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PubMed1993

Brucellar sacroiliitis: findings in 63 episodes and current relevance.

Between 1974 and 1989 we prospectively observed 530 patients with brucellosis. The findings for 62 patients (42 males and 20 females; mean age, 34.7 years) with 63 episodes in which the sacroiliac joint was involved (the most frequent osteoarticular location [11.7%]) were analyzed. Ten of the older patients (mean age, 55.3 years) had concomitant spondylitis. Systemic symptoms were usually important, and characteristic pain and findings of sacroiliitis were observed in approximately 75% of cases. Blood cultures were positive for Brucella melitensis for 44 patients. The most frequent radiographic findings were blurring of articular margins (42 cases) and widening of the sacroiliac space (20 cases). No radiographic anomalies were detected in 13 cases. Results of 99mTc and gallium-67 bone scans were abnormal in approximately 90% of cases (abnormalities were often mild). Overall, clinical, radiographic, and isotopic bone scan findings were sensitive and useful, although they were occasionally minimal or difficult to evaluate, making diagnostic findings confusing or misleading. Brucellar sacroiliitis is a mild disease associated with a good outcome similar to that observed for patients with uncomplicated brucellosis.

Adolescent↗

PubMed1994

Magnetic resonance imaging of septic sacroiliitis.

Five cases of septic sacroiliitis diagnosed by magnetic resonance imaging (MRI) are presented. Imaging was performed between 2 and 14 days after onset of symptoms and consisted of varying combinations of coronal short tau inversion recovery (STIR), axial T2-weighted spin echo (SE), and coronal and axial pre- and postcontrast T1-weighted SE scans. Abnormalities included demonstration of sacroiliac joint effusions, bone oedema and adjacent inflammation as high signal on STIR and T2-weighted SE scans, and identification of abscesses in two cases as rim-enhancing lesions anterior to the joint on gadolinium-enhanced T1-weighted SE scans. The role of MRI and other forms of imaging in septic sacroiliitis is discussed.

Adolescent↗

PubMed1984

Isolated sacroiliitis as monosymptomatic form of ankylosing spondylitis--a possible cause of chronic back pain.

In a retrospective analysis of 770 cases of ankylosing spondylitis or allied disorders 146 patients (19 percent) were found to have isolated sacroiliitis without involvement of the spine. The mean disease duration of isolated sacroiliitis was 11.9 years. The conclusions were based on anamnestic, clinical and radiological data. Of those patients with isolated sacroiliitis 29 percent were female, compared to 11 percent of female patients with typical spinal disease. Cases restricted to the sacroiliac joints for a longer period can be observed frequently in younger patients and may be regarded as an abortive and monosymptomatic form of ankylosing spondylitis insofar as other seronegative spondarthritides can be excluded.

Antibodies, Antinuclear↗

PubMed2004

Interventions in chronic low back pain.

BACKGROUND: Chronic low back pain presents a major challenge for general practitioners and is a significant drain on community resources. Patients often feel frustrated by modern medicine's apparent failure to validate their symptoms with a specific diagnosis and management plan. OBJECTIVE: This article presents an evidence based guide to current interventions, including an algorithm for the interventional diagnostic workup of low back pain that has persisted beyond 3 months. DISCUSSION: Modern imaging techniques rarely determine the cause of pain. The GP must look for 'red flag' clues in the history. Management of low back pain includes NSAIDs, simple injections of plain local anaesthetic without adrenalin or cortisone, referral to a masseuse, cortisone, physiotherapist and/or a musculoskeletal pain physician. Specific management includes medial branch and sacroiliac joint blocks, and radiofrequency neurotomy. Patients with long term pain may be referred to a psychologist for cognitive behavioural therapy.

Algorithms↗

PubMed1978

Quantitative sacroiliac scintigraphy in patients with Crohn's disease.

Sixty patients with Crohn's disease have been assessed radiologically and by quantitative sacroiliac scintigraphy for evidence of sacroilitis and/or ankylosing spondylitis. The incidence of radiologic sacroiliitis (11%) and ankylosing spondylitis (5%) was no greater in our series than previously reported. However, the incidence of increased uptake of radiotracer at the sacroiliac joints was 52%. There was no correlation in the group as a whole between radiologic and/or scintigraphic evidence of sacroiliitis and the tissue antigen HLA-B27.

Adolescent↗

PubMed2003

Seronegative spondyloarthropathy of familial Mediterranean fever.

Familial Mediterranean fever (FMF) is characterized by an autosomal inheritance pattern, Mediterranean ancestry, and history of recurrent fever. We present a 30-year-old Turkish man with FMF and accompanying seronegative spondyloarthropathy. His diagnose depended on the clinical course of his disease: recurrent fever accompanied by abdominal pain attacks together with a positive family history and his ethnic origin and sacroiliitis. We review the common manifestations of FMF and remind physicians that sacroiliac joint involvement must be kept in mind in presence of articular symptoms in a FMF patient.

Adult↗

PubMed2004

Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience).

Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, which are a useful diagnostic and therapeutic tool. In this study we present our experience in CT-guided percutaneous musculoskeletal biopsies, drainages of musculoskeletal abscesses, facet and sacroiliac joint injection and radiofrequency thermal ablation of painful metastases or osteoid osteomas.

Abscess↗

PubMed1977

Occult injuries of the pelvic ring.

With major trauma to the pelvis, injuries at more than one site within the pelvic ring are common. However, minor injuries seem to result in isolated fractures most frequently of the pubic rami. By means of the bone scan we have demonstrated in 6 consecutive cases that these apparent isolated injuries are associated with disruptions elsewhere within the ring, usually the acetabulum or sacroiliac joints. This finding may explain the complaints of pain in the sacral region or about the hip in some patients following isolated fractures of the pubic rami.

