RESUMO
Axial spondylarthritis in adulthood (SpAA) is frequently initially manifested as a sacroiliitis, whereas this not true for enthesitis-related arthritis (EAA), which begins in childhood and adolescence. Classically, EAA begins with peripheral arthritis and only a part transitions into a juvenile SpA (jSpA) or SpAA. The criteria used for classification of SpAA and EAA are currently being validated and revised. For the first time imaging is included for EAA. For both diseases nonsteroidal anti-inflammatory drugs (NSAID) are initially used therapeutically, followed by biologicals or synthetic targeted disease-modifying drugs in refractory courses. Steroids should be avoided in long-term treatment. For optimal transition and further care in adulthood, a close cooperation between internistic and pediatric rheumatologists is necessary.
Assuntos
Artrite Juvenil , Produtos Biológicos , Sacroileíte , Espondilartrite , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Juvenil/diagnóstico , Artrite Juvenil/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Criança , Humanos , Sacroileíte/diagnóstico , Sacroileíte/terapia , Espondilartrite/tratamento farmacológico , Espondilartrite/terapiaRESUMO
OBJECTIVES: To demonstrate a possible basis for a quantitative magnetic resonance imaging (MRI) approach that uses histographic analysis to determine bone marrow oedema (BME) and fat metaplasia at sacroiliac joints (SIJs) level in patients with axial spondyloarthritis (axSpA). METHODS: In this prospective, cross-sectional study, consecutive axSpA patients with inflammatory low back pain underwent 1.5-T MRI. MRI images were scored on a 4-point (0-3) scoring system both for BME and fat metaplasia by two radiologists. A region-of-interest based histographic quantitative analysis was used to assess MRI images. Using the area under the receiver operating characteristic curve (AUC-ROC) approach was tested the diagnostic accuracy of histographic analysis for detecting BME vs. BME and fat metaplasia on MRI images. RESULTS: 17 of the 43 patients (39.5%) included only had a BME lesion, while the remaining 26 patients (60.5%) had both BME and fat metaplasia at the SIJ level. Inter-rater agreement between readers was good (weighted kappa 0.643). On MRI images, BME and BME+fat metaplasia showed significant difference in histographic analysis (p<0.001), with an AUC-ROC of 0.898, and an optimal cut-off point of 311 at histographic analysis in the distinction of BME vs. fat metaplasia. CONCLUSIONS: Histographic analysis could represent a method for quantifying BME on MRI images of SIJs in patients with axSpA. This type analysis can provide important prognostic information and guide the choice of treatment in patients with sacroiliitis.
Assuntos
Tecido Adiposo/diagnóstico por imagem , Doenças da Medula Óssea/diagnóstico por imagem , Articulação Sacroilíaca/diagnóstico por imagem , Espondilartrite/complicações , Tecido Adiposo/patologia , Espondiloartrite Axial/diagnóstico por imagem , Espondiloartrite Axial/patologia , Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Doenças da Medula Óssea/etiologia , Estudos Transversais , Edema/diagnóstico por imagem , Edema/etiologia , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Imageamento por Ressonância Magnética/métodos , Metaplasia/diagnóstico por imagem , Metaplasia/patologia , Estudos Prospectivos , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico , Sacroileíte/terapia , Espondilartrite/diagnóstico por imagem , Espondilartrite/patologiaRESUMO
PURPOSE: With the aging population, it is clear that the demand for future chronic pain treatment modalities is at an all-time high. One of the newest treatment modalities that is gaining popularity with both practitioners and patients alike is that of regenerative medicine and the use of stem cells to treat chronic painful conditions. This article aims to distill the most recent, available data from both laboratory research and clinical trials to better illuminate the potentials for these therapies in the treatment of chronic pain. RECENT FINDINGS: There are numerous investigations underway using mesenchymal stem cells (MSCs) to treat painful, largely degenerative conditions. A large majority of these investigations focus on osteoarthritis of the knee and have demonstrated significantly improved pain scores. Some of these investigations have demonstrated significantly increased articular cartilage and meniscus growth as well as improved function. These studies have been smaller (n, 18) and need to be corroborated on a macrolevel. Platelet-rich plasma (PRP)-based therapies have been most extensively studied in the treatment of knee osteoarthritis. Multiple prospective and randomized trials and meta-analyses have afforded level I evidence in support of PRP's safety and efficacy in chronic knee pain