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Results for “Sacroiliitis”

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At least 19 recordsLinked to original sources

PubMed1999

Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography. A prospective, longitudinal study.

OBJECTIVE: To investigate the diagnostic value of magnetic resonance imaging (MRI) in the detection of early sacroiliitis. METHODS: Twenty-five consecutive HLA-B27 positive patients with inflammatory low back pain and < or = grade 2 unilateral sacroiliitis on conventional radiography (modified New York criteria) were studied. Erythrocyte sedimentation rate, C-reactive protein, plain radiography (PR), and MRI of the sacroiliac (SI) joints were obtained at study entry and PR of the SI joints after 3 years. Each radiograph and MR image set was interpreted independently. SI joints were scored according to the modified New York Criteria for radiological sacroiliitis. MRI scans were also scored for the presence of subchondral marrow edema. The relationship between > or = grade 2 sacroiliitis (by modified New York criteria for radiological sacroiliitis) shown on MRI and the subsequent development of > or = grade 2 sacroiliitis on PR after 3 years was investigated. RESULTS: At study entry > or = grade 2 sacroiliitis was found on MRI in 36 of 50 SI joints. Edema was found in 20 of 50 SI joints. After 3 years > or = grade 2 sacroiliitis was found on PR in 21 of 44 SI joints. The positive predictive value of > or = grade 2 sacroiliitis on MRI for the development of > or = grade 2 sacroiliitis on PR after 3 years was 60%; sensitivity was 85% and specificity 47%. CONCLUSION: Our data suggest that MRI of the SI joints can be used to identify sacroiliitis earlier than PR.

Adult↗

PubMed2003

Clinical assessment of sacroiliitis and HLA-B27 are poor predictors of sacroiliitis diagnosed by magnetic resonance imaging in psoriatic arthritis.

OBJECTIVE: To determine the frequency and clinical predictors of sacroiliitis diagnosed by magnetic resonance imaging (MRI) in a psoriatic arthritis (PsA) population. METHODS: The studied comprised 103 patients with PsA. A careful clinical assessment for sacroiliitis was made from history and examination, and HLA-B27 testing was performed. Sixty-eight patients underwent tilted coronal fat-saturated T1-weighted and STIR MRI of the sacroiliac joints. RESULTS: Clinical features of moderate or severe sacroiliitis were found in 24/68 (35%) patients. MRI features of sacroiliitis were found in 26/68 (38%) patients. Clinical features of sacroiliitis were present in 14/42 (33%) with normal MRI scans and 10/26 (38%) with abnormal scans (normal vs abnormal scans, P = 0.7). The presence of sacroiliitis on MRI was associated with restricted spinal movements (P = 0.004) and the duration of PsA (P = 0.04). There was no correlation between HLA-B27 and sacroiliitis diagnosed by MRI. CONCLUSION: Sacroiliitis diagnosed by MRI occurs commonly in PsA but is difficult to detect clinically.

Adult↗

PubMed2002

The influence of patient characteristics, disease variables, and HLA alleles on the development of radiographically evident sacroiliitis in juvenile idiopathic arthritis.

OBJECTIVE: To assess the frequency of sacroiliitis and the radiographic and clinical outcome in juvenile idiopathic arthritis (JIA) and determine patient characteristics, early disease variables, and genetic markers that predict development of sacroiliitis. METHODS: We performed a retrospective cohort study of 314 (79%) of the 400 JIA patients first admitted to the hospital between 1980 and 1985. The participants were examined after a median disease duration of 14.9 years (range 11.7-25.1). Radiographs of the sacroiliac joints, hips, ankles, and tarsi were obtained and studied in a blinded manner by 2 radiologists. The presence of HLA-DRB1 and DPB1 alleles was determined by genotyping and that of HLA-B27 by serologic testing. Variables relating to the onset and course of the disease were obtained by chart reviews. RESULTS: Twenty (6%) of the JIA patients developed radiographic sacroiliitis according to the New York criteria. In 9 patients (45%), sacroiliitis had not been demonstrated before the followup examination. At followup, spinal flexion (lateral and anterior) was reduced in 70-75% of patients with sacroiliitis and in 30-35% of those without sacroiliitis. Compared with the JIA patients without sacroiliitis, those with sacroiliitis more frequently had inflammatory back pain, enthesitis, radiographic changes in the hips and calcanei, erosions of any peripheral joint, and uveitis. Predictors of sacroiliitis were HLA-B27, absence of DPB1*02, hip joint involvement within the first 6 months, and disease onset after age 8 years. The following factors were more common among patients in whom sacroiliitis developed than in other JIA patients: DRB1*04, male sex, family history of ankylosing spondylitis, psoriasis, inflammatory back pain, and enthesitis within the first 6 months. CONCLUSION: In the current study, radiographically evident sacroiliitis had developed in 6% of JIA patients after a median disease duration of 14.9 years. HLA-B27, absence of DPB1*02, late onset of disease, and early hip involvement were predictors of sacroiliitis.

