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Axial spondyloarthritis (axSpA) is a chronic, immune-mediated inflammatory disorder involving the sacroiliac (SI) joints, spine, entheses and peripheral joints. It encompasses both radiographic (r-axSPA) and non-radiographic (nr-axSPA) axial SpA according to the presence or absence of radiographic sacroiliitis. To study the demographic features, clinical manifestations and imaging characteristics of axSpA and to assess the differences between r-axSpA and nr-axSpA. This study was conducted on 80 axSpA patients. All Patients were subjected to detailed medical history, assessment of disease activity, functional status, laboratory investigations and imaging.Bath AS Disease Activity Index (BASDAI), AS disease activity score (ASDAS), Bath AS Functional Index (BASFI) were assessed. Radiographic sacroiliitis was assessed using the Stoke Ankylosing Spondylitis Spinal Score (mSASSS). The 80 axSpA patients were 59 (73.8 %) nr-axSpA and 21 (26.3 %) with r-axSpA. The mean age of the patients was 35 ± 8.6 (18–55 years). 43 (53.8 %) were males and 37 (46.3 %) females and the median disease duration was 6.5 years (0.5–22 years). Human leucocytic antigen was positive in 16.3 % and psoriasis was present in 13.8 %. Smoking (61.9 % vs 20.3 %; p < 0.0001, hip arthritis (47.6 % vs 13.6 %;p = 0.001), ASDAS (3.03 ± 0.64 vs 2.59 ± 0.79; p = 0.02), BASDAI (3.4 ± 1.1 vs 2.7 ± 1.3;p = 0.03), BASFI (4.7 ± 1.1 vs 3.1 ± 1.3; p < 0.0001) and mSASSS (17 vs 0) were significantly higher in r-axSpA. Characteristics of axSpA of Egyptian patients are comparable with those of other patients across the world. By comparing r-axSpA and nr-axSPA patients, both groups are significantly different regarding sex, smoking, hip arthritis, disease activity scores and mSASSS. [ABSTRACT FROM AUTHOR]

Le rhumatisme psoriasique axial a de nombreuses caractéristiques en commun avec la spondyloarthrite axiale, mais il s'en distingue par certains aspects qui lui sont spécifiques. Il présente notamment des différences radiographiques et cliniques par rapport à la spondyloarthrite axiale. L'imagerie montre généralement des syndesmophytes asymétriques touchant essentiellement le rachis cervical, ainsi que, moins fréquemment, une sacro-iliite. Le rhumatisme psoriasique axial se manifeste à un âge plus avancé et est associé à une rachialgie inflammatoire moins sévère que dans le cas de la spondyloarthrite axiale. L'axe interleukine-23/interleukine-17 est au cœur de la pathogenèse des deux maladies, mais des thérapies ciblant ces cytokines ont obtenu des réponses différentes. Les inhibiteurs de l'interleukine-23, qui ne sont pas efficaces dans la spondyloarthrite axiale, pourraient l'être dans le rhumatisme psoriasique. Des analyses post hoc de résultats d'essais cliniques menés sur les inhibiteurs de l'interleukine-23 dans le rhumatisme psoriasique ont récemment suggéré une efficacité possible dans le rhumatisme psoriasique axial et de nouvelles études devraient être conduites pour évaluer cette hypothèse. Par ailleurs, des critères de classification du rhumatisme psoriasique axial et des outils plus adaptés pour évaluer la réponse thérapeutique sont nécessaires. Axial psoriatic arthritis (axPsA) has considerable overlap with axial spondyloarthritis (axSpA) but has some unique features that sometimes preclude classification into axSpA. It has some clinical and radiographic differences compared to axSpA. Imaging typically shows asymmetric syndesmophytes, mainly in the cervical spine, with less frequent sacroiliitis. It more commonly presents later in life and is associated with less severe inflammatory back pain than axSpA. The interleukin (IL) IL-23/IL-17 axis is central to the pathogenesis of both diseases. However, the response to therapies targeting these cytokines has been different. IL-23 inhibitors are ineffective in axSpA but may be effective in psoriatic arthritis (PsA). Recent post hoc analyses of clinical trial data with IL-23 inhibitors in PsA have raised the possibility of their efficacy in axPsA and need evaluation in future clinical trials. Moreover, there is a need for classification criteria for axPsA and better tools to assess therapeutic response. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) sensitivity and specificity seem to be less studied in enthesitis-related arthritis (ERA). We aimed to determine the ability of sacroiliac MRI to diagnose ERA patients. We conducted a retrospective study including 44 patients with juvenile idiopathic arthritis (JIA). Each patient had a sacroiliac joint MRI. We divided patients into two groups: G1 patients with ERA and G2 patients with non-ERA subtype. ERA was noted in 61% of the cases. Sacroiliac joints were painful in 15 patients (34%). MRI was normal in 25 patients (57%) (G1:11 versus G2:14) and showed bone marrow edema in the sacroiliac joints in 19 patients (34%) (G1 = 16 versus G2 = 3, p = 0.005). Sacroiliac joints MRI's sensitivity and specificity in the ERA diagnosis were 61.54% and 82.35%, respectively. Positive and negative predictive values were 84.21% and 58.33%, respectively. Furthermore, sacroiliac joint pain in the clinical examination was able to predict sacroiliac bone edema in MRI with an odds ratio of 6.8 (95% CI 1.68–28.09; p = 0.006). Our study showed that sacroiliac joint MRI has good specificity and positive predictive value in the diagnosis of ERA patients among JIA patients. This underlines the usefulness of sacroiliac joint MRI in the early diagnosis of ERA patients. [ABSTRACT FROM AUTHOR]

To investigate the acute inflammatory and structural changes of sacroiliitis as auxiliary findings on magnetic resonance enterography (MRE) and their presence on closely timed conventional magnetic resonance imaging of the sacroiliac joint (SI joint MRI). We screened axial spondyloarthritis patients for the simultaneous presence of MREs and SI joint MRIs. Two blinded radiologists evaluated SI joint MRIs and MREs on two separate occasions. We used the Assessment of SpondyloArthritis International Society (ASAS)/Outcome Measures in Rheumatology Network (OMERACT) definitions for SI joint MRI. We implemented previously published standard definitions for osteitis, erosion, sclerosis, and fatty infiltration of SI joint in MREs that contain T1w and T1w post-gadolinium sequences. SI joint MRI and MRE images were present in 43 patients. The median time between the two modalities was 14 (0–89) days. Twelve patients had ASAS-defined positive SI joint MRI. Radiologist-1 and radiologist-2 detected osteitis on MRE in nine and eight out of these 12 patients, respectively. The two radiologists detected ankylosis and fatty metaplasia with a complete agreement and sclerosis with an almost perfect agreement. Both radiologists agreed on erosions on SI joint MRI in the same 10 cases. Radiologists did not identify acute inflammatory or structural changes on MRE in patients with a negative SI joint MRI for these lesions. Along with intestinal findings, additional reporting of acute inflammatory and structural changes of the SI joint on a MRE is valuable and may alert physicians to the presence of previously not diagnosed axial spondyloarthritis. • Acute inflammatory and structural changes of the SI joint may readily be available on MRE. • MRE may alert physicians to the presence of previously undiagnosed axial spondyloarthritis. • MRE reveals important radiologic data on the presence of sacroiliitis. [ABSTRACT FROM AUTHOR]

