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PubMed1982

HLA-B27 in possible ankylosing spondylitis with peripheral arthritis.

Among 86 patients selected as possibly having ankylosing spondylitis because of clinical symptoms and radiologically normal sacroiliac joints. HLA-B27 was positive in 41%. Four years later a representative sample of 38 individuals were re-examined and radiographed. HLA-B27 positive patients developed sacroiliitis as defined by radiological criteria twice as often (P less than 0.05). They also showed increased uptake of technetium 99 m upon quantitative scintigraphy with a region of interest method and more often probable or definite ankylosing spondylitis as defined by the New York criteria. Further differences between the HLA-B27 positive and negative follow-up groups concerned the frequency of clinical symptoms and peripheral arthritis. It is suggested that HLA-B27 typing may be helpful both in diagnosis and in judging the prognosis of possible or abortive ankylosing spondylitis.

Adult↗

PubMed1981

Genetic background of acute anterior uveitis.

To determine the hereditary pattern of acute anterior uveitis, we examined seven families-one family with four cases, one family with three cases, and four families with two cases of acute anterior uveitis. A total of 16 patients with uveitis and 28 relatives underwent ocular examinations and serologic determination of HLA antigens, protease inhibitor alpha 1-antitrypsin typing, and X-ray examination of sacroiliac joints. Sacroiliitis was found in 11 of 16 patients (68.8%) and incomplete Reiter's disease in seven of 16 (43.8%). HLA-B27 antigen was found in all patients with uveitis and in six of 21 (28.6%) relatives. HLA-Cw1 antigen was found in nine of 14 (64.3%) patients with uveitis, often in the same haplotype with HLA-B27 antigen. HLA-DR4 antigen was found in seven of 11 (63.6%) patients with uveitis. There was no significant association of the alpha 1-antitrypsin variant MZ with uveitis. We believe that a pleiotropic gene associated with HLA-B27 antigen with autosomal dominant inheritance, incomplete penetrance, and variable expressivity may determine susceptibility to acute anterior uveitis in linkage disequilibrium with HLA-Cwl antigen.

Acute Disease↗

PubMedDate not supplied

A comparison of MR and CT in suspected sacroiliitis.

OBJECTIVE: A prospective study to compare the MR and CT images of patients with suspected sacroiliitis and to establish the optimal MR sequences to demonstrate the changes of sacroiliitis was conducted. MATERIALS AND METHODS: Thirty-nine patients and nine controls were imaged in the axial plane, with SE T1-, T2-weighted fast spin echo (T2), T1 with fat suppression (T1WFS), and fast short tau inversion recovery (fast STIR) sequences on a 1.5 T system. The sacroiliac joints of all patients were imaged with CT. The images were evaluated by two independent radiologists. Following the blinded reading, direct comparison of T1 and T1WFS, T2, and fast STIR of the CT positive group was made to determine the optimal MR sequences. RESULTS: The sensitivity and specificity of MR images for the detection of cortical erosions and subchondral sclerosis when compared to CT images were 100 and 94.3%, respectively; interobserver variation was low (k = 0.80). T1WFS and fast STIR images were superior to T1 and T2 images, respectively, in demonstrating the changes of sacroiliitis. CONCLUSION: MRI (T1WFS and fast STIR) can replace CT in cases with a strong clinical suspicion of sacroiliitis and equivocal or normal plain radiographs.

Adult↗

PubMed1977

[Chronic prostatitis and Bechterew's disease].

A group of patients between 35 and 65 years old with chronic prostatitis were examined for the presence of Becherew's disease. In this connection the New York and Roman criterions for morbus Bechterew were applied. There were found one ankyosing spondylarthritis, one ankylosis of the sacroiliac joint, and 11 times a tentative sacroileitis were stated. Altogether the proved and tentative findings were only 3.68 per cent of all examinations. In our countries the morbus Bechterew is found in 0,21 per cent of the normal population. So the protion of the Bechterew's disease in patients with chronic prostatitis is indeed a little higher than average, but not so frequent as often pretended in recent times. After a second series 58 patients being treated because of Bechterew's disease of different stages and different terms were examined for the possibility of a simultaneously elapsing chronic prostatitis. A chronic prostatitis was found in 38 per cent of these patients which correspondents to the incidence published in literature for the medium-age manhood. Nobody of the test persons had complaints on the part of the urologenital tract.