Adolescent↗

PubMed1999

Duplex and color Doppler sonographic findings in active sacroiliitis.

OBJECTIVE: The aim of this study was to describe the duplex and color Doppler sonographic findings in active sacroiliitis. SUBJECTS AND METHODS: Forty-one joints in 21 patients with active sacroiliitis, 20 sacroiliac joints in 10 patients with osteoarthritis, and 30 sacroiliac joints of 15 asymptomatic volunteers were investigated on duplex and color Doppler sonography. We investigated whether a vessel was present around the posterior portions of sacroiliac joints with color Doppler sonography. When an artery was detected, the resistive index (RI) was measured using duplex Doppler sonography in all groups and also after treatment in the patients with active sacroiliitis. RESULTS: Vascularization around the posterior portions of sacroiliac joints was seen in 41 joints of the 21 patients with active sacroiliitis, nine joints of six patients with osteoarthritis, and 13 joints of eight volunteers. The mean RI values were 0.62 +/- 0.13, 0.91 +/- 0.09, and 0.97 +/- 0.03, respectively. In the patients with active sacroiliitis, the mean RI value was 0.91 +/- 0.07 after therapy. The RI values for the patients with active sacroiliitis were significantly different from those of the patients with osteoarthritis (p < .001) and of the volunteers (p < .001). In addition, the RI values were significantly different before and after treatment in the patients with active sacroiliitis (p < .001). CONCLUSION: Vascularization around the posterior portions of sacroiliac joints increased and RI values decreased in patients with active sacroiliitis. Color and duplex Doppler sonography were able to reveal these changes and can be used in the diagnosis of active sacroiliitis and follow-up after treatment. Thus, RI values may be a quantitative indicator for clinical symptoms in patients with active sacroiliitis.

Adult↗

PubMed1994

Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients.

OBJECTIVE: To evaluate the new magnetic resonance imaging (MRI) method of dynamic MRI with fast imaging in the diagnosis of sacroiliitis among patients with spondylarthropathy. METHODS: Fifteen patients with a history of inflammatory back pain without radiographic evidence of grade II or greater sacroiliitis (group 1), 25 patients with definite ankylosing spondylitis (group 2), and 12 patients with noninflammatory spinal pain (controls) (group 3) were examined. Dynamic MRI with fast imaging was performed after intravenous bolus injection of the contrast agent gadolinium-diethylenetriamine pentaacetic acid. The degree of enhancement was graded as representing acute sacroiliitis, latent sacroiliitis, or no sacroiliitis. RESULTS: Acute sacroiliitis was detected in 22 of 30 sacroiliac (SI) joints in group 1 patients and in 27 of 50 SI joints in group 2 patients; latent sacroiliitis was seen in 25 of 80 SI joints in patients from groups 1 and 2. No group 3 patient was found to have sacroiliitis. CONCLUSION: Early sacroiliitis can be demonstrated by dynamic MRI in spondylarthropathy patients in whom abnormalities are not revealed by conventional radiography.

Adolescent↗

PubMed2001

A controlled study of sacroiliitis in Behçet's disease.

