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PubMed1994

[The involvement of the sacroiliac joints in rheumatoid arthritis. A retrospective radiographic study].

The frequency and type of involvement of the sacroiliac joints in rheumatoid arthritis (RA) is a controversial issue. In this study we compared sacroiliac plain radiographs of 120 RA patients and 106 age and sex-matched primary osteoarthritis (OA) patients. Nobody had a history of low back pain. On the basis of the radiologist's report, sacroiliac alterations were found in 24 (20.0%) RA patients (subchondral sclerosis in 20, joint space narrowing in 2, bone erosions in 1 and bone ankylosis in 1) and in 13 (12.3%) OA patients (subchondral sclerosis in all). Neither the frequency nor the radiographic pattern of alterations were significantly different between the two groups. We conclude that radiographic changes of the sacroiliac joints in RA are mostly of degenerative nature not differing from those found in a OA control population.

Adult↗
PubMedDate not supplied

Tomographic examinations of sacroiliac joints in adult patients with rheumatoid arthritis.

Tomography of the sacroiliac joints (SIJ) was performed in 72 patients with rheumatoid arthritis (RA) and in 50 controls. Twenty-seven rheumatoid patients (38%) showed typical sacroilitis with predominantly severe intraarticular ankylosis and subchondral erosions. Fourteen patients (19%) had a probable sacroilitis with mild erosions and intraarticular ankylosis and concomitant degenerative changes. Fifteen patients (21%) showed predominantly degenerative changes and 16 RA patients (22%) had no radiological manifestation of the SIJ. There was no relation between typical sacroilitis and age of patients, duration of disease, rheumatoid factor, Steinbrocker's stage and frequency of HLA B27.

Adult↗
PubMedDate not supplied

Imaging of sacroiliac joints.

The early diagnosis of inflammatory and degenerative disease of sacroiliac joints is markedly difficult because the clinical pattern is not dissimilar from that of diseases involving the lumbar spine and sciatic nerve. Furthermore as in inflammations in general, when only structural changes in the synovial membrane and cartilage are involved, the findings of conventional radiology are often nondiagnostic. CT is now considered the gold standard procedure because in spite of its nonnegligible limitations, single lesions in the synovial and ligamentous compartments can be distinctively evidenced. MRI, unlike other procedures, affords the early nonspecific documentation of intrinsic and/or reactive alterations in the subchondral bone, therefore it appears to fill the gap between the onset of symptoms and the imaging visualization of sacroiliitis.

Arthritis↗
PubMed1984

HLA-B27 and involvement of sacroiliac joints in rheumatoid arthritis.

The frequency of radiographic signs of sacroiliac joint involvement (greater than or equal to 2 and greater than or equal to 3 according to the New York criteria) was significantly higher in 28 HLA-B27 positive patients with classical seropositive rheumatoid arthritis (RA), than in 28 B27 negative RA controls. The B27 positive RA patients had more subcutaneous nodules (p less than 0.01), worse functional class (p less than 0.05), and higher levels of erythrocyte sedimentation rate (ESR) (p less than 0.05) and haptoglobin (p less than 0.05). Sacroiliitis, independent of HLA-B27, was associated with higher levels of ESR (p less than 0.05), and with a higher frequency of positive ANA test (p less than 0.05). It is neither related to the functional class nor to the duration of the disease.

Adult↗
PubMed2002

Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study.

BACKGROUND AND PURPOSE: The authors examined the intertester reliability of assessments made based on a composite of 4 tests of pelvic symmetry or sacroiliac joint (SIJ) movement that are advocated in the literature for identifying people with SIJ region dysfunction. "Sacroiliac joint region dysfunction" is a term used to describe pain in or around the region of the joint that is presumed to be due to malalignment or abnormal movement of the SIJs. SUBJECTS: Sixty-five patients with low back pain and unilateral buttock pain were seen in 1 of 11 outpatient clinics. METHODS: Thirty-four therapists, randomly paired for each subject, served as examiners. Kappa coefficients and observed proportions of positive (Ppos) and negative (Pneg) agreement were calculated to estimate reliability. RESULTS: For the composite test results, percentages of agreement ranged from 60% to 69%, kappa coefficients varied from.11 to.23, and Ppos was lower than 50%. DISCUSSION AND CONCLUSION: Reliability of measurements obtained with the 4 tests appears to be too low for clinical use. Given the measurement error found in this study, the authors suspect it is likely that either the proper treatment technique will not be chosen based on the test results or the intervention will be applied to the wrong side. The 4 tests probably should not be used to examine patients suspected of having SIJ region dysfunction, although the role of therapist training in use of the procedures is unclear.