Adult↗

PubMed1999

Electromyographic responses of back and limb muscles associated with spinal manipulative therapy.

STUDY DESIGN: Ten young, asymptomatic male subjects underwent 11 clinically relevant spinal manipulative treatments along the length of the spine to test the magnitude and extent of reflex responses associated with the treatments. OBJECTIVES: To determine the magnitude and extent of reflex responses elicited by spinal manipulative treatments. SUMMARY OF BACKGROUND DATA: Spinal manipulative treatments have been associated with a reflexogenic relief of pain and a loss of hypertonicity in muscles within the treatment area. However, there is no study in which results show the probability of occurrence or the extent of reflex responses during spinal manipulative treatments. METHODS: Asymptomatic subjects received spinal manipulative treatments on the cervical, thoracic, and lumbar levels and on the sacroiliac joint. Reflex activities were measured using 16 pairs of bipolar surface electrodes placed on the back and proximal limb musculature. The percentage of occurrence and the extent of reflex responses in the back and proximal limb musculature were determined. RESULTS: Each treatment produced consistent reflex responses in a target-specific area. The reflex responses occurred within 50-200 msec after the onset of the treatment thrust and lasted for approximately 100-400 msec. The responses were probably of multireceptor origin and were elicited asynchronously. CONCLUSIONS: This is the first study in which results show a consistent reflex response associated with spinal manipulative treatments. Because reflex pathways are evoked systematically during spinal manipulative treatment, there is a distinct possibility that these responses may cause some of the clinically observed beneficial effects, such as a reduction in pain and a decrease in hypertonicity of muscles.

Adult↗

PubMed1977

Coexistence of rheumatoid arthritis and ankylosing spondylitis--report of 10 cases.

The distinction between rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has hitherto relied on supporting evidence of characteristic radiological changes in the sacroiliac joints, together with the Rose-Waaler and Latex tests for rheumatoid factor (RF). This distinction has remained incomplete since some 30 per cent of patients with RA may have sacroiliitis, a similar proportion having negative routine tests for RF. The identification of the HLA B27 antigen, present in 90 per cent of cases of AS and six per cent of the normal population, has enabled a number of cases to be recognized in which both diseases appear to co-exist. Ten cases are described in which either RA appears to have developed in patients with AS, or AS in patients with RA. They all fulfil the ARA diagnostic criteria for classical RA, and the criteria for classical AS. The likelihood of these two diseases occurring by chance in an individual might be of the order of 1:50,000 to 1:200,000.

Aged↗

PubMed2006

[Ankylosing spondylitis--current state of imaging including scoring methods].

Conventional radiography and magnetic resonance imaging (MRI) are currently the most widely used imaging methods for the initial diagnostic evaluation and follow-up of patients with ankylosing spondylitis (AS). Scintigraphy, computed tomography (CT), and positron emission tomography (PET) only play minor roles, although some are being further developed. AS is characterized by inflammatory changes to the sacroiliac joints (SIJs) and spine, as well as asymmetrical arthritis of the peripheral joints and joints near the trunk. The diagnosis of AS is based on clinical parameters and the presence of chronic inflammatory changes to the SIJs on conventional radiographs. Typical radiographic changes also involve the spine. MRI depicts not only chronic changes, but also active inflammatory lesions, which are important for the diagnosis of early disease and precursors of AS. The scoring system of choice for quantifying spinal changes depicted by conventional radiography is the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). MRI allows the quantitative evaluation of changes involving the SIJs and the spine. Various MRI scoring systems have been proposed to quantify these changes, but they require further validation. This review article presents the imaging modalities used in AS patients, typical findings, and relevant methods of analysis. The most recent developments are discussed.