demonstrating both decreased pain (via VAS) and increased functional status (via WOMAC and IKDC). There have been randomized controlled trials examining PRP therapies in treatment degenerative disc disease (intradiscal treatment), facet arthropathy (intra-facet injections), and sacroiliitis (SIJ) which have all yielded similar positive results. Each RTC demonstrated decreased pain scores and increased function but lacks the scale to derive concrete guidelines. Newer investigations are underway examining modified PRP formulas with increased fibrin (PRF) or various growth factors (PRGF) and have shown positive outcomes with respect to osteoarthritic conditions in small trials. Animal trials are underway further investigating these therapies as well as specific gene modulation therapies. This review of the most recent investigations into the application and uses of biologic stem cell-derived treatments for chronic painful conditions should act to illustrate the growing, favorable data for these types of modalities both with respect to pain control and functional improvement.
Assuntos
Dor Crônica/terapia , Transplante de Células-Tronco Mesenquimais , Plasma Rico em Plaquetas , Terapia Biológica , Fibrina , Humanos , Peptídeos e Proteínas de Sinalização Intercelular , Degeneração do Disco Intervertebral/terapia , Artropatias/terapia , Osteoartrite do Joelho/terapia , Sacroileíte/terapia , Articulação ZigapofisáriaRESUMO
The sacroiliac joint (SIJ) is a possible source of persistent or new onset pain after lumbar or lumbosacral fusion. The aim of this paper is to systematically review and analyze the available literature related to the incidence, diagnosis and management of sacroiliitis after spinal arthrodesis. The authors independently screened the titles and abstracts of all articles identified concerning sacroiliac joint pain after lumbar or lumbosacral fusion, to assess their suitability to the research focus. The average incidence of sacroiliitis after lumbar or lumbosacral arthrodesis was found to be 37 ± 28.48 (range 6-75), increasing directly to the number of fused segments involved, especially when the sacrum is included. The most accurate evaluation is the image-guided injection of anesthetic solutions in the joint. Surgery treatment may be considered when conservative therapy fails, with open surgery or with minimally invasive SIJ fusion. Although the risk of developing SIJ degeneration is unclear, the results indicate that pain and degeneration of SIJ develop more often in patients undergoing lumbosacral fusion regardless of the number of melting segments. The treatment of sacroiliitis appears to be independent of his etiology, with or without previous instrumentation on several levels.
Assuntos
Complicações Pós-Operatórias/etiologia , Sacroileíte/etiologia , Fusão Vertebral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Artrodese , Criança , Síndrome Pós-Laminectomia/etiologia , Síndrome Pós-Laminectomia/cirurgia , Síndrome Pós-Laminectomia/terapia , Feminino , Humanos , Incidência , Injeções Intra-Articulares , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Articulação Sacroilíaca/fisiopatologia , Articulação Sacroilíaca/cirurgia , Sacroileíte/diagnóstico , Sacroileíte/epidemiologia , Sacroileíte/terapia , Sacro/cirurgia , Adulto JovemRESUMO
BACKGROUND: This study compared clinical, laboratory and radiographic features of axial spondyloarthritis (axSpA) between ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA) of young male patients. Additionally, we sought factors which can predict the baseline inflammatory status of sacroiliac joint (SIJ) in axSpA. METHODS: We retrospectively reviewed the medical records of 322 patients who visited our hospital due to inflammatory back pain, and 159 male patients with axSpA were enrolled. Enrolled patients were divided into two groups, AS group and nrAxSpA group, and medical records, laboratory data, radiologic findings were collected and analyzed. RESULTS: Alternating buttock pain and CRP elevation were significantly frequent in AS patients than nrAxSpA patients (68.8% vs 41.3%, P = 0.001, 63.5% vs 37.1%, P = 0.002), and SPondyloArthritis Research Consortium of Canada (SPARCC) score of SIJ was higher in AS patients than nrAxSpA patients (14.0 vs 5.0, P < 0.0001). Baseline sacroiliitis severity, psoriasis, and CRP elevation had positive association in univariate and multivariate regression analysis for SIJ inflammatory SPARCC score. CONCLUSION: AS patients were more frequently in acute inflammatory state than nrAxSpA patients according to laboratory and MRI finding. Baseline sacroiliitis grade was significantly associated with baseline inflammatory SPARCC score of SIJ. AS patients might need more intense initial treatment to resolve active inflammatory lesion of SIJ and prevent further radiologic progression.
