Topographic MRI evaluation of the sacroiliac joints in patients with axial spondyloarthritis / Avaliação topográfica das articulações sacroilíacas por ressonância magnética em pacientes com espondiloartrite axial

Abstract Objective: To evaluate the imaging features of spondyloarthritis in magnetic resonance imaging (MRI) of the sacroiliac (SI) joint and topography (in thirds) and affected margin, considering that this issue is rarely addressed in the literature. Methods: A cross-sectional study evaluating MRI (1.5 T) of SI in 16 patients with axial spondyloarthritis, for the presence of acute (subchondral bone edema, enthesitis, synovitis and capsulitis) and chronic (erosions, subchondral bone sclerosis, bony bridges, and fatty infiltration) changes, performed by two blinded radiologists. MRI findings were correlated with clinical data, including age, duration of disease, medications, HLA-B27, BASDAI, ASDAS-ESR and ASDAS-CRP, BASMI, BASFI, and mSASSS. Results: Bone edema pattern and erosions were predominant in the upper third of SI (p = 0.050 and p = 0.0014, respectively). There was a correlation between disease duration and structural changes by affected third (p = 0.028-0.037), as well as between the presence of bone bridges with BASMI (p = 0.028) and mSASSS (p = 0.014). Patients with osteitis in the lower third showed higher values for ASDAS (ESR: p = 0.011 and PCR: p = 0.017). Conclusion: Chronic inflammatory changes and the pattern of bone edema predominated in the upper third of SI, but a simultaneous involvement of middle or lower thirds of the joint was also noted. The location of involvement in the upper third of SI is insufficient to differentiate between degeneration and inflammation.

Resumo Objetivo: Avaliar as características de imagem das espondiloartrites na ressonância magnética (RM) das articulações sacroilíacas (SI) quanto à topografia (em terços) e margem acometida, uma vez que esse aspecto é pouco abordado na literatura. Métodos: Estudo transversal com avaliação por RM (1,5 T) das SI em 16 pacientes com diagnóstico de espondiloartrite axial quanto à presença de alterações agudas (edema ósseo subcondral, entesite, sinovite e capsulite) e crônicas (erosões, esclerose óssea subcondral, ponte óssea e substituição gordurosa), feita por dois radiologistas, cegos para os dados clínicos. Os achados da RM foram correlacionados com dados clínicos, incluindo idade, tempo de doença, medicações, HLA-B27, BASDAI, ASDAS-VHS e ASDAS-PCR, BASMI, BASFI e mSASSS. Resultados: Padrão de edema ósseo e erosões apresentaram predomínio no terço superior das SI (p = 0,050 e p = 0,0014, respectivamente). Houve correlação entre o tempo de doença e alterações estruturais por terço acometido (p = 0,028-0,037), bem como a presença de pontes ósseas com o BASMI (p = 0,028) e o mSASSS (p = 0,014). Pacientes com osteíte no terço inferior apresentaram maiores valores de ASDAS (VHS: p = 0,011 e PCR: p = 0,017). Conclusão: As alterações inflamatórias crônicas e o padrão de edema ósseo predominaram no terço superior das SI, mas também havia acometimento concomitante dos terços médio ou inferior da articulação. A localização do acometimento no terço superior das SI se mostra insuficiente para a diferenciação entre degeneração e inflamação.

Predictive factors of radiographic progression in ankylosing spondylitis

BACKGROUND/AIMS: The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to determine the clinical factors and laboratory measures that are useful in predicting the radiographic progression of patients with AS. METHODS: In 64 consecutive patients with AS, we collected radiographic and laboratory data over 3 years. Radiographic data included images of the sacroiliac (SI) and hip joints and laboratory data included areas under the curve (AUC) of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alkaline phosphatase (ALP), and hemoglobin (Hb). We investigated associations among changes in radiographic scores, initial clinical manifestations and laboratory measurements. RESULTS: Changes in scores for the SI joint and lumbar spine did not correlate with AUC for ESR, CRP, or ALP. AUC for Hb did not significantly correlate with radiographic progression in any joint. Patients with hip arthritis at the initial visit showed significantly higher radiographic score changes after 3 years in the SI and hip joint compared to those without hip arthritis. Patients who had shoulder arthritis as the initial manifestation had significantly increased AUCs for ESR and CRP compared to those without shoulder arthritis. However, at 3 years, the change of the lumbar spine score was significantly higher in patients without shoulder arthritis. CONCLUSIONS: These results indicate that hip arthritis at presentation is a useful clinical marker for predicting the structural damage to the SI and hip joint, and suggest that initial shoulder arthritis correlates with slower radiographic progression of the lumbar spine.