Septic sacroiliitis is one of the infectious causes of sacroiliitis and it is seen rarely. In current literature, cases of septic sacroiliitis caused by several microorganisms have been reported so far. This case report presents the first case of septic sacroiliitis caused by Staphylococcus xylosus and also complicated with an abscess formation. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is the imaging modality of choice for identifying sacroiliitis in juvenile idiopathic arthritis (JIA). Besides active lesions of sacroiliitis, of which bone marrow edema (BME) is the key feature, structural damage lesions can also be detected. Structural changes include erosion, sclerosis, fat lesion, backfill and ankylosis, and are more common at later stages. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the course of the disease and evaluating treatment options. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of structural damage of sacroiliitis. This atlas can serve as a reference for assessing structural lesions of SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 1, Active Lesions. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is an increasingly important tool for identifying involvement of the sacroiliac joints (SIJ) in juvenile idiopathic arthritis (JIA). The key feature for diagnosing active sacroiliitis is bone marrow edema (BME), but other features of active arthritis such as joint space inflammation, inflammation in an erosion cavity, capsulitis and enthesitis can be seen as well. Structural changes may also be seen. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the disease course, choice of therapeutics and evaluating treatment response. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of SIJ inflammation. This atlas demonstrates fundamental MRI disease features of active inflammation in a format that can serve as a reference for assessing SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 2, Structural Lesions. [ABSTRACT FROM AUTHOR]

The prevalence of physicians experiencing work-related musculoskeletal disorders is high. Traditionally, minimally invasive surgery (MIS) sacroiliac joint (SIJ) fusions are performed with the patient oriented in the prone position, with an incision made inferior to the iliac crest. However, a novel technique that orients the patient in the lateral decubitus position has the potential of significantly enhancing ergonomics and ease of approach. The primary objectives of this study were to quantify surgical parameters, describe this 'lateral-decubitus MIS' technique, and identify imaging angle parameters that predict feasibility. A prospective cohort of patients who underwent MIS SIJ arthrodesis in the lateral decubitus position was evaluated at a single institution between 2017 and 2020. Medians and ranges of intraoperative blood loss, operative time, revision rate, infection, and total radiation dose were recorded. Sacral inlet and outlet angles were defined and collected to assess for operative candidacy. Thirty-nine cases were identified in 34 patients who underwent the technique with an age range of 31–78 years. Median blood loss was 22.5 mL, operating room time was 32.5 minutes, and radiation dose was 30.9 rads. Average sacral inlet was 24.51° and average sacral outlet was 65.44°. Median length of stay was 0.94 days. No cases were aborted or required revision. A total of 93% of study participants reported improvement in pain. Operative parameters were comparable to the traditional prone approach. The aim was to provide an insight into outcomes and metrics observed from pioneering this style of procedure. A future study comparing traditional perioperative parameters together with surgical ergonomics is needed. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the performance of a deep learning radiomics (DLR) model, which integrates multimodal MRI features and clinical information, in diagnosing sacroiliitis related to axial spondyloarthritis (axSpA). A total of 485 patients diagnosed with sacroiliitis related to axSpA (n = 288) or non-sacroiliitis (n = 197) by sacroiliac joint (SIJ) MRI between May 2018 and October 2022 were retrospectively included in this study. The patients were randomly divided into training (n = 388) and testing (n = 97) cohorts. Data were collected using three MRI scanners. We applied a convolutional neural network (CNN) called 3D U-Net for automated SIJ segmentation. Additionally, three CNNs (ResNet50, ResNet101, and DenseNet121) were used to diagnose axSpA-related sacroiliitis using a single modality. The prediction results of all the CNN models across different modalities were integrated using a stacking method based on different algorithms to construct ensemble models, and the optimal ensemble model was used as DLR signature. A combined model incorporating DLR signature with clinical factors was developed using multivariable logistic regression. The performance of the models was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Automated deep learning-based segmentation and manual delineation showed good correlation. ResNet50, as the optimal basic model, achieved an area under the curve (AUC) and accuracy of 0.839 and 0.804, respectively. The combined model yielded the highest performance in diagnosing axSpA-related sacroiliitis (AUC: 0.910; accuracy: 0.856) and outperformed the best ensemble model (AUC: 0.868; accuracy: 0.825) (all P < 0.05). Moreover, the DCA showed good clinical utility in the combined model. We developed a diagnostic model for axSpA-related sacroiliitis by combining the DLR signature with clinical factors, which resulted in excellent diagnostic performance. [ABSTRACT FROM AUTHOR]

A universally accepted definition of axial psoriatic arthritis (axPsA) is lacking. We aimed to 1) assess the presence of axial involvement as defined by "at least unilateral grade 2 sacroiliitis (Uni2SI)" and 2) assess the radiographic progression of Uni2SI and identify risk factors for progression. PsA patients participating in a prospective observational cohort were classified according to their highest sacroiliitis grade. The baseline features of patients with Uni2SI were compared to patients meeting the radiographic criteria of the modified New York Ankylosing Spondylitis (mNY AS) criteria. Risk factors were examined for progression from Uni2SI in a sub-group of patients with >1 follow-up radiographs. Logistic regression and a survival analysis were carried out and identified risk factors associated with radiographic mNY AS compared to Uni2SI. Axial disease defined as ≥Uni2SI was detected in 612/1354 patients (45%). mNY AS sacroiliitis was observed in 477 patients (35%). Radiographic progression of Uni2SI was assessed in 154 patients, 80 (52%) progressed to mNY AS criteria within 5.5 years. At baseline, progressors were diagnosed at a younger age (35.6 vs. 38.9, p = 0.05), had less degenerative disc disease (OR = 0.47, p = 0.02), worse peripheral radiographic damage (OR=1.02, p = 0.03) and worse psoriasis (OR = 1.09, p = 0.01) compared to non-progressors. Patients with an elevated erythrocyte sedimentation rate were more likely to progress (HR = 1.83, p = 0.02), while patients with longer disease duration were less likely to progress (HR = 0.95, p = 0.02). The radiographic mNY AS criteria appear to be suitable for defining axial PsA according to radiographs. MRI definitions are needed as well for the most appropriate definition of axial PsA. [ABSTRACT FROM AUTHOR]