Assuntos
Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Adulto , Estudos Transversais , Progressão da Doença , Humanos , Imageamento por Ressonância Magnética , Masculino , Prognóstico , Estudos Retrospectivos , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/patologia , Sacroileíte/terapia , Índice de Gravidade de Doença , Espondilartrite/patologia , Espondilartrite/prevenção & controle , Adulto JovemRESUMO
OBJECTIVE: To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS: The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS: Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION: This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/terapia , Entesopatia/terapia , Terapia Ocupacional , Modalidades de Fisioterapia , Reumatologia/normas , Sacroileíte/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/efeitos adversos , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Produtos Biológicos/uso terapêutico , Consenso , Entesopatia/diagnóstico , Entesopatia/epidemiologia , Glucocorticoides/uso terapêutico , Humanos , Fatores de Risco , Sacroileíte/diagnóstico , Sacroileíte/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVE: To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS: The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS: Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION: This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Juvenil/terapia , Entesopatia/terapia , Glucocorticoides/uso terapêutico , Sacroileíte/terapia , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Artrite/terapia , Humanos , Injeções Intra-Articulares , Terapia Ocupacional , Modalidades de FisioterapiaRESUMO
The chronic joint inflammation in axial spondyloarthritis (axSpA) is characterized by infiltration of activated macrophages. The haptoglobin-hemoglobin receptor CD163 and the mannose receptor CD206 are strongly expressed on M2c and M2a macrophages, respectively. We measured the soluble forms of the receptors (sCD163 and sCD206) in plasma (PL) in two axSpA cohorts. All patients fulfil the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axSpA and/or the 1984 modified New York criteria for ankylosing spondylitis. The first cohort included anti-TNF-α treated patients with active axSpA (n = 30); the second cohort included patients in early disease stages (n = 38). Plasma sCD163 and sCD206 were both within the reference interval of healthy controls (HC), but sCD163 decreased slightly during anti-TNF-α treatment [baseline: 1.49 mg/L (IQR: 1.22-1.77 mg/L, 12 weeks: 1.29 (IQR: 1.09-1.57) mg/L, 20 weeks: 1.25 (IQR: 0.99-1.75) mg/L, 52 weeks: 1.39 (IQR: 1.15-1.78) mg/L], while sCD206 increased [baseline: 0.17 (IQR: 0.13-0.21) mg/L, 12 weeks: 0.19 (0.16-0.23) mg/L, 20 weeks: 0.20 (0.14-0.24) mg/L, 52: 0.19 (IQR: 0.14-0.23) mg/L], pointing toward a shift in polarization of involved macrophages. Plasma levels of sCD206 proved significantly higher in patients with early disease stages and definite radiological sacroiliitis (n = 10). This was not the case for sCD163. A significant increase in response to anti-TNF-α treatment, could suggest sCD206 as a marker of response to anti-TNF-α treatment, however, the potential for the two macrophage markers as diagnostic and prognostic indicators of disease in axSpA is weak.