Diagnostic Imaging↗

PubMed1994

[Sacroiliitis in seronegative arthritis. The anatomicopathological aspects and imaging methods compared].

Sacroiliitis is usually the first and main feature of seronegative spondyloarthropathies. In its early stages it is difficult for diagnostic imaging techniques to demonstrate it and specificity is poor. At the same time, there may be few or even no symptoms at all. Therefore, the anatomical damage is quite often diagnosed at an advanced and irreversible stage. This study was aimed at assessing sacroiliac joint impairment during seronegative arthritis by means of diagnostic imaging techniques. The abnormal features of this condition are reported, pointing out the different findings of ankylosing spondylitis, psoriatic arthritis, Reiter's disease, reactive arthritis and sacroiliitis associated with chronic enteritis--e.g., Crohn's disease, ulcerative colitis, etc. Then, the capabilities and the features of each imaging method (conventional radiology, CT, bone scan, MRI) are reported. Modern techniques are dealt with in depth, especially relative to their capabilities in solving radiographic dilemmas. Technological progress is currently focused on MRI, whose use in early inflammatory sacroiliitis during seronegative spondyloarthropathies remains however in the experimental stage. Therefore, plain radiography is still the method of choice and its findings are used as a diagnostic criterion in unquestionable cases. To conclude, if the peculiar morphologic features of this condition are known and supported by clinical and radiographic findings, the condition can be diagnosed early, which means proper treatment and a lower incidence of highly invalidating sequelae.

Arthritis↗

PubMed1997

Treatment of coccidioidal spinal infection: experience in 16 cases.

Sixteen patients with spinal infection from Coccidioides immitis were treated. Lesion location was cervical in two, thoracic in four, lumbar in six, sacroiliac joint in one, and disseminated spinal in three. The neurological status was intact in 11 patients. One patient had incomplete quadriplegia, three patients had incomplete paraplegia, and a fifth patient had a lumbar root lesion. Treatment was medical only in 4 patients (one of whom required surgery 2 years later) and combined medical and surgical in 13 patients. All patients received amphotericin B intravenously. Follow-up averaged 24 months in 15 patients (range, 12-42 months). The outcome in four patients treated medically alone was one death, one remission, one relapse with disease progression, and one without follow-up. The outcome in the combined medical and surgical group was nine fusions, one pseudarthrosis, and three lesional excisions, all with remission. Successful treatment outcome is disease arrest, as opposed to "cure."

Adult↗

PubMed1997

Chronic recurrent multifocal osteomyelitis: a radiological and clinical investigation of five cases.

OBJECTIVE: To make a detailed evaluation of the clinical and radiological course of five children with chronic recurrent multifocal osteomyelitis (CRMO). Emphasis was laid on the correlation between clinical data and radiological findings. DESIGN AND PATIENTS: Clinical data, histology (n = 11), bone scintigraphy (n = 17), and the plain radiographs (n = 198) of these patients were reviewed. The mean time of observation was 6.6 years (range 1-14.5 years). Thirty-two lesions seen at the time of primary diagnosis (n = 22) or during the course of the disease (n = 10) were evaluated. Twenty-seven foci were located in bone; in five cases the sacroiliac joints were involved. RESULTS: Bone scintigrams showed nearly all foci (31/32) and were especially helpful in clinically asymptomatic lesions (14/32) or foci which were radiographically difficult to detect or not seen at all (8/32). Only 14 of 32 foci were locally symptomatic clinically. In all cases with a short interval (< or = 3 weeks) between the onset of local symptoms and evaluation by plain radiographs (n = 5) osteolysis was shown without a sclerotic margin. All bone lesions with a longer duration of local symptoms (n = 7) revealed a variable radiographic pattern: osteolysis with sclerotic rim in three, a mixed lytic-sclerotic lesion in three and pure sclerosis in one. In two cases low back pain could be ascribed to sacroiliitis. CONCLUSION: Only careful correlation between clinical, scintigraphy and radiographic features permits an accurate assessment of disease activity in CRMO. The bone lesions detected radiographically soon after the onset of symptoms resemble those of acute osteomyelitis.

