) joint magnetic resonance imaging (MRI).
METHODS
A computer vision workflow automatically locates the SI joints, segments regions of interest (ilium and sacrum), performs objective quadrant extraction, and predicts presence of BME, suggestive of inflammatory lesions, on a quadrant level in semicoronal slices of T1/T2-weighted MRI scans. Ground truth was determined by consensus among human readers. The inflammation classifier was trained using a ResNet18 backbone and five-fold cross-validated on scans of patients with spondyloarthritis (SpA) (n = 279), postpartum individuals (n = 71), and healthy subjects (n = 114). Independent SpA patient MRI scans (n = 243) served as test data set. Patient-level predictions were derived from aggregating quadrant-level predictions, ie, at least one positive quadrant.
RESULTS
The algorithm automatically detects the SI joints with a precision of 98.4% and segments ilium/sacrum with an intersection over union of 85.6% and 67.9%, respectively. The inflammation classifier performed well in cross-validation: area under the curve (AUC) 94.5%, balanced accuracy (B-ACC) 80.5%, and F1 score 64.1%. In the test data set, AUC was 88.2%, B-ACC 72.1%, and F1 score 50.8%. On a patient level, the model achieved a B-ACC of 81.6% and 81.4% in the cross-validation and test data set, respectively.
CONCLUSION
We propose a fully automated ML pipeline that enables objective and standardized evaluation of BME along the SI joints on MRI. This method has the potential to screen large numbers of patients with (suspected) SpA and is a step closer towards artificial intelligence-assisted diagnosis and follow-up.
Topics: Female; Humans; Sacroiliac Joint; Bone Marrow; Artificial Intelligence; Spondylarthritis; Bone Marrow Diseases; Inflammation; Magnetic Resonance Imaging; Edema; Machine Learning; Sacroiliitis
PubMed: 37410803
DOI: 10.1002/art.42650 -
Arthritis Research & Therapy Apr 2021Radiographs of the sacroiliac joints are commonly used for the diagnosis and classification of axial spondyloarthritis. The aim of this study was to develop and validate...
BACKGROUND
Radiographs of the sacroiliac joints are commonly used for the diagnosis and classification of axial spondyloarthritis. The aim of this study was to develop and validate an artificial neural network for the detection of definite radiographic sacroiliitis as a manifestation of axial spondyloarthritis (axSpA).
METHODS
Conventional radiographs of the sacroiliac joints obtained in two independent studies of patients with axSpA were used. The first cohort comprised 1553 radiographs and was split into training (n = 1324) and validation (n = 229) sets. The second cohort comprised 458 radiographs and was used as an independent test dataset. All radiographs were assessed in a central reading session, and the final decision on the presence or absence of definite radiographic sacroiliitis was used as a reference. The performance of the neural network was evaluated by calculating areas under the receiver operating characteristic curves (AUCs) as well as sensitivity and specificity. Cohen's kappa and the absolute agreement were used to assess the agreement between the neural network and the human readers.
RESULTS
The neural network achieved an excellent performance in the detection of definite radiographic sacroiliitis with an AUC of 0.97 and 0.94 for the validation and test datasets, respectively. Sensitivity and specificity for the cut-off weighting both measurements equally were 88% and 95% for the validation and 92% and 81% for the test set. The Cohen's kappa between the neural network and the reference judgements were 0.79 and 0.72 for the validation and test sets with an absolute agreement of 90% and 88%, respectively.
CONCLUSION
Deep artificial neural networks enable the accurate detection of definite radiographic sacroiliitis relevant for the diagnosis and classification of axSpA.
Topics: Deep Learning; Humans; Magnetic Resonance Imaging; Radiography; Sacroiliac Joint; Sacroiliitis; Spondylarthritis
PubMed: 33832519
DOI: 10.1186/s13075-021-02484-0 -
BMJ Case Reports May 2023Although SARS-CoV-2 syndrome primarily affects the lungs, systemic manifestations have been reported. New rheumatic immune-mediated inflammatory diseases have been...
Although SARS-CoV-2 syndrome primarily affects the lungs, systemic manifestations have been reported. New rheumatic immune-mediated inflammatory diseases have been reported following SARS-CoV-2 infection. We present a case of a woman in her mid-30s who developed inflammatory back pain due to bilateral sacroiliitis with erosions after contracting SARS-CoV-2 infection. Her inflammatory markers on presentation were normal. MRI of the sacroiliac joints demonstrated bone marrow oedema and erosive changes in both sacroiliac joints. As the patient was intolerant to non-steroidal anti-inflammatory drugs, adalimumab 40 mg subcutaneous (SC) injection was administered, which improved her symptoms in 8 weeks. However, due to the drug's side effects, SC adalimumab was switched to intravenous infliximab. The patient is currently tolerating her intravenous infliximab well and has experienced significant improvement in her symptoms. We reviewed the current literature on the prevalence of axial spondyloarthropathy after SARS-CoV-2 infection.
Topics: Female; Humans; Spondylarthritis; Infliximab; Adalimumab; COVID-19; SARS-CoV-2; Sacroiliac Joint; Sacroiliitis; Magnetic Resonance Imaging; Rheumatic Diseases; Pain
PubMed: 37230746
DOI: 10.1136/bcr-2022-252985 -
The Journal of the American Academy of... Dec 2021Identifying the specific source of gluteal pain can elude the most seasoned orthopaedic diagnosticians. Patients will often present with a protracted course of symptoms,...