Acetabulum↗

PubMed1983

Spondyloepiphyseal dysplasia.

Skeletal dysplasia with autosomal dominant inheritance was found in four members of one family and in one sporadic case. The syndrome comprises brachydactyly E, platyspondyly, abnormality of the sacroiliac joint, disturbance of metaphyseal modelling, epiphyseal dysplasia, and short stature. This study deals with a particular type of spondyloepiphyseal dysplasia and compares it with similar cases in two previously published papers.

Adult↗

PubMed1994

Acute postpartum inflammatory sacroiliitis. A report of four cases.

We report four patients with unilateral postpartum sacroiliitis presenting with agonising unilateral pain, an elevated ESR, elevated alkaline phosphatase levels, leucocytosis and positive bone scans. The diagnosis of a non-infectious inflammatory cause was supported by the postpartum onset, the response to non-steroidal anti-inflammatory drugs, negative aspiration cultures in two cases and the lack of changes in the sacroiliac joints on long-term follow-up radiographs.

Acute Disease↗

PubMed1977

Scintigraphic findings in ankylosing spondylitis.

A prospective study of bone scintigraphic findings has been carried out in 63 patients, firmly diagnosed as having ankylosing spondylitis. In addition to abnormal uptake of the radiotracer at the sacroiliac joints, a peripheral arthropathy has been a common finding, particularly in the proximal joints, occurring in up to 50% of patients. Increased uptake of radiotracer in the spine has also been found both diffusely and focally. Focal increases have been noted at the apophyseal joints in 40% of patients and in three patients with a sterile intervertebral diskitis, an unusual complication of this disease only diagnosed in two patients after bone scintigraphy.

Evaluation Studies as Topic↗

PubMed2002

Psoas abscess as a complication of pyogenic sacroiliitis: report of a case.

A psoas abscess is, either primary or secondary, a rare entity for a general surgeon. Images by ultrasonography and computed tomography (CT) can help a general surgeon to make an accurate diagnosis when encountering the patient complaining of unilateral lower abdominal deep pain with fever. A case of pyogenic abscess of the psoas muscle as a result of sacroiliitis in a 22-year-old man is reported herein. The abdominal CT and magnetic resonance imaging scans demonstrated a large multilocular abscess extending along the iliopsoas muscle, and erosion and a widening of the left sacroiliac joint. The abscess was drained with an open surgical approach and the patient responded well to antibiotic therapy. Aggressive surgical and medical treatment is necessary in patients with psoas abscess to prevent complications.

Adult↗

PubMed1987

Two unusual presentations of pyogenic sacroiliitis.

Two cases of sacroiliac joint infection with abscess formation are described. The abscesses dissected through fascial planes into the lower leg in both cases and also proximally into the paraspinals in one case. Both patients survived following extensive surgical drainage and appropriate antibiotic treatment.

Abscess↗

PubMed1985

Infantile infectious sacroiliitis.

Two infants with pyogenic sacroiliitis are presented. In both babies, the clinical findings were initially attributed to septic arthritis of the ipsilateral hip. The correct diagnosis was not established in either infant until radionuclide scanning showed increased uptake in the ipsilateral sacroiliac joints. Both cases emphasize the importance of proceeding quickly to radionuclide imaging in the baby with clinical and laboratory findings of inflammation in the vicinity of the hip and a negative hip aspiration.

Arthritis, Infectious↗

PubMed1997

Hypophosphatemic rickets with sacroiliitis-like presentation in an adolescent.

Rickets can manifest with a wide variety of rheumatic symptoms. In this paper, a fifteen year old female patient with hypophosphatemic rickets presenting with symptoms suggesting sacroiliitis at disease onset is reported. The sacroiliac joint involvement in this case was attributed to the subchondral bone fractures due to the secondary hyperparathyroidism. Her symptoms resolved completely after treatment with calcitriol and phosphate solution for hypophosphatemic rickets.

Adolescent↗

PubMed1999

[Psoas abscess in pyogenic sacroiliitis].

A 47-year-old man was admitted with septic fever over a few days. A CT-scan showed a psoas abscess, which was drained by surgery. In the meantime antibiotics were started. In spite of this treatment, he continued to have septic fever. Bone scintigraphy and MR-scan showed activity in the right sacroiliac joint compatible with sacroiliitis. The joint was opened surgically and revised. The patient was treated with antibiotics for nine weeks and was fully restituted. It must be concluded that the psoas abscess was secondary to the sacroiliitis, a rare event.

Anti-Bacterial Agents↗

PubMed2001

The preauricular sulcus: its radiologic evidence and prevalence.

The preauricular sulcus is a groove frequently seen on the iliac bone, adjacent and parallel to the inferior surface of the sacroiliac joint. It has been described as a characteristic of the female pelvis. A total of 3200 pelvic radiographs (1508 male and 1692 female) were examined and in 393 female (about 23%) the preauricular sulcus was encountered. None was seen in male radiographs.

Female↗

PubMedDate not supplied

[Criticism of sacroiliitis staging in ankylosing spondylitis].

Information-theoretical considerations demonstrate the uselessness, in terms of understanding and diagnosis, of seven different systems for grading sacroiliitis in ankylosing spondylitis used by German, French, Canadian, Norwegian, Swedish, and Swiss authors. The illustrations prove that it is not possible to differentiate between a normal and abnormal (inflammatory) x-ray of the sacroiliac joints without the application of tomography. A grading system promises diagnostic and communicative success only when based upon tomography results (6 standard sections in adults), and when it takes the "multicolored picture" into consideration ("multicolored picture": no = sacroiliitis stage 0; yes = stage 1; complete bilateral ankylosis: yes = stage 2).

Diagnosis, Differential↗