Adult↗
PubMed1984

Pathologic changes in aging sacroiliac joints. A study of dissecting-room skeletons.

Pathologic changes of the sacroiliac joints were observed in 1986 skeletons from dissecting rooms in St. Louis, Missouri and Johannesburg, South Africa. In addition to being the largest population samples ever studied from this standpoint, these samples are the first to include blacks. Para-articular osteophytosis culminating in ankylosis is considered first, followed by the less common intraarticular changes that also occasionally culminate in ankylosis. Expressed as "average involvement" by decade, sex, laterality, and ethnic group, these joint changes are shown clearly to worsen progressively from the age of about 40 years. Osteophytosis especially becomes more common in black males, both American and African Bantu, than in American white males, and generally more common in males than in females. When occurring only (or mainly) unilaterally, the changes average out in favor of the right side, but only slightly. Joint mobility, or lack thereof, is assigned a large etiologic role.

Adult↗
PubMed1984

Computed tomography of the sacroiliac joints: comparison with complex-motion tomography.

Forty-seven patients with sacroiliac joint abnormalities were examined with computed tomography and conventional complex-motion tomography. Twenty-nine patients had spondyloarthritis. Of the 29, complex-motion tomography detected bone erosions in 16 patients, whereas computed tomography revealed erosions in nine. Computed tomography was more sensitive in detection of joint narrowing, joint widening, osteosclerosis, and intraarticular bony ankylosis. In the remaining 13 patients, computed tomography was the modality of choice in detection of paraarticular soft tissue pathology, such as abscess or tumor, and in detection of the lesions involving the sacral canal and neural foramina.

Adult↗
PubMed1982

Radiological study of the sacroiliac joints in vertebral ankylosing hyperostosis.

A radiological study of the sacroiliac joints was undertaken in 54 patients (32 males, 22 females) with vertebral ankylosing hyperostosis (VAH) and in 46 control patients (24 males, 22 females) matched for age and sex. The ages ranged from 38 to 90 years. The radiographs were taken in anteroposterior, oblique, and craniocaudal projections. The films were read for cranial, ventral, and caudal capsular ossifications, for ventral and caudal osteophytes, and for bone sclerosis. Cranial and/or ventral capsular ossifications were found in 28 (87.5%) males with VAH and in 4 (16.6%) control males (p less than 0.0005), but only in 2 females with VAH and no control female. Sacroiliac capsular ossifications in males with VaH are frequent from the onset, but complete bridging of the joint is not reached before the sixth decade. Women, either VAH or control, have more sacroiliac osteophytes than men. There were 11 out of 22 control women with osteophytes versus 4 out of 24 men (p less than 0.025). The incidence of osteophytes does not seem to increase with age after 50 years. Our findings support the idea of VAH being a distinct entity and not a major form of osteophytosis.

Adult↗
PubMed1977

Comparison of radiographic abnormalities of the sacroiliac joint in degenerative disease and ankylosing spondylitis.

Degenerative disease of the sacroiliac joint is common in middle-aged and elderly patients. Its radiographic features simulate those of ankylosing spondylitis. Interosseous space narrowing, subchondral sclerosis, and osteophytosis are apparent. Although intraarticular bony ankylosis is generally absent, anterior paraarticular bridging osteophytes resemble true osseous fusion of the joint cavity on frontal radiographs. Focal sclerosis in degenerative disease is most common on the superior and inferior margins of the articular cavity and can usually be differentiated from that accompanying ankylosing spondylitis and osteitis condensans ilii.

Adult↗
PubMed1997

Biomechanical modelling of the human sacroiliac joint.