Actualizar las recomendaciones para el manejo de pacientes con espondiloartritis (EspA) en la población mexicana e identificar las variables que podrían influir en el manejo del paciente. Un grupo de 15 expertos en EspA tradujo, analizó y modificó las recomendaciones del Colegio Mexicano de Reumatología (CMR) y del grupo Sociedad Internacional de Evaluación de las Espondiloartritis (ASAS)/Liga Europea contra el Reumatismo (EULAR) del 2016 a través de la revisión sistemática de la literatura realizada por dos revisores externos en el período de 2015 a 2018 utilizando los niveles de GRADE y Oxford y el porcentaje de concordancia (Delphi). En comparación con las recomendaciones anteriores, no hubo cambios significativos desde el año 2015. Sin embargo, modificamos los 5 principios fundamentales y reducimos el número de recomendaciones a 10 por la incorporación de la primera en el texto, la combinación de 5 recomendaciones en 2 y la adición de una nueva. Confirmamos la tendencia del uso de glucocorticoides para pacientes con actividad inflamatoria y escaso acceso a productos biológicos. Se identificaron las características sociodemográficas y clínicas de los pacientes con EspA y su posible influencia en la aplicación de las recomendaciones. Las 10 recomendaciones del CMR y el análisis de las características de los pacientes mexicanos con EspA se centran en el tratamiento escalonado con medios farmacológicos y no farmacológicos, fácilmente accesibles, o por el contrario sustancias de alta tecnología para un pequeño porcentaje de la población. To update the recommendations for the management of patients with Spondyloarthritis (SpA) in the Mexican population, and identify which variables could influence patient management. A group of 15 experts in SpA translated, analyzed and modified the recommendations of the Mexican College of Rheumatology (CMR) and the International Society for the Assessment of Spondyloarthritis (ASAS)/European League Against Rheumatism (EULAR) 2016 group through a systematic review of the literature by two external reviewers during the period from 2015 to 2018 using the grade of recommendation, Oxford levels of evidence, percentage of concordance (Delphi). Compared to previous recommendations, there were no significant changes from the year 2015. However, we modified the five fundamental principles and reduced the number of recommendations to ten by incorporating the first item in the text and combining five recommendations into two and adding a further recommendation. We confirmed the tendency to use glucocorticoids for patients with inflammatory activity and scarce access to biologicals. We identified the sociodemographic and clinical characteristics of patients with SpA and their influence on the application of the recommendations. The ten recommendations of the CMR and the analysis of the characteristics of the Mexican patients with SpA focussed on step therapy, including pharmacological and non-pharmacological therapies, in a spectrum from easily accessible to high-tech substances available to a small percentage of the population. [ABSTRACT FROM AUTHOR]

Background: Sarcoidosis and spondyloarthritis (SpA) have been regularly associated. Bone iliac granulomas have also been described. We propose herein a systematic review of rheumatologic axial manifestations of sarcoidosis.Methods: PubMed and the Cochrane Library were used to conduct this systematic literature review. Case reports and cross-sectional studies were reviewed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.Results: A total of 41 articles were eligible. Three cross-sectional studies on the association between SpA and sarcoidosis showed a prevalence of sacroiliitis and SpA ranging from 12.9 to 44.8% and 12.9 to 48.3% in inflammatory back pain (IBP) subgroups, respectively. However, the IBP definitions and sacroiliac joint (SIJ) imaging modalities (X-rays or magnetic resonance imaging) were heterogeneous, and X-ray was mainly used for sacroiliitis diagnosis (in 78% of cases). Thirty-one case-report articles of the sarcoidosis-sacroiliitis association were identified, representing 35 patients. ASAS criteria for SpA were met in half of cases (16/32) and 46% (12/26) had HLA B27 positivity. Sarcoidosis occurred after sacroiliac symptoms in 47% of cases. In the seven case-report articles with granulomatous sacroiliac bone involvement, unilateral involvement seemed higher than in the sarcoidosis-sacroiliitis group.Conclusion: Literature analysis found a good evidence of the association between SpA and sarcoidosis, and special attention should be given to patients reporting IBP. Unilateral sacroiliitis may raise suspicion of granulomatous bone involvement, distinct from sacroiliitis. Imaging modalities used to study the SIJ in patients with sarcoidosis have been heterogeneous and further investigation is needed. [ABSTRACT FROM AUTHOR]

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare monogenic primary immunodeficiency due to mutations of FOXP3, a master transcription factor of regulatory T cells (Treg). IPEX syndrome leads to fatal course in most cases during early childhood or severe multi-organ immune-mediated disorders in patients who survive. Currently hematopoietic stem cell transplantation represents the only known effective cure for IPEX syndrome. However, older patients with a mild disease not severe enough to justify transplantation, raise concerns regarding the appropriate therapeutic management, which is therefore based on supportive and replacement therapies combined with pharmacological immunosuppression. Herein, we report the case of a 22-year-old man with an incomplete IPEX syndrome without endocrine disorders having suffered from severe enteropathy since his birth treated with a combination of various immunosuppressant agents. He developed severe exacerbation of inflammatory low back pain in relation to sacroiliitis. Eventually, infliximab was initiated to control his back pain with rapid resolution as well as digestive improvement and also reduced biological inflammatory markers. In parallel, flow cytometry analysis revealed an increase in the frequency of circulating FOXP3+ CD4+ Treg cells. Altogether these data highlight that anti-TNF may represent a promising therapeutic option in patients with IPEX syndrome. [ABSTRACT FROM AUTHOR]

To evaluate the short term effect of maximally tolerated dose of non-steroidal anti-inflammatory drugs (NSAIDs) on disease activity and radiographic progression of axial spondyloarthritis (axSpA) patients. A six-week prospective study on thirty patients with active axSpA. All patients were assessed at baseline visit, a follow-up visit after 2 weeks, and 6 weeks of treatment with a maximally tolerated dose of NSAID. Disease activity was assessed by determining Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), and functional assessment by using Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal mobility was assessed by the mean improvement in Bath Ankylosing Spondylitis Metrology Index (BASMI). Magnetic Resonance Imaging (MRI) of sacroiliac joints (SIJs) was taken at baseline and at the end of the study and was evaluated according to Berlin scoring method. Improvement in laboratory activity markers and all disease activity scores has been observed at week 6 of maximally tolerated dose of NSAIDs which were significant (p < 0.001). Additionally, ASDAS clinically important improvement was achieved in 63.3% of patients, and BASDAI50 was achieved in 30% and 56.7% of patients at week 2 and week 6, respectively. Furthermore, Berlin score showed an improvement by 14.2% with a reduction in bone marrow edema signal intensity of SIJs in 40% of patients. In Egyptian cohort of patients with axSpA, intake of maximally tolerated dose of NSAID could improve the health-related quality of life, disease activity scores, and sacroiliac joint inflammation on MRI. [ABSTRACT FROM AUTHOR]

Background Context: Positron emission tomography (PET) is a potential imaging technique for the diagnosis of AS. The visualization of physiological change makes PET potentially suitable for early detection of inflammatory processes, even before anatomical changes occur. Thus, PET might provide specificity via the use of receptor targeting tracers and allows quantification of disease activity in order to accurately monitor therapeutic effects.Purpose: To examine fluorine-18 sodium fluoride (18F-NaF) PET/computed tomography (PET/CT) findings in patients with inflammatory low back pain and evaluate the utility of this modality in the diagnosis of ankylosing spondylitis (AS) according to the Assessment of SpondyloArthritis International Society (ASAS) criteria.Study Design: Retrospective cohort study.Patients Sample: Sixty-eight patients who underwent 18F-NaF PET/CT imaging between April 2015 and April 2017 for evaluation of inflammatory low back pain.Outcome Measures: We defined AS-positive lesions on PET/CT as symmetric sacroiliac joint uptake that suggests sacroiliitis, syndesmophytes on the spine, and enthesopathy at any site.Methods: All patients were evaluated using the ASAS criteria and assigned to either the AS or the control group. The diagnostic criteria of AS on PET/CT images were defined as 18F-NaF PET/CT images with at least one of AS-positive findings.Results: The diagnostic rate of AS was 72.1% among the 68 patients according to the ASAS criteria. The baseline characteristics between the two groups differed significantly in terms of serum C-reactive protein levels and the presence of human leucocyte antigen-B27. Compared to the control group, in the AS group, 39 patients (79.5%) exhibited typical 18F-NaF PET/CT-positive findings, such as enthesopathy (65.3%, p=.003), syndesmophytes (61.2%, p=.006) and symmetric sacroiliitis (67.3%, p=.001). PET-positive findings had significantly higher area under the curve values than did single 18F-NaF PET/CT- positive findings, and they had the best performance for concordant diagnosis according to the ASAS criteria.Conclusions: 18F-NaF PET/CT yielded significantly different findings between the two groups according to the ASAS criteria and is useful for diagnosing AS. [ABSTRACT FROM AUTHOR]