The aim of the study was to evaluate the prevalence of sacroiliitis in a group of patients with Behçet's disease (BD). Pelvic X-rays of 27 patients with BD responding to the International Study Group of BD and 30 controls (15 AS and 15 sciatica) were read blind and sacroiliac involvement was graded according to the New York criteria. In a second step, patients or controls with equivocal sacroiliitis had a sacroiliac CT scan. Two patients with BD (7.4%) and all patients with AS had evident bilateral sacroiliitis (at least grade 2). One patient with BD and two patients with sciatica had equivocal sacroiliitis (grade 1). CT confirmed sacroiliitis in the two patients with BD and eliminated inflammatory sacroiliitis in the three other patients with equivocal sacroiliitis showing mild degenerative lesions. A review of the literature showed that sacroiliitis and AS are rarely associated with BD. There remains insufficient evidence to suggest that sacroiliitis is an intrinsic feature of BD and that BD belongs to the group of SpA.

Adult↗

PubMed2006

Sacroiliitis as an initial manifestation of acute myelogenous leukemia.

Sacroiliitis is the most pathognomonic and earliest manifestation of ankylosing spondylitis. We herein report a 28-year-old female patient who presented with sacroiliitis as an initial manifestation of acute myelogenous leukemia (AML). She had a 3-month history of anemia and walking difficulty. Bone marrow findings revealed an increase of blasts with trilineage dysplasia. Although she was initially diagnosed with myelodysplastic syndrome (MDS), blasts rapidly increased and AML developed 1 month after the diagnosis of MDS with Sacroiliitis. Induction chemotherapy failed to induce a complete remission of AML, but it did effectively treat the sacroiliitis. However, the sacroiliitis relapsed when the leukemia cells progressed thereafter. Oral corticosteroids helped ameliorate the sacroiliitis. She underwent bone marrow transplantation (BMT) from an HLA-identical sister during a nonremission period; however, the leukemic cells began to rapidly increase from day 30 after BMT. The close relationship between the occurrence of sacroiliitis and AML suggested that autoimmune sacroiliitis was a paraneoplastic phenomenon of AML in this patient. Although autoimmune disorders develop in a substantial number of MDS patients, they are rarely observed in de novo AML. No previous report has described sacroiliitis as the initial manifestation of de novo AML.

Adrenal Cortex Hormones↗

PubMed1981

CT of sacroiliitis.

Sacroiliitis is often difficult to diagnose with certainty using conventional radiographs and radionuclide scanning. Computed tomography was used to study the sacroiliac joints in 20 consecutive patients clinically suspected of having sacroiliitis on initial evaluation. Of these 20 patients, 17 fulfilled conventional clinical criteria for sacroiliitis; computed tomography demonstrated changes of sacroiliitis in 12 of these 17 patients. CT revealed no changes of sacroiliitis in the three patients who failed to meet conventional clinical criteria for sacroiliitis. Conventional radiography demonstrated diagnostic changes of sacroiliitis in only five patients. Seven patients with CT changes of sacroiliitis had equivocal or negative conventional films. CT therefore seems superior to conventional radiography in detecting sacroiliitis.

Arthritis↗

PubMedDate not supplied

MR imaging of septic sacroiliitis.

Septic sacroiliitis is difficult to diagnose, causing delayed treatment and increased morbidity. The traditional imaging techniques for diagnosis have been CT and nuclear medicine. Our purpose was to determine the ability of MR imaging to detect septic sacroiliitis, to evaluate the features of septic sacroiliitis with MR, and to compare the relative detection rate of MR, CT, and nuclear medicine. All patients with a discharge diagnosis of septic sacroiliitis who were evaluated by MR imaging of the pelvis were retrospectively evaluated. Five patients were collected with six septic sacroiliac joints, which were also evaluated with CT, 99mTc-methylene diphosphonate bone scans, and 67Ga-citrate scans. Abnormalities consistent with sacroiliitis were seen in all sacroiliac joints both prospectively (impression from the initial report) and retrospectively on MR. In addition to the nonspecific MR findings of inflammation and/or fluid in the sacroiliac joint space, bone marrow of the sacrum and/or ilium, and iliopsoas muscle, fluid/inflammation was uniquely identified tracking posterior to the iliopsoas muscle in each of these patients with septic sacroiliitis. Even in retrospect, a definite diagnosis of sacroiliitis could be made in only five of six joints by 67Ga-citrate scans, three of six joints by CT scans, and one of six joints by 99mTc-methylene diphosphonate bone scans. These results suggest MR imaging may be a sensitive modality in the early diagnosis of septic sacroiliitis.