Bone Resorption↗

PubMed2004

Sacrococcygeal chordoma: MR imaging in 30 patients.

OBJECTIVE: To evaluate MR imaging of sacrococcygeal chordoma. DESIGN AND PATIENTS: Thirty patients (age range 22-80 years) underwent MR imaging for the diagnosis and preoperative evaluation of sacrococcygeal chordomas. Eight patients had follow-up MR examination after treatment. The MR images were performed with T1- and T2-weighted imaging, and gadolinium (Gd)-enhanced imaging. The MR images were analyzed for the signal intensity, enhancing pattern, tumor size, growth pattern of the soft tissue component, and tumor extension. RESULTS AND CONCLUSIONS: T1-weighted images showed low signal masses with foci of high signal intensity in 73% of cases. Tumors enhanced in a variety of patterns after the administration of Gd. Soft tissue masses extending anteriorly were seen in all cases with posterior extension in 77% of cases. The posterior masses involved the surrounding muscles and extended toward the greater sciatic notch, appearing with pseudopodia (87%). Sacroiliac joints were involved in 23% of cases. Four lesions showed intraspinal extension and involvement of the posterior spinal muscles above the level of bony involvement. In 6 patients recurrent tumors were found at or around the surgical margin of the tumor 6 months to 5 years after resection of the sacral tumor. In two of the patients, nodular metastases to the pelvic bones and femur were found 1-4 years after initial examination. In conclusion, MR imaging is useful in the diagnosis and preoperative assessment of sacrococcygeal chordoma. Characteristic findings included sacral mass with heterogeneously high signal intensity with crisscrossing septa on long-repetition-time imaging, well-encapsulated pseudopodia-like or lobulated appearance, and gluteal muscle infiltration. Follow-up MR imaging is helpful to assess for recurrent or metastatic lesions of chordomas.

Adult↗

PubMed2005

[Influence of clinical information on the diagnostic validity of MRI in the detection of abacterial sacroiliitis].

PURPOSE: To evaluate the influence of clinical information on the diagnostic validity of MRI in the detection of abacterial sacroiliitis. Evaluation of sensitivities, specificities, negative (NPV) and positive predictive values (PPV) for MRI with and without clinical information in comparison to a prior defined standard. MATERIALS AND METHODS: The results of routine MRI reports of 65 patients with the clinical suspicion of abacterial sacroiliitis referred by rheumatologists for MR assessment of the sacroiliac joints were retrospectively reviewed. These results were compared to the results of a blinded reading of the same examinations performed without any clinical information. The MRI protocol included T1-SE, STIR and T1-SE contrast-enhanced sequences with fat saturation. All patients were followed for at least four years. The standard of reference was defined by an experienced rheumatologist and included baseline and follow-up data (clinical, laboratory and imaging). Abacterial sacroiliitis was diagnosed in 19 patients. RESULTS: Under routine clinical conditions, MRI revealed a sensitivity of 94.7 % and specificity of 97.8 %. A PPV of 94.7 % and a NPV of 97.8 % were achieved. Without clinical information, MRI revealed a sensitivity and specificity of 64 and 80 %, and a PPV of 49 % and a NPV of 86 %, respectively. CONCLUSION: The additional knowledge of clinical information for the MR diagnosis of abacterial sacroiliitis increases its diagnostic value for the assessment of abacterial sacroiliitis.

Adolescent↗

PubMed1988

[Pyogenic sacroiliitis. Review of 8 personal cases and 200 cases from the literature].