Literature data on the frequency and pathogenesis of sacroiliac joint (SIJ) pain and arthropathy following lumbosacral fusion with long constructs combined with sacroiliac fixation remains scarce. From clinical experience, we noticed that many patients undergoing these surgeries develop SIJ disease postoperatively. We report a clinical observation of no occurrence or remission of SIJ pain following simultaneous SIJ fusion in cases of long-construct lumbosacral fusion and sacropelvic fixation with S2-alar-iliac screws. An illustrative case and description of the simultaneous SIJ fusion technique are discussed as well. Based on our experience, we believe that fusing the SIJ simultaneously during sacropelvic fixation in the context of a long lumbosacral fusion surgery may lead to a decline in the incidence of SIJ disease, as well as remission of SIJ pain in patients requiring revision surgeries. Future, multicenter prospective studies are needed to test and validate this observation. [ABSTRACT FROM AUTHOR]

Aim: To assess the presence, prevalence and characteristics of post-traumatic, inflammatory-like changes of the sacroiliac joint (SIJ) on pelvic computed tomography (CT).Materials and Methods: Sequential CT examinations from the acute (index) and follow-up post-traumatic periods of 24 patients that underwent pelvic trauma with SIJ involvement were evaluated and compared to 32 control patients with pelvic fractures that did not involve the SIJs. Index CT was evaluated for the presence of fracture, intra-articular step, and diastasis, whereas follow-up CT was scored for periarticular sclerosis, erosions, ankylosis, and backfill. Clinical follow-up was performed by pain provocation SIJ tests and a questionnaire (study representative subgroup, n=11, 46%) and from clinical files (control group, n=26, 31%). Pearson correlation coefficient was assessed between the index and follow-up CT variables. Linear regression was used to predict the influence of trauma variables on the development of inflammatory-like structural changes.Results: Total "structural, arthritis-like lesions' score from the follow-up CT examination was significantly higher in the study compared to the control group (3.25 versus 0.05 respectively, p<0.001). The presence of intra-articular diastasis and fracture were significant risk factors for the development of structural inflammatory-like lesions in the SIJ (1.19 and 2.1 respectively, p<0.001). Painful SIJs by physical examination were found in 50% of the clinically evaluated subgroup which was mechanical by nature in 81.8%.Conclusion: Traumatic SIJ fracture or diastasis is associated with the development of post-traumatic SIJ structural inflammatory-like lesions on pelvic CT, mimicking sacroiliitis. These findings may be the result of focal, post-traumatic joint inflammation, which leads to mechanical rather than inflammatory symptoms. [ABSTRACT FROM AUTHOR]

Acute appendicitis is the most common abdominal surgical emergency in the world and often requires surgical intervention. One of the complications of appendicitis is abscess formation. In rare cases, a localised abscess can occur in the adjacent organs, such as the iliac and psoas muscles. Sacroiliitis occurring secondary to, or concomitant with, acute appendicitis is extremely rare. However, a missed diagnosis of either or both conditions can lead to serious complications, including mortality. A 27-year-old male patient presented to the emergency department with a history of acute severe right hip pain that was aggravated by movement and associated with nausea and vomiting. CT suggested acute uncomplicated appendicitis with no localised contamination. He underwent an emergent laparoscopy which showed mild appendiceal inflammation and appendicectomy was performed. He became septic a few hours after the operation, resulting in admission to the high dependency care unit for close observation. On review the following day, he reported ongoing right hip pain and lower back pain with a new onset inability to weight-bear. An MRI scan was performed which showed features of infection around the right sacroiliac joint and Staphylococcus aureus grew in his blood culture. A diagnosis of acute pyogenic sacroiliitis was then made. The patient was treated with IV antibiotics for a total of four weeks, followed by two weeks of oral antibiotics. Acute pyogenic sacroiliitis is one of the rarer conditions seen that can mimic the acute abdomen, in this case acute appendicitis. MRI is the best diagnostic modality in sacroiliitis, in comparison to CT for appendicitis. In most cases of acute appendicitis, mixed bacteria including aerobes and anaerobes are seen in the blood culture while staphylococcus aureus is seen mostly in acute pyogenic sacroiliitis. Staphylococcus aureus -induced appendicitis is reported in less than 3.7 % of cases. An early diagnosis of either or both conditions can significantly reduce complications and, more importantly, expedite implementation of appropriate treatment. In our case we present a combination acute appendicitis, acute sacroiliitis and staphylococcus aureus septicaemia and provide proof that acute pyogenic sacroiliitis can be a rare complication of acute appendicitis. Thus, a high clinical index of suspicion should be considered in the appropriate clinical scenario. • Acute appendicitis is the most common abdominal surgical emergency in the world. • Acute pyogenic sacroiliitis can mimic symptoms of appendicitis with 12.6% of cases mimicking the acute abdomen. • Sacroiliitis that presents secondary to, or concomitantly with, acute appendicitis is extremely rare. • Early recognition and appropriate investigation is key to successful treatment and to prevent further complications. [ABSTRACT FROM AUTHOR]

• Axial psoriatic arthritis (axPsA) has considerable overlap with axial spondyloarthritis (axSpA) but has some unique features that sometimes preclude classification into axSpA. • There is a need for classification criteria for axPsA and better tools to assess therapeutic response. • Post hoc analyses of clinical trial data with IL-23 inhibitors in PsA have raised the question of their efficacy in axPsA. The reported effectiveness of IL-23 inhibitors in axPsA needs to be evaluated in future clinical trials. Axial psoriatic arthritis (axPsA) has considerable overlap with axial spondyloarthritis (axSpA) but has some unique features that sometimes preclude classification into axSpA. It has some clinical and radiographic differences compared to axSpA. Imaging typically shows asymmetric syndesmophytes, mainly in the cervical spine, with less frequent sacroiliitis. It more commonly presents later in life and is associated with less severe inflammatory back pain than axSpA. The interleukin (IL) IL-23/IL-17 axis is central to the pathogenesis of both diseases. However, the response to therapies targeting these cytokines has been different. IL-23 inhibitors are ineffective in axSpA but may be effective in psoriatic arthritis (PsA). Recent post hoc analyses of clinical trial data with IL-23 inhibitors in PsA have raised the possibility of their efficacy in axPsA and need evaluation in future clinical trials. Moreover, there is a need for classification criteria for axPsA and better tools to assess therapeutic response. [ABSTRACT FROM AUTHOR]