Assuntos
Antígenos CD/sangue , Antígenos de Diferenciação Mielomonocítica/sangue , Lectinas Tipo C/sangue , Macrófagos/imunologia , Lectinas de Ligação a Manose/sangue , Receptores de Superfície Celular/sangue , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Adalimumab/uso terapêutico , Adulto , Anti-Inflamatórios/uso terapêutico , Antígenos CD/genética , Antígenos CD/imunologia , Antígenos de Diferenciação Mielomonocítica/genética , Antígenos de Diferenciação Mielomonocítica/imunologia , Biomarcadores/sangue , Movimento Celular , Estudos de Coortes , Diagnóstico Precoce , Feminino , Expressão Gênica , Humanos , Lectinas Tipo C/genética , Lectinas Tipo C/imunologia , Ativação de Macrófagos , Macrófagos/efeitos dos fármacos , Macrófagos/patologia , Masculino , Receptor de Manose , Lectinas de Ligação a Manose/genética , Lectinas de Ligação a Manose/imunologia , Pessoa de Meia-Idade , Radiografia , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/imunologia , Sacroileíte/imunologia , Sacroileíte/patologia , Sacroileíte/terapia , Solubilidade , Espondilartrite/imunologia , Espondilartrite/patologia , Espondilartrite/terapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/imunologiaRESUMO
BACKGROUND: Tuberculosis is the leading infectious cause of death worldwide. Among native Swiss people, tuberculosis is more common in older people than in younger people. Approximately 25-30% of reported cases of tuberculosis are purely extrapulmonary; skeletal tuberculosis is reported in 3-5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of tuberculous sacroiliitis with secondary psoas abscess, as this clinical picture is very rare. CASE PRESENTATION: A magnetic resonance imaging scan of an 85-year-old (Swiss-German) Caucasian woman with chronic left-sided hip pain and limitation of hip joint movement showed a progressive destruction of her sacroiliac joint and a large collection in her left iliopsoas muscle. Drainage of the abscess revealed pus; a polymerase chain reaction assay was positive for Mycobacterium tuberculosis complex. Tuberculous sacroiliitis with secondary iliopsoas abscess was diagnosed 9 months after the start of the symptoms. Combination treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. CONCLUSIONS: Sacroiliitis with secondary psoas abscess is an unusual cause of hip pain and is likely to be overlooked since joint pain of the lower extremity and lumbar pain are some of the most common complaints in older individuals. A high level of suspicion and invasive diagnostic procedures are needed for timely diagnosis of tuberculous sacroiliitis not only in immunocompromised patients living in or originating from endemic areas.
Assuntos
Abscesso do Psoas/diagnóstico , Articulação Sacroilíaca , Sacroileíte/diagnóstico , Tuberculose Osteoarticular/diagnóstico , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Feminino , Humanos , Abscesso do Psoas/terapia , Sacroileíte/terapia , Tuberculose Osteoarticular/terapiaRESUMO
BACKGROUND: The sacroiliac joints have complicated biomechanics. While the movements in the joints are small, they exert a significant effect on gait. This study aimed to assess how sacroiliac joint manipulation influences selected gait parameters. MATERIAL AND METHOD: The study enrolled 57 healthy subjects. The experimental group consisted of 26 participants diagnosed with dysfunction of one sacroiliac joint. The control group was composed of 31 persons. All subjects from the experimental group underwent sacroiliac joint manipulation. RESULTS: The experimental group showed significant lengthening of the step on both sides and the stride length in this group increased as well. Moreover, the duration of the stride increased (p=0.000826). The maximum midfoot pressure was higher and maximum heel pressure decreased. The differences were statistically significant. CONCLUSIONS: 1. Subclinical dysfunctions of the sacroiliac joints may cause functional gait disturbance. 2. Manipulation of the iliosacral joint exerts a significant effect on gait parameters, which may lead to improved gait economy and effec-tiveness. 3. Following manipulation of one iliosacral joint, altered gait parameters are noted on both the manipulated side and the contralateral side, which may translate into improved quality of locomotion.
