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PubMed1993

A prospective study of patients with spondyloarthropathy with special reference to HLA-B27 and to gut histology.

Ileocolonoscopy was performed on 357 patients meeting the European Spondylarthropathy Study Group criteria for spondyloarthropathy. HLA loci A, B and C were determined in all patients; HLA-B27 was detected in 196 and was absent in the 161 remaining patients. A number of clinical, laboratory and radiological variables were determined before ileocolonoscopy and compared between the HLA-B27+ and HLA-B27- patients. The HLA-B27+ patients were mainly men, with significantly more family members with spondyloarthropathies. Clinical evidence of tendinitis and uveitis was more frequently found in these patients. Like several authors, we found that these patients were more severely affected since they presented more severe radiological involvement of the sacroiliac joints. Syndesmophytes, bamboo spine and erosive joint lesions were more frequent in this group, the hip involvement being of the concentric type. In HLA-B27+ patients ankylosing spondylitis was more prevalent, while in the B27- patients enterogenic, urogenital or undifferentiated spondyloarthropathy was diagnosed. The HLA-B27- patients experienced more episodes of diarrhea, and Crohn-like inflammatory gut lesions were more frequently seen on ileocolonoscopy. In this group a number of patients probably had a form of subclinical Crohn's disease of which the locomotor symptoms were the only clinical expression.

Adolescent↗
PubMed1984

Radiological changes in men and women with ankylosing spondylitis.

The radiographic changes of ankylosing spondylitis were studied in 50 females and 82 males. There was a tendency for the males to have more severe arthritic changes in the sacroiliac joints than the females, but the difference did not reach statistical significance. Males significantly more often had radiological involvement of the lumbar spine. More restricted lumbar mobility, total spinal flexion, and chest expansion were found in males with x-ray changes in the lumbar spine than in males without such features. No such significant difference could be found in females. These findings may indicate a less severe disease as judged roentgenologically in females than in males. The correlations between restriction of chest and spinal mobility and x-ray changes were stronger in males.

Adult↗
PubMed1992

Magnetic resonance imaging in the detection of sacroiliitis.

The value of magnetic resonance imaging (MRI) in establishing the diagnosis of sacroiliitis was studied in 20 patients with established or suspected disease on conventional radiographs and in 10 healthy subjects. Coronal T1 weighted, axial T2 weighted and proton density MRI images of the sacroiliac joints in addition to plain film radiographs were obtained. All films were graded from 0 to 4 according to the modified New York criteria and independently for changes in joint width, erosions, sclerosis and ankylosis. Using the modified New York criteria, more abnormalities were detected by MRI than by conventional radiography (p = 0.04). This was due to the detection of definite abnormalities (grades 2-4) by MRI in joints that were graded normal or suspicious (grades 0-1) on plain films (p = 0.01). MRI tended to be superior to plain films in visualizing erosions. Only MRI detected abnormalities of articular cartilage (19 patients) and in subchondral bone marrow (7 patients). The latter 2 types represented fatty infiltration and inflammatory change. Intraobserver and interobserver variation were similar for the interpretation of MRI scans and plain film radiographs. These results suggest that MRI detects changes of established sacroilitis. Due to its ability to directly image articular cartilage it may be particularly useful in patients with early disease.

Adult↗
PubMed1993

A controlled study of sacroiliitis in Behçet's disease.

Radiographs of the sacroiliac joints of 34 patients with Behçet's disease were read blind by a senior radiologist. They were compared with those from 25 controls, 14 of whom were healthy. The remainder (11) had other rheumatological disorders including six who had AS. One patient with Behçet's disease had radiologically proven sacroiliitis only but her history was atypical and she was B27 positive. All patients with AS had definite sacroiliitis. Five out of 34 patients with Behçet's disease and four of 25 controls (three healthy, one with SLE) had equivocal sacroiliitis. Whilst appreciating that the numbers in this study are not large, we find no evidence of an increased prevalence of sacroiliitis in Behçet's disease.

Adult↗
PubMed1991

Anatomic and experimental basis for the insertion of a screw at the first sacral vertebra.