Identifying the specific source of gluteal pain can elude the most seasoned orthopaedic diagnosticians. Patients will often present with a protracted course of symptoms, and failure to successfully identify and treat the underlying etiology leads to frustration for both patient and clinician. Pain deep in the buttocks can arise from compression, inflammation, or injury of one or more of the structures in this anatomically dense area. Although sacroiliitis, hip arthritis, and trochanteric bursitis may also masquerade as gluteal pain, sciatic nerve irritation in its various presentations causes a substantial percentage of cases. Deep gluteal syndrome, hamstring syndrome, and ischiofemoral impingement can have overlapping presentations but can be differentiated by clinical examination and judiciously placed diagnostic corticosteroid injections. Although nonsurgical management, including physical therapy, relative rest, and injections represent the mainstay of treatment, open and endoscopic surgical approaches have yielded encouraging success rates in refractory cases.
Topics: Humans; Orthopedic Procedures; Orthopedics; Pain; Physical Examination; Sciatic Nerve
PubMed: 34874333
DOI: 10.5435/JAAOS-D-21-00707 -
RMD Open May 2022Axial spondyloarthritis (axSpA) comprises both radiographic and non-radiographic disease. However, the paucity of specific objective measures for the disease and current...
OBJECTIVE
Axial spondyloarthritis (axSpA) comprises both radiographic and non-radiographic disease. However, the paucity of specific objective measures for the disease and current classification criteria showing suboptimal specificity contribute to disease heterogeneity observed in clinical practice and research. We used a historical cohort of patients with axSpA to assess sources of heterogeneity.
METHODS
The study involved 363 axSpA probands recruited from membership of the Swiss Ankylosing Spondylitis Patient Society. Participants underwent examination by a rheumatologist, completed questionnaires and provided blood samples for HLA typing. Patients underwent radiography of sacroiliac joints and were categorised according to the New York (NY) criteria (ankylosing spondylitis (AS) or non-radiographic axSpA (nr-axSpA)) and HLA-B27 status. Genetic characterisation by single nucleotide polymorphism microarray was performed and AS polygenic risk scores (PRS) were calculated.
RESULTS
Considerable heterogeneity was observed. The male to female ratio for AS (NY+) was 3:1, but 1:1 for nr-axSpA. For HLA-27(+) AS, the ratio was 2.5:1, but nearly 1:1 for HLA-B27(-) disease. Women with nr-axSpA had strikingly lower mean PRS and lower HLA-B27 prevalence than men with nr-axSpA or NY(+) male and female patients with AS. PRS was able to distinguish male but not female patients with nr-axSpA from related healthy first-degree relatives. Radiographic sacroiliitis was strongly associated with HLA-B27, especially in men.
CONCLUSION
Women clinically diagnosed with axSpA but without radiographic sacroiliitis as a group have a disease that is distinct from AS by the modified New York criteria overall and from nr-axSpA in men. Given the high degree of heterogeneity, stratified or adjusted analysis of effectiveness studies is indicated, taking genetics, sex and radiographic damage (sacroiliitis) into account.
Topics: Axial Spondyloarthritis; Female; HLA-B27 Antigen; Humans; Male; Sacroiliitis; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 35523521
DOI: 10.1136/rmdopen-2022-002302 -
The role of lymphocyte-monocyte ratio on axial spondyloarthritis diagnosis and sacroiliitis staging.BMC Musculoskeletal Disorders Jan 2021Axial spondyloarthritis (axial SpA) is a chronic inflammatory disorder could lead to disability due to the failure of timely treatment. The role of...
BACKGROUND
Axial spondyloarthritis (axial SpA) is a chronic inflammatory disorder could lead to disability due to the failure of timely treatment. The role of lymphocyte-to-monocyte ratio (LMR) in axial SpA remains unclear. The aim of this study was to investigate the role of LMR in axial SpA diagnosis, disease activity classification and sacroiliitis staging.
METHODS
Seventy-eight axial SpA patients [51males and 27 females; mean age 41.0 (29-52) years] and 78 healthy controls (HCs) [55males and 23 females; mean age 40 (30-53) years] were enrolled in this study. The diagnosis of axial SpA was performed according to the New York criteria or the Assessment of Spondyloarthritis international Society (ASAS) classification criteria, whereas the staging of sacroiliitis in axial SpA patients was determined by X-ray examination. Comparisons of LMR levels between groups were performed using t test. Pearson or Spearman correlation analysis were used to assess correlations between LMR and other indicators. Receiver operating characteristic (ROC) curves were used to determine the role of LMR in the diagnosis of axial SpA.
RESULTS
Higher neutrophil-to-lymphocyte ratio(NLR), red blood cell distribution width(RDW), platelet-to-lymphocyte ratio(PLR), mean platelet volume(MPV), erythrocyte sedimentation rate (ESR), and C-reactive protein(CRP) levels and lower red blood cell (RBC), hemoglobin (Hb), Hematocrit (Hct), LMR, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin/globulin (A/G) levels were noted in axial SpA patients compared to HCs. Positive correlations were observed between LMR and RBC, Hb, Hct and A/G, whereas negative correlations were found between LMR and NLR, PLR, AST, and TBIL (P < 0.05). ROC curves showed that the area under the curve (AUC) for LMR in the diagnosis of ankylosing spondylitis was 0.803 (95% CI = 0.734-0.872) with a sensitivity and specificity of 62.8 and 87.2%, respectively, and the AUC (95% CI) for the combination of ESR, CRP and LMR was 0.975 (0.948-1.000) with a sensitivity and specificity of 94.9 and 97.4%, respectively. LMR levels were lower (P < 0.05) and significant differences in LMR values were observed among different stages (P < 0.05).
CONCLUSIONS
Our study suggested that LMR might be an important inflammatory marker to identify axial SpA and assess disease activity and X-ray stage of sacroiliitis.
Topics: Adult; Female; Humans; Lymphocytes; Monocytes; New York; Sacroiliitis; Spondylarthritis
PubMed: 33453722
DOI: 10.1186/s12891-021-03973-8