Assuntos
Marcha/fisiologia , Manipulações Musculoesqueléticas , Articulação Sacroilíaca/fisiopatologia , Sacroileíte/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Sacroileíte/diagnósticoRESUMO
Spondyloarthritides (SpA) are inflammatory rheumatic diseases affecting the axial skeleton, peripheral joints and entheses, and also manifest at extraskeletal sites. According to the more recently introduced nomenclature, predominant axial SpA is distinguished from predominant peripheral SpA. Axial SpA is further divided into radiographic and nonradiographic axial SpA. Genetic factors are relevant, with HLA-B27 being most important. The interleukin 23/17 pathway seems to be relevant and points towards new therapeutic targets. Inflammatory back pain is the leading symptom in axial SpA and has certain characteristics. In addition, HLA-B27 and sacroiliitis on imaging are important for diagnosis. Therapy consists of physiotherapy, nonsteroidal anti-inflammatory drugs (first line) and biologicals (second line). Conventional disease-modifying antirheumatic drugs are effective only in peripheral arthritis.
Assuntos
Espondilite Anquilosante/diagnóstico , Anti-Inflamatórios não Esteroides/uso terapêutico , Produtos Biológicos/uso terapêutico , Terapia por Exercício , Antígeno HLA-B27/genética , Humanos , Interleucina-17/fisiologia , Interleucina-23/fisiologia , Sacroileíte/diagnóstico , Sacroileíte/genética , Sacroileíte/imunologia , Sacroileíte/terapia , Transdução de Sinais/fisiologia , Espondilite Anquilosante/genética , Espondilite Anquilosante/imunologia , Espondilite Anquilosante/terapia , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
In Japan, sacroiliitis is a very rare extraintestinal manifestation in patients with ulcerative colitis (UC), and it typically presents with intestinal symptoms. Radiography is used for diagnosis, and reveals erosions, sclerosis, and ankylosis, but magnetic resonance imaging is more useful for early detection. The treatment of spondyloarthropathy such as sacroiliitis and spondylitis includes physiotherapy, nonsteroidal anti-inflammatory drugs, sulfasalazine, and immunomodulators. In patients intolerant or cases refractory to these treatments, anti-tumor necrosis factor agents are recommended. Granulocyte and monocyte adsorption (GMA) apheresis was developed in Japan in the 1980s, and is currently used widely in clinical practice for UC patients. Unlike conventional medication, GMA apheresis has no serious adverse effects. We present the first report of a UC patient with sacroiliitis, who responded well to GMA therapy. GMA apheresis may be considered a new treatment option for UC-associated spondyloarthropathy that is refractory or tolerant to conventional treatment.
Assuntos
Remoção de Componentes Sanguíneos/métodos , Colite Ulcerativa/complicações , Colite Ulcerativa/terapia , Granulócitos , Monócitos , Sacroileíte/etiologia , Sacroileíte/terapia , Adulto , Colite Ulcerativa/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Sacroileíte/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
La tuberculosis es una de las principales causas infecciosas de muerte en el mundo, pese a que existe un tratamiento específico. La sacroileítis representa el 10% de la afectación ósea en la tuberculosis y sigue siendo una entidad de difícil diagnóstico y de tratamiento controvertido. Presentamos el caso de una mujer de 40 años, que comienza con dolor lumbar bajo, asociado a tumoración y fiebre. Luego de una demora inicial se llega al diagnóstico por punción biopsia. Recibe tratamiento médico. El conocimiento de esta enfermedad facilitará el diagnóstico temprano y su tratamiento. Se discuten la presentación clínica, los métodos auxiliares de diagnóstico y el tratamiento, y se presenta una revisión bibliográfica de la enfermedad. Nivel de Evidencia: IV