Adult↗

PubMed2003

Low back pain, sacroiliitis, and the relationship with HLA-B27 in Crohn's disease.

OBJECTIVE: To determine the prevalence of sacroiliitis in patients who have back pain in Crohn's disease (CD) using computed tomography (CT); and to reassess the association of sacroiliitis in CD with HLA-B27. METHODS: A total of 134 consecutive patients with CD completed a questionnaire about musculoskeletal symptoms. Those reporting low back pain were assessed, including plain radiographs and CT of the sacroiliac joints. HLA-B27 status was determined in patients with and without back pain. RESULTS: There were 70 (52%) patients with low back pain, of whom 31 (45%) had CT evidence of sacroiliitis. These were characterized by more frequent morning spinal stiffness and positive sacroiliac compression tests even when sacroiliitis was not suspected. Nine had previously recognized radiological and clinical ankylosing spondylitis (AS), and of these 78% were HLA-B27 positive. Of those with newly identified sacroiliitis, 14% were HLA-B27 positive. This frequency was not statistically dissimilar to the 9% HLA-B27 positivity of those without back pain. CONCLUSION: Sacroiliitis defined by CT is a common cause of low back pain in CD. A relationship of sacroiliitis and HLA-B27 could be confirmed only for those with classical AS. Our results accord with the possibility that sacroiliitis in CD is an isolated phenomenon, which is unrelated to HLA-B27 and which may evolve into classical spinal ankylosis in genetically susceptible subjects.

Adult↗

PubMed1998

Use of dynamic magnetic resonance imaging to detect sacroiliitis in HLA-B27 positive and negative children with juvenile arthritides.

OBJECTIVE: Involvement of the sacroiliac (SI) joints is a hallmark of the spondyloarthropathies (SpA), especially, in early and later stages of ankylosing spondylitis in adults. The significance of sacroiliitis in juvenile SpA is less clear and the diagnosis of juvenile SpA is difficult due to the mostly nonspecific or absent history of back pain in children and the time delay associated with the diagnosis of sacroiliitis by conventional radiographs. Our aim was to evaluate dynamic magnetic resonance imaging (MRI) of the SI joints in children and to assess the frequency and the determinants of SI joint involvement in juvenile SpA and other juvenile arthritides. METHODS: Clinical examinations and dynamic MRI were performed in 130 children < 16 years of age with joint complaints, 100 with probable SpA, and 30 controls. The degree of back pain was assessed by a visual analog scale (VAS) (0 = no pain, 10 = very severe pain). The following groups were defined before MRI investigation according to modified European Spondylarthropathy Study Group (ESSG) criteria for SpA: Group 1: undifferentiated SpA (uSpA, n = 41, 88% B27+); Group 2: differentiated SpA (n = 29, 97% B27+), comprising reactive arthritis (n = 16), ankylosing spondylitis (n = 9), psoriatic arthritis (n = 3), and arthritis in inflammatory bowel disease (n = 1); Group 3: patients with no signs of SpA other than oligoarthritis, here named juvenile chronic arthritis (JCA) II (n = 30, 93% B27+); Group 4: HLA-B27+ controls without arthritis (n = 12); and Group 5: HLA-B27-controls with various other non-SpA diagnoses (n = 18). MRI was evaluated according to published criteria allowing for differentiation between acute and chronic changes in SI joints. RESULTS: Acute sacroiliitis without chronic changes could only be detected by dynamic MRI: in 17 patients (11 in Group 1, 3 in Group 2, 3 in Group 3) together in 14/70 (20%) patients with SpA. All these 17 patients had normal pelvic radiographs. Using MRI acute and/or chronic sacroiliitis were found in 35 patients: 17/41 in Group 1 (41%), 15/29 in Group 2 (52%), and 3/30 (10%) patients in Group 3, but in no patients in Groups 4 and 5. Chronic SI joint changes > grade 1 were detected by MRI in 18/70 patients with SpA (25.7%). In comparison, radiographic changes > grade 1 were less often detected in 14/70 patients with SpA (20%) or 23/210 SI joints examined (11 %), compared to 29/210 SI joints found in the MRI examinations (14%) (p = 0.05). Among the 70 patients with SpA, those with MRI diagnosis of acute sacroiliitis had a significantly longer disease duration (62+/-34 vs 28+/-16 months; p = 0.01) and higher C-reactive protein (12+/-12 vs 9+/-14; p = 0.01), and also reported more back pain on VAS (4.3+/-3.6 vs 1.2+/-2.2; p = 0.001) than those without sacroiliitis. CONCLUSION: Dynamic MRI and MRI are useful to detect acute and chronic sacroiliitis in children. The main advantages in comparison with conventional radiographs are the ability to detect acute changes in the SI joints, the higher sensitivity to detect chronic changes, and clearly, the lack of radiation exposure; while the disadvantages are the high costs and the duration of the procedure. Sacroiliitis is fairly common in juvenile SpA and seems to be associated with disease intensity and duration.