The authors present the anatomic and experimental basis of an original technique for screwing at the first sacral level employed in lumbosacral fusion. The anatomic studies were based on specimens from the anatomy museum, frozen sections of the sacrum and CT examinations with three-dimensional reconstruction and assessment of the density of the different structures of S1 in Hounsfield units (HU). The findings were that the ala and lateral portions of S1 contain yellow marrow forming what amounts to a fatty sphere bounded by the cortical bone of the sacroiliac joint, the linea terminalis and the spongy bone of the pedicles and of the body of S1. The experimental study was made by avulsion of sacral screws (system of Cotrel Dubousset), each of 7mm diameter. No screw perforated the sacral cortex. Three directions were tested. The insertion of a screw through the pedicle and body of S1 is advised, with the point of insertion below and lateral to the articular process of S1 and an oblique course forward and inward at an angle of 10 degrees to the sagittal plane. This internal obliquity is limited by the posterior prominence of the iliac ala.

Adult↗
PubMed1991

Quantitative radio-isotope scanning in ankylosing spondylitis: a clinical, laboratory and computerised tomographic study.

Quantitative sacroiliac and lumbar spine radio-isotope (Tc-99m MDP) scans were performed in 42 patients with ankylosing spondylitis, and repeated 12 months later in 25. Clinical and laboratory assessments as well as computerised tomographic (CT) scans of the sacroiliac joints (SIJ) and lateral lumbar spine x-rays, were performed. Bone (using the L3/4 area of the lumbar spine, sacrum, SIJ's and knee) to soft tissue (ST) ratios all correlated strongly with each other. Patients with high SIJ:ST ratios had significantly greater low-back stiffness (p less than 0.05). Change in serum IgA levels correlated negatively with change in bone: ST ratios. There was no relationship between bone: ST ratios and any other clinical or laboratory variables. The change in SIJ:ST ratios correlated positively with change in CT erosion score (p less than 0.05) and negatively with change in CT ankylosis score (p less than 0.05).

Adult↗
PubMedDate not supplied

Asymptomatic sacroiliitis in inflammatory bowel disease. Assessment by computed tomography.

Plain film radiographs and computed tomography scans of sacroiliac joints in 65 asymptomatic patients with known inflammatory bowel disease were performed and evaluated by two radiologists. Computed tomography revealed the presence of asymptomatic sacroiliitis in 21 (32%) of the 65 patients (New York grades 2 to 4); asymptomatic sacroiliitis was identified by plain film radiography in only 10 (18%) of 57 patients (p < 0.001). No correlation was observed between the presence or absence of sacroiliitis, and the age and sex of patients, disease type, or duration of disease. The prevalence and diagnostic value of computed tomography in the detection of asymptomatic sacroiliitis in patients with inflammatory bowel disease are discussed.

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↗
PubMed1995

Chronic sciatica caused by tuberculous sacroiliitis. A case report.

STUDY DESIGN: This is a case report. OBJECTIVES: To report and discuss a case of tuberculosis sacroiliitis with anterior synovial cyst presenting as chronic sciatica. SUMMARY OF BACKGROUND DATA: This is a report of clinical manifestation, physical findings, computed tomography scan, and results after surgical treatment in a 58-year-old woman with tuberculous sacroiliitis, which caused chronic sciatica. METHODS: The physical findings, laboratory data, radiographs, and computed tomography scan of sacroiliac joints were studied. Sacroiliitis with anterior synovial cyst was shown in computed tomography scan. Posterior arthrotomy and drainage of the synovial cyst were performed. After surgery, she was treated with three combined antituberculosis drugs for 9 months. RESULTS: Löwenstein-Jensen culture and histologic examination confirmed the diagnosis of tuberculous sacroiliitis. At 3 years, she had no back pain or sciatica and a complete functional recovery. CONCLUSIONS: Tuberculous sacroiliitis with anterior synovial cyst is a rare cause of chronic sciatica. Lateral compression of the pelvis, Gaenslen's test, and Patrick's test should be included in evaluation of patients with sciatica. Computed tomography scan is a superb diagnostic method for sacroiliitis. Arthrotomy and drainage effectively relieve the sciatica. Three combined antituberculosis drug therapy should be given after surgery.

Female↗
PubMed1999

Inter-examiner and intra-examiner reliability of the standing flexion test.