Tuberculosis is a worldwide known cause of death, even nowadays with specific treatment. Tuberculosis of the sacroiliac joint represents 10% of bone involvement in this disease; diagnosis still remains a challenge, and treatment is controversial. We present a 40-year-old woman with lower back pain, fever and a lower back mass. After an initial delay, diagnosis of tuberculosis of the sacroiliac joint was established by fine-needle aspiration of the joint. Awareness of this particular presentation will facilitate early diagnosis and treatment. Clinical presentation, diagnostic methods and treatment are discussed, and a bibliographic review of this entity is made. Level of Evidence: IV
Assuntos
Adulto , Sacro/patologia , Tuberculose Osteoarticular/diagnóstico , Sacroileíte/diagnóstico , Sacroileíte/terapiaRESUMO
Brucellosis is a zoonotic infection, which is still a major public health concern worldwide. Common clinical findings are usually nonspecific involving fever, arthralgia, myalgia, weakness and malaise. Since none of the symptoms of brucellosis is pathognomonic, it may have a similar course with various multisystemic diseases. In terms of focal involvement, sacroiliitis is the most common musculoskeletal manifestation in adult patients, while it is quite rare in pediatric patients. Blood culture is the gold standard in the diagnosis of brucellosis. In the absence of culture facilities, the diagnosis traditionally relies on serologic testing with a variety of agglutination tests such as the Rose Bengal test and the serum agglutination test. However, these agglutination tests are accompanied by frequent false negative results such as seen in prozone phenomenon, which may lead to diagnostic delays. In this article we present a rarely encountered pediatric brucellosis patient who had sacroiliitis-spondylitis, which are rarely reported in children, and exhibited prozone phenomenon in agglutination tests.
Assuntos
Brucelose/complicações , Brucelose/diagnóstico , Sacroileíte/etiologia , Espondilite/etiologia , Vértebras Torácicas , Fatores Etários , Brucelose/terapia , Criança , Humanos , Masculino , Sacroileíte/diagnóstico , Sacroileíte/terapia , Espondilite/diagnóstico , Espondilite/terapiaAssuntos
Querubismo/complicações , Sacroileíte/complicações , Espondiloartropatias/complicações , Adolescente , Querubismo/diagnóstico , Querubismo/etnologia , Humanos , Judeus , Imageamento por Ressonância Magnética , Masculino , Prognóstico , Radiografia Panorâmica , Sacroileíte/diagnóstico , Sacroileíte/etnologia , Sacroileíte/terapia , Espondiloartropatias/diagnóstico , Espondiloartropatias/etnologia , Espondiloartropatias/terapiaRESUMO
OBJECTIVE: The purpose of the present study was to evaluate the role of diagnostic tools and management options for patients with pyogenic sacroiliitis, including potential complications. MATERIALS AND METHODS: This retrospective study included 16 patients with pyogenic sacroiliitis who were admitted to a single orthopaedic centre between 2007 and 2012. The following data were collected: demographics, history, radiography, magnetic resonance images (MRI), biological data, type of pathogenic agent, abscess formation, type of management, and clinical outcome. RESULTS: Our study demonstrated that only one-fifth of the patients with lumbogluteal or hip pain had established diagnoses of suspected pyogenic sacroiliitis upon admission. MRIs confirmed this diagnosis in all cases. MRI examinations revealed joint fluid in the sacroiliac joint and significant oedema of the adjacent bone and soft tissues. In 12 of the 16 cases, erosions of the subchondral bone were encountered. Contrast-enhanced MRI revealed that 9 patients had abscesses. All patients received antibiotic therapy. Antibiotic treatment was only successful in 9 cases. The other 7 patients underwent computed tomography (CT)-guided abscess drainage. Drainage was sufficient for 4 patients, but 3 patients required open surgery. One patient required sacroiliac arthrodesis. The clinical outcomes included minimal disability (n = 10), moderate disability (n = 5), and full disability (n = 1) of the spine. CONCLUSIONS: Contrast-enhanced MRI is mandatory for a reliable diagnosis. Abscess formation was observed in approximately half of the MRI-diagnosed sacroiliitis cases and required minimally invasive drainage under CT guidance or frequently open surgery.