Adolescent↗

PubMed2000

Imaging of sacroiliitis.

Inflammation of one or both sacroiliac joints is a characteristic feature of patients with spondyloarthropathies (SpA). Sacroiliitis often leads to inflammatory back pain (IBP). IBP and asymmetric peripheral arthritis of the lower limbs are the main clinical symptoms and criteria for classification and diagnosis of SpA in which sacroiliac joints are uni- or bilaterally affected with an intensity ranging from mild to very severe inflammation resulting in partial or complete ankylosis Sacroiliitis is a very frequent feature of undifferntiated SpA. In ankylosing spondylitis (AS) inflammation in the axial skeleton occurs rarely in the absence of sacroiliitis. Objective evidence of sacroiliitis obtained by imaging procedures, especially x-rays, has always been part of diagnostic and classification criteria for AS. This is in contrast to spinal radiography which, however, has been recently included in a core set of outcome items to be assessed in clinical studies. In early and acute stages of sacroiliitis the diagnosis can be difficult because conventional radiographs -- which are known to have considerable intra- and interobserver variability -- may be normal. Since IBP is not a specific indicator of sacroiliitis there is need for valuable imaging techniques. Scintigraphy lacks specificity. Computed tomography (CT) is a very good method to demonstrate already established bony changes and magnetic resonance imaging (MRI) has the advantage of combining a good visualisation of the complicated anatomy of the sacroiliac joint with the ability to localise different degrees of inflammation and oedema and prove a possible spread to muscles as it occurs in septic sacroiliitis, an important differential diagnosis.

Diagnosis, Differential↗

PubMed1981

A hospital-based survey of radiological sacroiliitis and HLA-B27 and Cw2 in Navajo and Hopi Indians.

The frequency of radiological sacroiliitis and its association with HLA-B27, Cw1, and Cw2 were determined in Navajo and Hopi Indians coming to a community hospital. In the Navajo, the phenotype frequency of HLA-B27 was 36% and the frequency of sacroiliitis, 11%. In contrast, among the Hopi, the phenotype frequency of HLA-B27 was 9% and the frequency of sacroiliitis, 4%. Of the Navajo men, who had sacroiliitis and were HLA typed, 83% were HLA-B27 positive. The increased frequency of radiological sacroiliitis and were HLA typed, 83% were HLA-B27 positive. The increased frequency of radiological sacroiliitis in the Navajo was felt to be related to the high frequency of HLA-B27 and Reiter's syndrome in this population. HLA-B27, HLA-Cw1, and HLA-Cw2 are known to be in linkage disequilibrium, and about one-half of the men with sacroiliitis from both tribes had concurrence of HLA-B27 and HLA-Cw2.

Arizona↗

PubMed2004

Radiological sacroiliitis, a hallmark of spondylitis, is linked with CARD15 gene polymorphisms in patients with Crohn's disease.