Psoriasis is a disease of autoimmune imbalance in a genetically susceptible individual. It has a wide range of mild to severe cases. On the contrary to cutaneous affection which attracts the patient attention to seek medical help, articular affection can have a delayed diagnosis. This study aimed to detect radiologic evidence of sacroiliitis in psoriasis patient not under treatment for articular disease. Twenty skin psoriasis patients participated in the study. None had been previously diagnosed with articular manifestations related to psoriasis. Imaging of the sacroiliac joint by magnetic resonance imaging- Short TI inversion recovery technique (MRI- STIR technique) was ordered for all patients. The presence of bone marrow edema in T2 weighted image was considered diagnostic of active sacroiliitis. Psoriasis areas and severity index (PASI) score was used to assess skin psoriasis severity. Patients were 11 female and 9 males with mean age of 31 ± 5.7 years and mean disease duration of 6.9 ± 3.1 years. The mean PASI score was 19.5 ± 5.2. Clinical sacroiliitis was detected in 25% of patients, plantar fasciitis in 35% and Achilles tendinitis in one patient (5%). MRI with STIR technique was positive for unilateral sacroiliitis showing bone marrow edema in 3 (15%) patients; one male and two females. There was no association between PASI score and presence of radiologic sacroiliitis. Radiologic sacroiliitis is not uncommon in skin psoriasis patients not known to have articular involvement and was not related to the skin disease severity. [ABSTRACT FROM AUTHOR]

• First computer-based method for the diagnosis and grading of sacroiliitis CT scans as incidental findings. • Fully automatic algorithm based on supervised machine and deep learning techniques. • Custom slice and case grading with a custom convolutional neural network and random forest classifiers trained with a relatively small dataset. • Experimental results on 484 sacroiliiac joints yield a binary case classification accuracy and sensitivity of 92% and 95%. • Early diagnosis of sacroiliitis may lead to preventive treatment which can significantly improve the patient's quality of life in the long run. Early diagnosis of sacroiliitis may lead to preventive treatment which can significantly improve the patient's quality of life in the long run. Oftentimes, a CT scan of the lower back or abdomen is acquired for suspected back pain. However, since the differences between a healthy and an inflamed sacroiliac joint in the early stages are subtle, the condition may be missed. We have developed a new automatic algorithm for the diagnosis and grading of sacroiliitis CT scans as incidental findings, for patients who underwent CT scanning as part of their lower back pain workout. The method is based on supervised machine and deep learning techniques. The input is a CT scan that includes the patient's pelvis. The output is a diagnosis for each sacroiliac joint. The algorithm consists of four steps: (1) computation of an initial region of interest (ROI) that includes the pelvic joints region using heuristics and a U-Net classifier; (2) refinement of the ROI to detect both sacroiliiac joints using a four-tree random forest; (3) individual sacroiliitis grading of each sacroiliiac joint in each CT slice with a custom slice CNN classifier, and; (4) sacroiliitis diagnosis and grading by combining the individual slice grades using a random forest. Experimental results on 484 sacroiliiac joints yield a binary and a 3-class case classification accuracy of 91.9% and 86%, a sensitivity of 95% and 82%, and an Area-Under-the-Curve of 0.97 and 0.57, respectively. Automatic computer-based analysis of CT scans has the potential of being a useful method for the diagnosis and grading of sacroiliitis as an incidental finding. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Chronic back pain (CBP) is a frequent complaint in patients with sarcoidosis, which challenges the clinician as multiples causes may potentially underlie this symptom. Interestingly, some reports suggest that the coexistence of sarcoidosis and spondyloarthritis (SpA) may be frequent. This study aimed to determine the prevalence of axial radiographic and non-radiographic SpA in patients with sarcoidosis and CBP and assess the association between patient characteristics and SpA. This cross-sectional study enrolled 64 patients with a diagnosis of sarcoidosis and CBP. Patients describing CBP underwent a full spine MRI and radiography. All patients with inflammatory CBP underwent complementary sacroiliac joint MRI. The diagnosis of axial SpA was based on the Assessment of SpondyloArthritis International Society classification criteria. Among the 64 patients (49 women) with sarcoidosis and CBP, 29 had inflammatory pain; 15/64 had a diagnosis of SpA (23.4% [95% CI: 13.7–35.6], 14/29 (48.3% [95% CI: 29.5–67.5] of those with inflammatory back pain). MRI sacroiliitis was found in 13 patients. On both univariate and multivariate analysis, SpA diagnosis was associated with inflammatory CBP (OR=28.5, 95% CI: 1.91–425.4) and sarcoidosis limited to the thorax (OR=6.74, 95% CI: 1.08–42.1). SpA was associated with young age (p = 0.0093) and male sex (p = 0.021) only on univariate analysis. Besides, 12/64 patients (18.8%, 95% CI: 10.1–30.5) had a diagnosis of sarcoidosis spine bone lesions, 7/64 (10.9%, 95% CI: 4.5–21.2) symptomatic vertebral fracture and 30/64 (46.9%, 95% CI: 34.3–59.8) degenerative spine. The prevalence of SpA is increased in sarcoidosis patients with inflammatory back pain. The systematic use of spine and sacroiliac MRI in this subgroup is justified. The association between other patient features and SpA needs further confirmation. [ABSTRACT FROM AUTHOR]

Calcium pyrophosphate dihydrate deposition disease (CPPD) has been reported to involve the spine, but few systematic studies have been published. To further characterize the spinal involvement with CPPD by a review of CPPD patients hospitalized in a rheumatology department. We retrospectively reviewed data for patients consecutively admitted with a diagnosis of CPPD in the rheumatology department of Lariboisière hospital in Paris, France over 5 years by using a standardized protocol and electronic case report forms. Imaging studies were also reviewed. Spinal CPPD was diagnosed in 37/152 (24.3%) CPPD patients. Patient with spinal involvement had more widespread peripheral CC. The cervical (n = 21) and lumbar (n = 19) segments were most involved. CT-scan was more sensitive than plain radiographs for detecting spinal calcifications. Crown dens syndrome was a prominent feature of cervical involvement. Inflammatory sterile spondylo-discitis was observed in 6 patients. Lesions were frequently multiple and were classified into 4 types. Ruling out septic discitis required image-guided biopsies in 3 patients. Sacroiliac involvement included calcification in 5 patients and severe sterile destructive arthropathy and joint fusion in one patient each. Degenerative changes were common, and CPPD could not be implicated because of the patients 'age and lack of a control population. In 12 patients, severe clinical features requiring hospitalization were related to such degenerative changes. Symptomatic involvement of the spine was observed in 24% of this series of hospitalized CPPD patients. Specific entities were the cause of hospitalisation in 25 of the 37 patients with spinal calcification and included inflammatory pain related to crystal deposits and destructive arthropathy of the spine and sacroiliac joints. Discitis exhibited a wide range of MRI features and biopsies were needed to rule out infection in 3 of the 6 discitis. [ABSTRACT FROM AUTHOR]

The purpose of this report is to demonstrate the creation of a 4-rod lumbosacral construct, when "stacked" sacral-2-alar-iliac (S2AI) screws are not possible due to a concurrent treatment of sacroiliitis with a posterior approach sacroiliac joint fusion device. This technique uses a combined S2AI and subcrestal iliac approach to achieve the 4-rod lumbosacral construct, while simultaneously biomechanically supporting the S2AI screws and treating the sacroiliitis. [ABSTRACT FROM AUTHOR]