The practice of musculoskeletal medicine requires the use of a wide variety of clinical examination procedures to establish a diagnosis, plan treatment, and monitor patient progress. Many of these examination procedures constitute a significant part of daily practice. Despite their extensive use, the reliability and validity of many of these assessment procedures remains questionable. The aim of this study was to determine the inter- and intra-examiner reliability of palpatory findings for the standing flexion test; one test for sacroiliac joint (SIJ) dysfunction. Nine examiners performed the standing flexion test on nine asymptomatic subjects. Inter-examiner reliability data, with a mean percentage agreement of 42% and a kappa coefficient of 0.052, demonstrated statistically insignificant reliability. Intra-examiner reliability data demonstrated a mean percentage agreement of 68% and a kappa coefficient of 0.46 indicating moderate reliability. These results suggest that the reliability of the standing flexion test as an indicator of SIJ dysfunction still remains questionable. Before this test can be relied upon as an accurate indicator of SIJ dysfunction it must undergo further research. This research must not only further standardize the procedure, but also ascertain reliability and validity.

Adult↗
PubMed1985

Application of Bayes' theorem to the diagnosis of ankylosing spondylitis from radioisotope bone scans.

The ratio of the uptake of radioactivity in each sacroiliac joint to the uptake in the sacrum has been measured in 57 patients with early ankylosing spondylitis and in 51 control subjects. The distribution of ratios of uptake obtained in each of these two groups shows appreciable overlap, and it is shown that the specification of a 'normal range' in this sort of situation can be misleading in the interpretation of the uptake ratio obtained in a given subject. An alternative approach described here is to use Bayes' theorem, which combines a probability based on the numerical value of the measured ratio with the pretest clinical impression about the likelihood of ankylosing spondylitis to yield a post-test probability of the presence of the disease.

Adolescent↗
PubMed2006

Mechanical effects of partial sacrectomy: when is reconstruction necessary?

We examined the mechanical consequences of high partial transverse sacrectomy. Ten human cadaveric pelves were randomly assigned to three groups. In the Control Group, the sacrum was left entirely intact. In Group I, transverse partial sacrectomy was performed just caudal to the S1 neural foramina. In Group II, transverse partial sacrectomy was performed just cephalad to the S1 neural foramina. Each pelvis was mounted on a testing apparatus and loaded vertically at the L4/L5 disk space until failure occurred. The average resection of the sacroiliac joints was 16% in Group I, and 25% in Group II. The average load to failure was 3014 N in the Control Group, 2166 N in Group I, and 1045 N in Group II. The average stiffness was 353 N/mm in the Control Group, 222 N/mm in Group I, and 100 N/mm in Group II. All specimens failed because of fractures through the sacrum (mostly Denis Zone II) in the sagittal plane. Using the literature to predict normal forces at the lumbosacral junction, we suggest Group I pelves could withstand postoperative mobilization without fracture, whereas Group II would probably not. Reconstruction should therefore be considered when performing transverse partial sacrectomy above the S1 nerve root.

Aged↗
PubMed1984

Quantitative sacroiliac scintigraphy. The effect of method of selection of region of interest.

Various authors have advocated quantitative methods of evaluating bone scintigrams to detect sacroiliitis, while others have not found them useful. Many explanations for this disagreement have been offered, including differences in the method of case selection, ethnicity, gender, and previous drug therapy. It would appear that one of the most important impediments to consistent results is the variability of selecting sacroiliac joint and reference regions of interest (ROIs). The effect of ROI selection would seem particularly important because of the normal variability of radioactivity within the reference regions that have been used (sacrum, spine, iliac wing) and the inhomogeneity of activity in the SI joints. We have investigated the effect of ROI selection, using five different methods representative of, though not necessarily identical to, those found in the literature. Each method produced unique mean indices that were different for patients with ankylosing spondylitis (AS) and controls. The method of Ayres (19) proved superior (largest mean difference, smallest variance), but none worked well as a diagnostic tool because of substantial overlap of the distributions of indices of patient and control groups. We conclude that ROI selection is important in determining results, and quantitative scintigraphic methods in general are not effective tools for diagnosing AS. Among the possible factors limiting success, difficulty in selecting a stable reference area seems of particular importance.

Adult↗
PubMed1998

Iliosacral screw insertion using computer-assisted CT image guidance: a laboratory study.