The Clinical Usefulness of Multidetector Computed Tomography of the Sacroiliac Joint for Evaluating Spondyloarthropathies

BACKGROUNDS: Due to the low sensitivity of plain radiography, the diagnosis of early stage ankylosing spondylitis (AS) is often difficult since many patients do not meet the radiographic criteria. The objective of our study was to investigate the diagnostic value of performing multidetector computed tomography (MDCT) of the sacroiliac (SI) joint in the evaluation of AS patients. METHODS: Thirty seven patients with definite or probable AS were evaluated. Plain radiography and MDCT imaging of the pelvis were performed for evaluating the SI joints. Two radiologists analyzed the images, and they graded the sacroiliitis on a scale of 0-4 according to the modified NY criteria. The clinical variables we analyzed included the disease duration, the treatment duration, the prescribed drugs, peripheral joint involvement, enthesopathy, the functional limitations and the BASDAI.. RESULTS: MDCT detected more bilateral sacroiliitis as compared to the plain radiography (86.5% vs. 75.7%, respectively), and MDCT yielded a higher grade of disease in 32.4% (right SI joint) and 24.3% (left SI joint) of the patients. More patients satisfied the modified NY criteria with using MDCT as compared with that when using the plain radiography (81.1% vs. 54.1%, respectively, p=0.002). CONCLUSIONS: Visualization of the sacroiliac joint by MDCT provided a better diagnosis of AS, and especially during the early stage of the disease.

Fijación percutánea de fracturas sacroiliacas guiada por TAC. Experiencia de 2 años / Iliosacral screw fixation of posterior pelvic ring injuries guided by CT scan

Entre Febrero de 2001 y Noviembre de 2002 se realizó un estudio observacional, descriptivo, tipo serie de casos en los Departamentos de Ortopedia y Traumatología del Hospital de San José, la Clínica Palermo y la Fundación Santa Fe de Bogotá: 10 pacientes (12 fracturas) con lesiones inestables del anillo pélvico a quienes se les realizó fijación percutánea dirigida por TAC de la porción posterior del anillo pélvico. Seis mujeres (60%) y 4 (40%) hombres, con un promedio de edad de 33.4 años (16 a 54 años). Las fracturas se clasificaron de acuerdo a la clasificación AO / OTA siendo el 50 % tipo B y el 50% tipo C. La causa de la fractura fue accidente de tránsito en 8 pacientes (80%) y caída de altura en 2 pacientes (20%). A todos los pacientes se les realizo fijación de la articulación sacro ilíaca con tornillos canulados de 7.0, bajo anestesia regional o local con sedacion, y no encontramos lesión neurológica o vascular alguna en el pre ni en el post operatorio. Tiempo quirúrgico en promedio de 50 minutos, sangrado de 7cc, corta estancia hospitalaria con un buen manejo del dolor y pronta reintegración a sus actividades diarias. En los controles POP se evaluó a través de RX la consolidación de las fracturas la cual fue del 100% en todos los pacientes.

Bone mineral content and risk of vertebral fractures in ankylosing spondylitis

Osteoporosis and vertebral fractures are encountered in ankylosing spondylitis. This study was undertaken to visualize whether such is due to the disease itself or due to mechanical factors and limited mobility. The study was performed on 26 ankylosing spondylitis patients recruited from the Out-patient Clinic of the Rheumatology and Rehabilitation Departments of Al-Azhar and Al-Menya Universities Hospitals. Sixteen of them had the disease for less than 10 years [G1] and ten had it for more than 10 years [G2]. Twenty-five apparently normal staff members matched in age and sex were taken as a control group. Patients underwent medical history taking, clinical examination, metreological assessment, radiological evaluation according to New York criteria, determination of vertebral fractures according to Black et al. [1991] as well as DEXA examination of the lumbar spine, femoral neck and wrist. There was a reduction of BMC in all of the studied areas lumbar spine, femoral neck and distal forearm in AS patients. Two out of sixteen [12.50%] patients with mild AS [<10 years] had vertebral fractures as compared with three out of twelve [25%] patients with AS [>10 Years] and one out of 25 controls [4%]. No significant correlation was observed between vertebral fractures and BMC in any of the examined areas

Retroperitoneal cold abscess with tuberculosis of sacro-iliac joint and pubic bone: a case report of unusual presentation of osteo-articular tuberculosis.

Tuberculosis involving sacro-iliac joint and pubic bone presenting with massive retroperitoneal abscess is a rare entity. A 29-year-old female presented with history of discharging sinus in the sacrococcygeal region of 2 months duration. Plain x-ray revealed osteolytic lesion in right pubic bone and left sacro-iliac joint. Computed tomography scan revealed massive pus collection in the retroperitoneal region. Pus was drained extraperitoneally. Biopsy of the scraping of the abscess wall showed granulation tissue with foreign body type of giant cell. On follow-up the patient was doing well.