Sacroiliitis is a rare complication of enteric fever, seen in <1% of the cases and its concomitant presence with hepatitis has been reported only once. Incorrect or delayed diagnosis of enteric fever may lead to serious complications. Here, we present a complicated case of enteric fever in a 15 years old female who was misdiagnosed elsewhere to be a case of dengue fever owing to thrombocytopenia at presentation along with a weak positive dengue IgM immunochromatography test. The patient eventually developed a rare combination of complications (sacroiliitis, hepatitis, ascites and pleural effusion) and was transferred to our hospital where specific antimicrobial treatment was instituted after isolation of Salmonella Typhi from the clinical samples. This case demonstrates the importance of establishing the correct diagnosis by optimum utilization of the diagnostic services at the time of admission to prevent potentially life threatening complications in an otherwise treatable condition. [ABSTRACT FROM AUTHOR]

Abstract Introduction Musculoskeletal involvement is the second common manifestation in Familial Mediterranean Fever patients (FMF). Sacroiliitis and spondyloarthritis (SpA) are a rare condition in this disease. Case report We present a 52-year-old woman with FMF and SpA and discuss particularities of this link. The patient had FMF since the age of 20 with intermittent inflammatory low back pain since the age of 28 and polyarthralgia of knees, left wrist and shoulders for a year. On examination there was limited extension of the left wrist and range of motion of the spine; pelvic examination and sacroiliac joints were normal. Molecular genetic analysis revealed a homozygous mutation of M649V. Laboratory investigations revealed an elevated C-reactive protein and erythrocyte sedimentation rate (31 mg/dl and 69 mm/1sth respectively). Further investigation showed a negative human leukocyte antigen-B27, antinuclear antibodies, anti-citrullinated peptides antibodies and rheumatoid factor. Pelvic and spine x-rays showed small areas of bilateral increased density and irregularity over the sacroiliac joints indicating grade 3 bilateral sacroiliitis and syndesmophytes. Magnetic resonance imaging of the spine revealed dorsal spondylitis and syndesmophytes. The diagnosis of SpA was retained according to Amor's criteria. The patient was treated initially with non-steroidal anti-inflammatory drugs, physiotherapy and sulphasalazine which were ineffective after 3 months. The patient then received anti-tumor necrosis factor-α with good response. Conclusion Spndyloarthritis should be considered in FMF patients with associated sacroiliitis especially when there are leading symptoms and/or imaging abnormalities in the spine. Awareness of this co-existence is important among rheumatologsits for a timely and precise management plan. [ABSTRACT FROM AUTHOR]

Aim of the work To determine the frequency, clinical and radiological features of axial spondyloarthritis in patients with inflammatory bowel diseases (IBD) and to characterize differences between patients with and without axial spondyloarthritis. Patients and Methods Patients included in this cross-sectional study were recruited from the Gastroenterology Department, University of Tunisia over six months. Sixty-four patients with IBD were questioned and examined for axial spondyloarthritis symptoms. Standard pelvic X-rays were performed for all and CT scans and MRI were done for some patients. Results There were 42 men (65.6%) and 22 women (34.4%) with a mean age of 47 ± 22 years. 32 patients (50%) had Crohn’s disease, 31 had ulcerative colitis and 1 patient has undifferentiated colitis. The disease was confined to the colon among a half of patients with ulcerative colitis. Regarding Crohn’s disease, all lesions were confined to the ileum and the colon. The mean IBD duration was 6.18±7.2 years. The occurrence of axial spondyloarthritis was 26.5% (17 patients who were symptomatic in 16 cases). The bowel disease preceded rheumatic manifestations in all cases. Nine patients (14.1%) had isolated sacroiliitis. The patients with and without axial spondyloarthritis had similar sociodemographic, anthropometric characteristics, comorbidities and bowel disease particularities except a higher percentage of corticosteroids use ( p  = .013). Conclusions Due to the high frequency, an early diagnosis of spondyloarthritis in patients with inflammatory bowel disease by thorough clinical exam and standard pelvic X-rays should be recommended. [ABSTRACT FROM AUTHOR]

Background Hip and axial involvement is uncommon during gout and may raise diagnostic challenges. We describe a rare case of tophaceous hip gout which lead to the diagnosis of asymptomatic axial tophaceous gout at a single rheumatology center. Case presentation A 35-year-old man, diagnosed with tophaceous polyarticular gout 14 years before presentation, consulted for a gout attack with reduced hip range‐of‐motion on physical examination and an increased serum uric acid level (655 µmol/L). He had been regularly taking colchicine, allopurinol (300 mg/j), and occasionally non-steroidal antiinflammatory drugs. Plain Radiography of the hips revealed bilateral circumferential joint space narrowing, subchondral erosions of the right acetabular, a calcified soft tissue tophus of the left hip and bilateral sacroiliitis grade IV. Computed tomography (CT) showed total ankylosis of the upper segments of both sacroiliac joints and bilateral hip joint space narrowing, subchondral geode eroding the right acetabulum. Moreover, CT revealed soft-tissue tophi involving the major trochanter of the left acetabulum, the right coxofemoral joint and lowest two levels of lumbar facet joints (L4-L5; L5-S1). A spinal and plevis magnetic resonance imaging (MRI) concluded on a gouty tophi, locolized bilaterally intraarticularly in the coxofemoral joints, gluteus medius bursae, lumbar facet joints (L4-L5; L5-S1), and cofirmed bilateral sacroiliitis. Conclusion The axial and hip gouty arthritis are exceptionnel localisation. Radiographic imaging tools, mainly CT and MRI, may show the monosodium urate crystals and tophi that can contribute to bone and joint lesions of gout. They also allow the exclusion of other possible etiologies such as spondylodiscitis, infection, and neoplasia. [ABSTRACT FROM AUTHOR]

Objectives: To determine the predictors of sacroiliitis detected by magnetic resonance imaging (MRI) in children with enthesitis-related arthritis.Methods: In this retrospective, longitudinal study, we retrieved clinical and laboratory data from the charts of patients with confirmed enthesitis related arthritis and evaluated their association with magnetic sacroiliitis detected at first MRI after disease onset. The MRI images of sacroiliac joints were read by 2 independent radiologists and validated against those from 25 age- and sex-matched subjects with known non-rheumatologic conditions.Results: We reviewed the clinical records of 20 patients with enthesitis-related arthritis for whom MRI images of sacroiliac joints were available. Five had bilateral MRI sacroiliitis, 3 unilateral sacroiliitis while 12 had no sacroiliitis. All MRI images of sacroiliiitis showed bone-marrow oedema but no erosions, sclerosis or sacroiliac enthesitis. Personal history of buttock pain or abnormal physical examination of sacroiliac joints predicted MRI sacroiliitis with a positive predictive value of 0.75 (95% confidence interval 0.35-0.95). In the absence of these clinical elements, MRI sacroiliitis was unlikely to be found (negative predictive value 0.83; 95% confidence interval 0.50-0.97).Conclusion: In children with enthesitis-related arthritis the presence of buttock pain or of abnormal sacroiliac joint examination is a strong predictor of magnetic sacroiliitis. [ABSTRACT FROM AUTHOR]