Procedures were performed to evaluate the efficacy of using a computer-assisted image-guided system to improve the accuracy of inserting iliosacral screws for posterior pelvic ring injuries. The fluoroscopic method currently in use has shortcomings that do not eliminate the risk to the L5 and sacral nerve roots and iliac vessels. The procedure was performed on embalmed cadaver pelvis specimens with intact soft tissues. Iliosacral screws were inserted across each sacroiliac joint after registering the opposite ilium to simulate a clinical situation. Two trials were performed. The first was necessary to become familiar with the system and test the basic methods of registration. In the second trial, deficiencies were corrected by using spherical-headed fiducial screws for fiducials and a better reference frame clamp, and by better spacing of more fiducials. Results were evaluated by inlet and outlet X-ray views and dissection. All eight S-1 iliosacral 7.0-mm cannulated screws were entirely inside bone. Of the eight S-2 screws, five were inside bone, two infringed upon an S-1 foramen, and one had threads out of the sacral body anteriorly and intruding into an S-1 foramen. This system was felt to be effective and sufficiently safe to warrant clinical trials.

Bone Screws↗
PubMed1982

Some pathological features of ankylosing spondylitis as revealed by microradiography and tetracycline labelling.

Five spine specimens obtained at autopsy and five biopsies of sacroiliac joints from subjects with ankylosing spondylitis were submitted to microradiography and to fluorescence microscopy for detection of tetracycline. Decalcified histological sections were also prepared. Microradiography provides a link between the clinical X-ray picture and the classical decalcified section; it enables calcified cartilage, and hence the early stage of most syndesmophytes to be recognised more easily and accurately; It revealed a peculiar calcification of elastic fibers of the ligamentum flavum. Tetracycline labels showed that: in an early case of sacro-iliac arthritis, calcification of the articular cartilage might partly explain the desification of the X-ray picture; syndesmophytes were thickening at both their superficial and deep faces; thickening, lengthening and internal remodelling of the intervertebral bridges occurred together; and calcium was deposited at the end-plates as well.

Adult↗
PubMed1987

Vertebral erosions in patients undergoing maintenance hemodialysis for chronic renal failure.

Unlike articular erosions in the appendicular skeleton, the frequency, appearance, and clinical relevance of vertebral erosions in azotemic osteodystrophy are not known. Lateral vertebral radiographs of 118 patients on maintenance hemodialysis were reviewed to assess the frequency, distribution, and rate of progression of vertebral erosions. Thirty (25%) of 118 patients showed a superficial corner erosion resembling the so-called Romanus lesion of ankylosing spondylitis. Their presence, whether at a single level or at multiple levels, did not correlate with erosive changes in the phalanges or sacroiliac joints that are known to occur in renal osteodystrophy. Vertebral erosions may progress slowly with time, but seem to have limited bearing on clinical symptoms. In two patients, however, the radiographic changes progressed dramatically, simulating an infection. Biopsy and surgical intervention were considered but not carried out because one patient declined and in the other an infected graft was identified as the source of infection. Both patients had negative scintiscans, and their subsequent clinical courses excluded infectious spondylitis. Vertebral erosions in patients on maintenance hemodialysis are frequent, and there appears to be a spectrum of changes from superficial erosions to large resorptive defects. Further diagnostic evaluation of these erosive changes appears to be warranted only rarely.

Adult↗
PubMed1978

HLA antigens in females with ankylosing spondylitis and other forms of seronegative rheumatic diseases.

A total of 222 female patients with seronegative rheumatic diseases were investigated by sacroiliac joint X-ray and HLA-A, B and Ctyped. The frequency of the B27 antigen was significantly increased in the following groups: definite pelvospondylitis (26 patients and relative risk (RR) = 99), possible pelvospondylitis (20 patients, RR=4.5), definite sacroiliitis (14 patients, RR-20.1) and uroarthritis (8 patients). When 24 B27 negative patients from these B27 associated diseases were analysed, significantly increased frequencies of the BW22 (RR=16.7) and CW1 (RR=14.4) antigens were found. There were no significantly deviating HLA frequencies in the following diagnostic groups: clinical sacroiliitis (20 patients), polyarthritis with clinically silent sacroiliitis (12 patients), polyarthritis without sacroiliitis (47 patients), arthralgia preceded by beta-streptococcal infection (17 patients), other arthralgia (33 patients), osteo-arthritis (13 patients) and other arthritis (12 patients).

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↗