BACKGROUND: Sacroiliitis is a common extraintestinal manifestation of Crohn's disease but its association with the HLA-B27 phenotype is less evident. Polymorphisms in the CARD15 gene have been linked to higher susceptibility for Crohn's disease. In particular, associations have been found with ileal and fibrostenosing disease, young age at onset of disease, and familial cases. OBJECTIVES: To investigate whether the presence of sacroiliitis in patients with Crohn's disease is linked to the carriage of CARD15 polymorphisms. METHODS: 102 consecutive patients with Crohn's disease were clinically evaluated by a rheumatologist. Radiographs of the sacroiliac joints were taken and assessed blindly by two investigators. The RFLP-PCR technique was used to genotype all patients for three single nucleotide polymorphisms (SNP) in the CARD15 gene. Every SNP was verified by direct sequencing. The HLA-B27 phenotype was determined. RESULTS: Radiological evidence of sacroiliitis with or without ankylosing spondylitis was found in 23 patients (23%), of whom only three were HLA-B27 positive. In contrast, 78% of patients with sacroiliitis carried a CARD15 variant v 48% of those without sacroiliitis (p = 0.01; odds ratio 3.8 (95% confidence interval, 1.3 to 11.5)). Multivariate analysis (logistic regression) showed that the association between sacroiliitis and CARD15 polymorphisms was independent of other CARD15 related phenotypes (ileal and fibrostenosing disease, young age at onset of disease, familial Crohn's disease) (p = 0.039). CONCLUSIONS: CARD15 variants were identified as genetic predictors of Crohn's disease related sacroiliitis. An association was demonstrated between these polymorphisms and an extraintestinal manifestation of Crohn's disease.

Adolescent↗

PubMed2000

MR imaging of septic sacroiliitis.

OBJECTIVE: To investigate the diagnostic value of magnetic resonance (MR) imaging in detecting septic sacroiliitis and to determine whether the MR characteristics allow this entity to be differentiated from sacroiliitis in spondylarthropathy (SpA). PATIENTS AND DESIGN: The imaging findings of 11 patients with septic sacroiliitis were retrospectively analyzed by two experienced radiologists. Radiographic surveys of the pelvis as well as computed tomography (CT) and MR images of the sacroiliac joints were available in all cases. Seven of the patients additionally underwent a follow-up MR examination. The MR imaging protocol comprised combinations of coronal and transverse T1-weighted spin-echo (SE) or fast SE sequences, T2-weighted gradient-echo (GE) sequences and short tau inversion recovery sequence (STIR) sequences as well as dynamic contrast-enhanced T1-weighted acquisitions. RESULTS: Three patients with a short disease history showed anterior and/or posterior subperiosteal infiltrations ("lava cleft phenomenon"), transcapsular infiltrations of juxtaarticular muscle layers, which obscured the fasciae, and periarticular bone marrow edema. The eight patients with more advanced stages of sacroiliitis additionally showed abscess formation, sequestration, and erosion. At follow-up MR examination (n=7) under systemic antibiotic treatment, the morphologic characteristics showed progression (n=1), regression (n=4), unchanged findings (n=1), or a mixed response (n=1). Clinical improvement precedes resolution of the MR findings. CONCLUSIONS: Anterior and/or posterior subperiosteal infiltrations and transcapsular infiltrations of juxtaarticular muscle layers were depicted in all patients. These MR imaging findings are characteristic of septic sacroiliitis and may be used to differentiate this entity from sacroiliitis in SpA.

Adolescent↗

PubMed2000

Subclinical sacroiliitis in inflammatory bowel disease: a clinical and follow-up study.