• Advanced MRI sequences are demonstrating their potential utility for a more precise assessment of SIJ. • Dixon sequences, T2-mapping, Diffusion Weighted Imaging or DCE-MRI can be acquired in the SIJ with promising results. • Further studies are needed to determine if the parameters derived from these sequences can be integrated into ASAS criteria. The introduction of MRI was supposed to be a qualitative leap for the evaluation of Sacroiliac Joint (SIJ) in patients with Axial Spondyloarthropathies (AS). In fact, MRI findings such as bone marrow edema around the SIJ has been incorporated into the Assessment in SpondyloArthritis International Society (ASAS criteria). However, in the era of functional imaging, a qualitative approach to SIJ by means of conventional MRI seems insufficient. Advanced MRI sequences, which have successfully been applied in other anatomical areas, are demonstrating their potential utility for a more precise assessment of SIJ. Dixon sequences, T2-mapping, Diffusion Weighted Imaging or DCE-MRI can be properly acquired in the SIJ with promising and robust results. The main advantage of these sequences resides in their capability to provide quantifiable parameters that can be used for diagnosis of AS, surveillance or treatment follow-up. Further studies are needed to determine if these parameters can also be integrated into ASAS criteria for reaching a more precise classification of AS based not only on visual assessment of SIJ but also on measurable data. [ABSTRACT FROM AUTHOR]

Objective: To assess the performance of pelvic plain radiograph (radiography), abdominal CT and sacroiliac joint MRI (MRI) compared with sacroiliac joints CT (SI joint CT) for the diagnosis of structural sacroiliitis in a population suffering from spondyloarthritis (SpA) meeting the New York or ASAS criteria.Methods: All SpA patients eligible for biologic treatment who received a pre-therapeutic check-up including the four imaging techniques in the same year were selected from 2005 to 2012. An assessment of sacroiliitis was based independently by a rheumatologist and a radiologist on radiography according to the modified New York criteria and on abdominal CT, MRI and SI Joint CT depending on the presence of erosion on at least two consecutive slices. A final diagnosis was established for conflicting exams.Results: Of the 58 selected patients, sacroiliitis was diagnosed on radiography, abdominal CT, MRI and SI Joint CT in 32, 26, 34 and 35 patients, respectively. Inter-reader agreements for the grade of sacroiliitis were substantial with a weighted Kappa that varied between 0.60 and 0.76 and they were moderate for the diagnosis of sacroiliitis with a Kappa that varied between 0.45 and 0.55 for the four imaging modalities. The sensitivities of radiography, abdominal CT and MRI were 82.8%, 71.4% and 85.7% respectively and the specificities were 86.9%, 100% and 82.6% respectively with excellent accuracy and positive predictive value and good negative predictive value.Conclusion: This study demonstrates the relevance of MRI and abdominal CT for the diagnosis of structural sacroiliitis with good sensitivities and excellent specificities. These imaging modalities may also contribute for the diagnosis of structural sacroiliitis. [ABSTRACT FROM AUTHOR]

Introduction Familial Mediterranean Fever (FMF) is a hereditary auto inflammatory disease. The most common joint attack is an acute large joint monoarthritis most often affecting the knee or hip and lasting for several days. Rarely, a more protracted arthritis may occur. Case report Herein, we describe a 47-year-old man with FMF in whom a few years elapsed before a definitive diagnosis could be made. The patient presented, since the age of 25, with a history of recurrent episodes of fever, abdominal pain, bloody diarrhea and intermittent attacks of acute bi-arthritis of hips. At the age of 40, he was referred under the suspicion of Spondylarthritis (SpA); in view of an inflammatory back pain, talalgia and bilateral coxitis. The result of blood tests suggested the presence of a high level of inflammation without leukocytosis. Human leukocyte antigen (HLA-B27) was negative. X-ray and computerized tomography of the pelvis showed an overall bilateral joint space narrowing of the hips and grade 3 bilateral sacroiliitis. During the hospitalization, he developed an acute episode of fever, abdominal pain and muscle contracture, spontaneously resolved in 12 h. We suspected FMF based on the clinical course and family history, as one of his brothers had suffered similar abdominal crises since childhood. Molecular analysis for FMF was done, and demonstrated a homozygote mutation of M649V. A definitive diagnosis of FMF was then made. Oral administration of colchicine was followed by a remission. Conclusion Clinicians should consider FMF with sacroiliitis and coxitis in the differential diagnosis of spondyloarthritis. [ABSTRACT FROM AUTHOR]

A comparison of 23 children with inflammatory bowel disease presenting with musculoskeletal symptoms and 46 children with arthritis of other causes yielded significantly higher rates in the inflammatory bowel disease group of sacroiliitis, arthralgia, additive and recurrent arthritis, microcytic anemia, elevated inflammatory markers, and hypoalbuminemia. Clinical awareness of these findings could expedite diagnosis and treatment. [ABSTRACT FROM AUTHOR]

• Incidental findings are more frequent on sacroiliac joint MRI than sacroiliitis itself. • Many incidental lesions remain unnoticed without synthetic CT, although they may have clinical significance. • Synthetic CT is often problem solving for diagnosis and may prevent additional (ionizing) imaging. To determine the prevalence of incidental findings on sacroiliac joint MRI and to determine the added value of MRI-based synthetic CT in the detection and evaluation of these incidental findings. In this retrospective study 210 patients clinically suspected of spondyloarthritis who underwent MRI of the sacroiliac joint with synthetic CT sequence were included. The images were reviewed by two radiologists in consensus for the prevalence of sacroiliitis, incidental findings, and the ability of synthetic CT and the conventional MRI to detect and diagnose these findings. In 44.7% of patients sacroiliitis was present. In 89.0% of patients MRI showed at least one incidental finding other than sacroiliitis. Degeneration of the sacroiliac joint was the most prevalent finding (140 patients, 66.6%). The most frequent incidental findings outside the sacroiliac joint were facet joint degeneration (29.0%), disc degeneration (25.2%), enostosis (19.5%) and lumbosacral transitional vertebrae (14.3%). A total of 788 lesions was recorded and synthetic CT was found to be problem solving or necessary for diagnosis in 543 (68.9%) of these lesions. 42.1% of lesions were not visible on conventional MRI (T1 TSE and STIR), most often degenerative osteophytes in the sacroiliac joint or lower lumbar spine. Incidental findings are seen more frequently on sacroiliac joint MRI than sacroiliitis, which is relevant as some will have clinical significance or require treatment. Nearly half of these incidental lesions were only visible on synthetic CT, which additionally has been shown to be problem solving for diagnosis in many other cases. [ABSTRACT FROM AUTHOR]

• IDEAL-IQ performs superior to T1 FSE in the detection of erosions of sacroiliitis. • IDEAL-IQ can detect fat metaplasia by qualitative and quantitative analysis. • Histogram analysis of IDEAL-IQ can obtain more information of fat metaplasia. • PDFF 75th is the most effective parameter for the detection of fat metaplasia. To evaluate the performance of a chemical shift-encoded sequence called IDEAL-IQ for detecting sacroiliac joint (SIJ) erosions and fat metaplasia compared to T1-weighted fast spin echo (T1 FSE) using qualitative and quantitative analysis. Thirty-four patients with suspicion of sacroiliitis who underwent both MRI and CT were included. Each SIJ was divided into four quadrants for analysis. For qualitative analysis, the diagnostic performance of IDEAL-IQ and T1 FSE for erosions were compared by the McNemar test, using CT as the gold standard. Cochran's Q and McNemar tests were used to determine differences in structural changes detected by different imaging methods. For quantitative analysis, two-sample t test and receiver operating characteristic (ROC) analysis were used for the analysis of histogram parameters of proton density fat fraction (PDFF). Diagnostic sensitivity and accuracy of IDEAL-IQ were greater than T1 FSE for erosions (all P < 0.05). IDEAL-IQ and CT detected more erosions than T1 FSE (all P < 0.05). IDEAL-IQ did not statistically significantly differ from T1 FSE for the detection of fat metaplasia (P = 0.678). All histogram parameters were different between groups with and without fat metaplasia (all P < 0.05) and could distinguish the two groups (all P < 0.05). PDFF 75th was the most effective histogram parameter. IDEAL-IQ detects SIJ erosions with better accuracy than T1 FSE and is similar to T1 FSE for detection of fat metaplasia, enabling further quantitative analysis of the latter via histogram analysis. [ABSTRACT FROM AUTHOR]