From a mechanical point of view, the human pelvis can be considered as a stable, complex three link structure. This three-link closed-chain system explains why there is so little motion in the sacroiliac joint. Based on the minimum total potential energy principle, a quasi-static model of the human pelvis with its three joints is developed. In the model, the articular cartilage linings of the joint surfaces are considered as thin layers with a geometric non-linear behaviour. They lie between two rigid curved surfaces that are represented by small three-node elements. Accessory ligaments and capsules are represented by a number of non-linear springs. A primary model is developed based on a female cadaver. According to the primary model, the translation of the sacroiliac joint in the direction of force is about 0.5 mm in the lateral direction, about 1.8 mm in the antero-posterior direction, and about 1.5 mm in the superior or inferior direction, when a load of 1000 N is applied to the sacrum. When a load of 50 N m-1 is applied to the sacrum, the rotation in the load direction is about 1.6 degrees in axial rotation, about 1.0 degree in flexion or extension and about 1.1 degrees in lateral bending.

Biomechanical Phenomena↗
PubMed1999

The incidence of sacroiliac joint disease in patients with low-back pain.

PURPOSE: The clinical presentation of intervertebral disc, facet joint, nerve root, and sacroiliac (SI) joint diseases are often indistinguishable. SI joint arthritis likely accounts for a significant proportion of what is called "low-back pain" or "sciatica." Our goal was to determine the incidence of SI joint arthritis in patients with this presentation. METHODS: Computed tomographic (CT) scans of the lumbosacral spine (LSS) of patients referred with low-back pain, sciatica, spinal stenosis or disc pathology were gathered over a 3-month period. Scans were retrospectively reviewed by 2 independent readers for SI joint arthritis. When there was disagreement, the 2 readers reviewed the case and reached a concensus opinion. SI joint arthritis was considered to be present if subchondral sclerosis, osteophytosis, or cartilage loss was noted on the CT scan. RESULTS: The SI joint(s) were visualized by both readers on 64 LSS CT scans performed in 29 women and 35 men, mean age 52 years. By the aforementioned criteria, 16 SI joints (25%) were considered normal by both readers. In 48 cases (75%), there was evidence of osteoarthritis. The diagnosis of osteoarthritis was made by concensus opinion in 8 of these 48 cases (16%). CONCLUSION: There is a relatively high incidence of SI joint arthritis in patients undergoing evaluation for "low-back pain" or "sciatica." Hence, SI joint arthritis should be considered a possible diagnosis in these patients.

Arthritis↗
PubMed1992

The sacroiliac joint: a critical review.

Clinicians continue to focus attention on the sacroiliac joint (SIJ) as one cause of low back pain. Considerable literature now exists to support the contention that symptoms arise from the sacroiliac region. In the last couple of decades, studies with quantitative data, often using sophisticated methods, have added to our knowledge from earlier descriptive reports of SIJ morphology and motion. The unique morphology of the SIJ, together with its location, makes study of the SIJ complex. All reported studies have limitations such as small sample size or lack of randomization or methodology. The purpose of this article is to review the literature to determine the support for current beliefs, opinions, and theories on joint morphology, life-span changes, and motion. Clinicians should provide well-documented clinical case-study series if we are to understand what occurs with treatments designed to affect the SIJ.

Biomechanical Phenomena↗
PubMed1987

Sacroiliac joint arthrodesis for chronic lower back pain.

We report our experience with sacroiliac joint arthrodesis in cases of overt osteoarthritis. Twenty-two operations were performed over a period of 3.5 years and reviewed between 12 and 55 months postoperatively. The clinical picture and diagnostic steps are discussed. We conclude that if the selection of patients is strict we can expect 70% satisfactory results.

Adult↗
PubMed1979

[Quantitative sacroiliac joint scintigraphy? (author's transl)].

Methodological aspects and clinical value of digital sacroiliac joint scintigraphy area are described. Preinformation of the observer affects the value of the uptake ratios significantly. A data processing is presented which reduces this effect. Nevertheless there is insufficient discrimination between normal persons and patients with acute inflammation. Routine bone scanning can therefore not be used to exclude "inflammatory changes".

Adult↗