Eight patients with a pyogenic infection of the sacroiliac joint are compared to 200 published cases. In all our patients the disease began with fever and immobilizing low back and buttock pain. All had bacterial growth in the blood cultures. Five out of 6 patients did not show inflammatory signs in the initial plain roentgenogram. Tc-99m scan was initially positive in 4 out of 6 patients. In 2 patients only the second scan, at 13 and 15 days respectively, was positive. All but one patient had a 4-6 week course of intravenous antibiotics. Three patients underwent surgery for abscesses or intraarticular sequestra. One patient with a small psoas abscess had only medical treatment under CT monitoring. All the patients recovered. From our observations and the literature we conclude that pyogenic sacroiliitis is often not recognized initially. Wrong diagnoses such as sepsis of unknown origin, appendicitis, discal hernia etc. can be avoided if pyogenic sacroiliitis is sought in a systematic fashion. The clinical diagnosis can be confirmed by bone scan, to be repeated at a later stage of disease (i.e. two weeks after onset) if the first examination is inconclusive.

Adolescent↗

PubMed1999

Intraexaminer and interexaminer reliability of the Gillet test.

OBJECTIVES: The purpose of this study was to determine the intraexaminer and interexaminer reliability of the Gillet test. STUDY DESIGN: In a test-retest study the incidence of asymmetric or symmetric sacroiliac joint motion was investigated with the Gillet test. METHODS: Forty-one male subjects volunteered for this study (mean age, 23 +/- 2.24 years). Thirty-eight subjects were examined in the first test procedure, and at least 4 days later 37 subjects were examined again. The subjects were subdivided into symptomatic and asymptomatic groups on the basis of certain criteria. RESULTS: To obtain the intraexaminer and interexaminer reliability values, Cohen's kappa, the percentage agreement, bias-adjusted kappa, and prevalence-adjusted bias-adjusted kappa were used. The mean Cohen's kappa did not exceed the value of 0.081. Only the percentage agreement of the symptomatic group did exceed the minimum level of 80%. When kappa was positive, the prevalence-adjusted bias-adjusted kappa was markedly higher than kappa; when kappa was negative, the prevalence-adjusted bias-adjusted kappa was only slightly higher than kappa. Only small differences were found between kappa and bias-adjusted kappa. CONCLUSION: The Gillet test, as performed in this study, does not appear to be reliable.

Adult↗

PubMed2003

Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings.

OBJECTIVE: To compare a new MRI scoring system of the sacroiliac joints (SIJs) in early spondylarthropathy (SpA) with clinical and laboratory parameters. METHODS: Forty-one patients (24 males, 17 females) with a median age of 26 yr and a median duration of inflammatory low back pain of 19 months were included. They all fulfilled the ESSG-criteria for SpA. The patients were examined by MRI of the SIJs using a new scoring system. Clinical examinations, biochemical tests, functional score (BASFI), and pain score (BASDAI) were also performed. RESULTS: 95% of the patients had inflammation and/or destructive bone changes of the SIJs at MRI. No correlation was found between MRI pathology and clinical findings. MRI demonstrated significantly greater severity of both inflammation and destruction of the SIJs in HLA B27 positive patients than in the HLA B27 negative patients. CONCLUSIONS: In patients with early SpA, MRI was able to detect inflammatory and destructive changes of the SIJs, but the changes were not associated to clinical findings. Our results suggest a role of MRI in the detection of early-stage sacroiliitis.

Adult↗

PubMedDate not supplied

Epidemiologic health study of workers in an aluminum smelter in Kitimat, B.C. II. Effects on musculoskeletal and other systems.

A health study was carried out on 2066 workers in an aluminum smelter in Kitimat, British Columbia to study the effects of exposure to fluoride and other air contaminants encountered on the potlines on the musculoskeletal system, hemopoietic tissue, liver, and renal function. Three hundred seventy-two railway repair workers from Squamish, British Columbia served as an "external" control group. Examination of the spine and sacroiliac joints and pelvic X-ray were conducted on long-term potline workers and a number of "internal" control workers in the smelter not exposed to any air contaminants. Urinary fluoride measurements and personal sampling for airborne fluoride were also carried out. Blood samples were collected for routine blood count and liver and renal function test. Definite cases of skeletal fluorosis were not found in any potroom workers. Some of the changes of early skeletal fluorosis described on pelvic X-rays, e.g., increased density, calcification of ligaments, and periosteal changes, were found in a few workers who were employed on the potlines for more than 10 yr. There was, however, poor agreement in the findings of the two radiologists who read the films. The entity "musculoskeletal fluorosis" does not exist in this smelter where the potroom workers were exposed to total fluoride levels below the currently accepted threshold limit value of 2.5 mg/m3. No ill effects on the hematopoietic tissue or liver and renal function were found.