The aim of this study was to evaluate the clinical features, evolution and reliability of spondyloarthropathy criteria in a subset of patients with subclinical sacroiliitis and inflammatory bowel disease (IBD). All patients with IBD (n 62) attending a gastroenterology clinic from a referral centre were included to assess the prevalence of articular involvement. Patients were evaluated according to a specific protocol designed for the study, which included epidemiological and clinical variables, physical examination and radiological assessment. Only those with subclinical sacroiliitis were followed prospectively for 4 years. This group was visited every 6 months with the same initial protocol. Sacroiliac joints were studied using frontal and oblique X-ray views and graded according to New York criteria. HLA B27 typing was performed by serological methods in all patients and in 80 healthy controls. The reliability of Amor and ESSG criteria for spondyloarthropathy was evaluated. Fifteen patients (24%) presented with isolated subclinical sacroiliitis. In this group a higher frequency of peripheral arthritis and erythema nodosum was observed (p = NS compared to those without sacroiliitis). Most cases (60%) were grade II unilateral sacroiliitis. Three patients were HLA B27+ (p>0.05 compared to healthy controls). The resultant sensitivity of Amor's and ESSG criteria ranged from 40% to 46%. An unexpectedly high freuqency (9.5%) of psoriasis was observed in the whole group. There is a high prevalence of isolated subclinical sacroiliitis in IBD. This may represent a forme fruste of enteropathic ankylosing spondylitis, a stunted form of axial involvement because of therapy, or a third category of rheumatic disease associated with IBD. It may also represent a common characteristic of spondyloarthropathies, rather than a specific finding of IBD. The recently developed spondyloarthropathy criteria are not particularly helpful for the diagnosis of this milder form of spondyloarthropathy.

Adult↗

PubMed1996

Fat suppressed contrast enhanced MR imaging in the assessment of sacroiliitis.

OBJECTIVE: To investigate the role of Gd-DTPA enhancement in the diagnosis of sacroiliitis. PATIENTS AND METHODS: Fifteen patients with definite sacroiliitis, five subjects from an 'equivocal group', and five controls were imaged with Fast STIR, T1-weighted with fat suppression (T1FS) before and after Gd-DTPA. The 'equivocal group' included those who had abnormally high signal on Fast STIR images only suggestive of early sacroiliitis. The enhancement factor was calculated for T1FS images. Patients graded their symptoms at the time of MR imaging. The extent of abnormal enhancement was defined as none, local, or extensive. RESULTS: Fourteen patients with definite sacroiliitis and one patient from the 'equivocal group' demonstrated abnormal Gd-DTPA enhancement of their sacroiliac joints or adjacent subchondral marrow. Correlation between the patients' symptoms and maximal enhancement of the subchondral marrow was r = 0.75, P < 0.01, and the extent of abnormal enhancement was r = 0.68, P < 0.01. CONCLUSION: Fat suppressed Gd-DTPA or Fast STIR images can be used to assess disease activity in patients with sacroiliitis. Abnormal Gd-DTPA enhancement in the 'equivocal group' is important additional evidence suggesting the diagnosis of early sacroiliitis.

Adult↗

PubMed1999

Studying patients with inflammatory back pain and arthritis of the lower limbs clinically and by magnetic resonance imaging: many, but not all patients with sacroiliitis have spondyloarthropathy.

OBJECTIVE: Clinical and magnetic resonance imaging (MRI) data of 170 consecutive patients with inflammatory back pain (IBP) and/or oligoarthritis of the lower limbs were evaluated in a retrospective study. The aim was to determine the frequency of sacroiliitis and spondyloarthropathy (SpA) in this population, and to assess the significance of HLA B27 measurements for diagnosis in early disease. METHODS: Pelvic X-rays were performed in all IBP patients and dynamic MRI of the sacroiliac joints in patients with IBP who had indefinite results on sacroiliac X-rays (n = 32). RESULTS: European Spondyloarthropathy Study Group criteria for SpA were fulfilled by 106/170 patients (62.4%); eight additional patients had symptoms suggestive of SpA (4.7%). The most frequent SpA subset was undifferentiated SpA (uSpA), diagnosed in 46/106 patients (43.4%). Sacroiliitis was detected by MRI in 21/32 patients with IBP and unclear X-rays (65.6%). Of those, 14 were diagnosed as SpA and seven females with moderate unilateral sacroiliitis, but no features of SpA, also not on follow-up (at least 1 yr), were classified as undifferentiated sacroiliitis (US). Ten of the 14 SpA (71.4%) and none of the seven US patients were HLA B27 positive. CONCLUSION: HLA B27 positivity in IBP patients with MRI-proven sacroiliitis positively predicts SpA. uSpA is a frequent SpA subset. There are HLA B27-negative non-SpA patients with moderate unilateral sacroiliitis whom we propose to be classified as US.

Adult↗