Air Pollutants↗

PubMed2000

MR imaging of septic sacroiliitis.

OBJECTIVE: To investigate the diagnostic value of magnetic resonance (MR) imaging in detecting septic sacroiliitis and to determine whether the MR characteristics allow this entity to be differentiated from sacroiliitis in spondylarthropathy (SpA). PATIENTS AND DESIGN: The imaging findings of 11 patients with septic sacroiliitis were retrospectively analyzed by two experienced radiologists. Radiographic surveys of the pelvis as well as computed tomography (CT) and MR images of the sacroiliac joints were available in all cases. Seven of the patients additionally underwent a follow-up MR examination. The MR imaging protocol comprised combinations of coronal and transverse T1-weighted spin-echo (SE) or fast SE sequences, T2-weighted gradient-echo (GE) sequences and short tau inversion recovery sequence (STIR) sequences as well as dynamic contrast-enhanced T1-weighted acquisitions. RESULTS: Three patients with a short disease history showed anterior and/or posterior subperiosteal infiltrations ("lava cleft phenomenon"), transcapsular infiltrations of juxtaarticular muscle layers, which obscured the fasciae, and periarticular bone marrow edema. The eight patients with more advanced stages of sacroiliitis additionally showed abscess formation, sequestration, and erosion. At follow-up MR examination (n=7) under systemic antibiotic treatment, the morphologic characteristics showed progression (n=1), regression (n=4), unchanged findings (n=1), or a mixed response (n=1). Clinical improvement precedes resolution of the MR findings. CONCLUSIONS: Anterior and/or posterior subperiosteal infiltrations and transcapsular infiltrations of juxtaarticular muscle layers were depicted in all patients. These MR imaging findings are characteristic of septic sacroiliitis and may be used to differentiate this entity from sacroiliitis in SpA.

Adolescent↗

PubMed2002

Prevalence of ankylosing spondylitis and other spondyloarthropathies among patients with inflammatory bowel disease: a population study (the IBSEN study).

OBJECTIVE: To study the occurrence of spondyloarthropathies (SpA) in patients with inflammatory bowel disease (IBD) seen 6 years after IBD diagnosis. METHODS: In a population based cohort of 654 patients with IBD, 521 patients (80%) were investigated, which included a complete rheumatological examination. Radiographs of the sacroiliac joints and lumbar spine were performed in 406 of these patients (78%). The development of SpA was analyzed with regard to the presence of HLA-B27, duration of IBD symptoms, and the extent of intestinal inflammation. RESULTS: The occurrence of ankylosing spondylitis (AS) was 2.6% in ulcerative colitis and 6% in Crohn's disease (p = 0.08), yielding an overall prevalence of 3.7% in IBD. No correlation between localization or extent of the intestinal inflammation and presence of AS was found. HLA-B27 was present in 73% of cases with AS. The overall prevalence of SpA was 22%. Inflammatory back pain without AS (IBP) was found in 18% of the patients. Typical features of SpA were rare, while fibromyalgia was common in IBP, indicating that IBP is not a precursor or manifestation of SpA in patients with IBD. The prevalence of radiological sacroiliitis without clinical features of SpA was 2.0%. CONCLUSION: AS occurred frequently in patients with newly diagnosed IBD. IBP did not seem to predispose to AS or other forms of SpA. The overall prevalence of SpA was 22%, whereas the prevalence of asymptomatic radiological sacroiliitis was low.

Adolescent↗