Non-radiographic axial spondyloarthritis (nr-axSpA) is part of the spectrum or continuum of axSpA and is characterized by the absence of definite structural damage in the sacroiliac joints. The introduction of the concept of axSpA with two - non-radiographic and radiographic - stages stimulated activities related to the improvement of early diagnosis and treatment of this disease, but also opened a number of controversial topics in the field. In this article, we are discussing several challenges related to the concept of nr-axSpA, the diagnosis, and the treatment in the historical context and in the light of the recent data. [ABSTRACT FROM AUTHOR]

Objectives: To compare fat-saturated T2-weighted (FST2W) with contrast-enhanced fat-saturated T1-weighted (cFST1W) pulse sequences in magnetic resonance (MR) imaging of sacroiliac joints in diagnosis of active sacroiliitis associated with axial spondyloarthropathies.Materials and Methods: MR examinations of 147 adult patients suspected for sacroiliitis were retrospectively analyzed. Signs of active inflammation, bone marrow edema/osteitis, capsulitis, enthesitis, and synovitis were noted both on FST2W and cFST1W images. Diagnosis of active sacroiliitis was made according to the Assessment in SpondyloArthritis international Society (ASAS) definition.Results: Sixty three patients were diagnosed as having active sacroiliitis based on both FST2W images showing bone marrow edema and cFST1W images showing osteitis. All areas with osteitis seen on cFST1W images were also noted as having bone marrow edema on FST2W images while FST2W images revealed 4 additional areas of active bone marrow changes. Qualitative and quantitative analyses also revealed that FST2W images were superior in showing active bone marrow lesions, the hallmark of active sacroiliitis, while cFST1W images helped detecting enthesitis and/or capsulitis and were necessary for detecting synovitis.Conclusion: Although cFST1W images help detecting enthesitis and/or capsulitis and are necessary for detecting synovitis, FST2W sequence is superior in detecting active bone marrow lesions and therefore more valuable in diagnosing active sacroiliitis associated with axial spondyloarthropathies based on ASAS criteria. [ABSTRACT FROM AUTHOR]

Aim: To determine the diagnostic utility of magnetic resonance imaging (MRI) features of sacroiliitis in juvenile spondyloarthritis (JSpA).Materials and Methods: This was a prospective study of 80 paediatric patients who underwent MRI of the sacroiliac joints that were clinically suspected to have sacroiliitis. The prevalence of MRI features of active and structural lesions of sacroiliitis was recorded. Patients were classified according to the International League of Association for Rheumatology criteria. The MRI findings were compared to the final clinical diagnosis.Results: Sacroiliitis was seen in 25/80 (31%) patients. MRI showed active inflammation in 23 patients (29%): synovial enhancement (28%), high short tau inversion recovery (STIR)-signal in the joint space (29%), bone marrow oedema (BMO; 20%), and capsulitis (8%). Structural changes were present in 14 patients (18%): erosion (14%), fat infiltration (13%), sclerosis (8%), and ankylosis (1%). Of all MRI features, ankylosis (100%), capsulitis (98%), BMO (96%), and erosion (96%) had the highest specificity for JSpA; global diagnostic impression (55%) and synovial enhancement (52%) were the MRI features with the highest sensitivity. The likelihood ratios (LR+) for diagnosis of JSpA were high for BMO (10.5), capsulitis (7.5), global diagnostic impression (6.9), and erosions (6.75), but greater for BMO concomitant with synovial enhancement (LR+ 19.5) and for erosion concomitant with BMO (LR+ 12) or synovial enhancement (LR+ 13.5).Conclusion: There are multiple features of active inflammation and structural damage visible at MRI of the sacroiliac joints that can provide a specific diagnosis of JSpA when present in children with suspected sacroiliitis. Synovial enhancement is the MRI feature with the highest sensitivity for JSpA. If BMO is seen concomitant with synovial enhancement or erosion, the diagnosis of JSpA is very likely. Ankylosis, capsulitis, bone marrow oedema, and erosion all have a high specificity for JSpA. Absence of MRI findings of sacroiliitis does not exclude the diagnosis of JSpA. [ABSTRACT FROM AUTHOR]

Back pain in childhood and adolescence is a common presentation. While the majority of cases have a benign aetiology, it can represent serious disease requiring prompt diagnosis and treatment. We aim to give an overview of the assessment of a child or adolescent presenting with back pain and the clinical features of the common and serious diagnoses. This article will provide practical advice on the approach to clinical assessment, investigation and management of back pain in children and young people. [ABSTRACT FROM AUTHOR]

Whole body MRI has been used to evaluate inflammatory lesions associated with axial spondyloarthritis (SpA). These sequences are extensive, time consuming and add to the cost of the investigation. We aimed to determine the utility of selected sequence MRI imaging of the axial skeleton including spine, pelvis and sacroiliac (SI) joints to identify features of (SpA). A retrospective study was conducted on 76 patients diagnosed with SpA that underwent a selective sequence MRI imaging of the axial skeleton. The MRI were reported by two musculoskeletal trained radiologists were reviewed. The MRI sequences included whole spine sequences of sagittal STIR (short tau inversion recovery), T1 weighted and T2 weighted sequences. Coronal STIR and T1 weighted images were studied for SI joints and pelvis. The MRI were assessed based on the guidelines outlined by the Assessment of SpondyloArthritis International Society (ASAS) for features of spondylitis, spondylodiscitis, enthesitis, synovitis, capsulitis, bone marrow edema, fatty marrow replacement, erosions and bony ankylosis. Inflammatory lesions were documented in the spine, sacroiliac, facet, hip and costovertebral joints. The mean scan duration was 28 min. SI joint involvement was noted in 74 (97.3%) of patients. The other most prevalent findings were spondylitis in 44 (57.8%) patients, costovertebral joint involvement in 31 (40.7%), facet joint lesions in 32 (42.1%), spondylodiscitis in 21 (27.6%), enthesitis in 13 (17.1%), hip lesions in 16 (21%) and ankylosis in 10 (13.1%). This selective sequence imaging of the pelvis and spine was able to identify typical lesions of SpA in a shorter time period. Fifty-five percent patients had lesions in the posterior elements including facet joints and costovertbral joints that would be missed on traditional SI joint imaging. [ABSTRACT FROM AUTHOR]

Objective: The aim of this retrospective study was to determine the magnetic resonance imaging (MRI) findings of patients with musculoskeletal brucellosis. Materials and methods: Sixty-eight among 304 patients with musculoskeletal brucellosis, aged 12-82 years (average, 50.2 years), were included in the study. Patients were diagnosed based on clinical findings, Brucella agglutination tests, and MRI findings. MRI was performed to all of the patients with sacroiliitis, spondylitisspondylodiscitis, and peripheral arthritis. Results: Brucella serum agglutination test was N1/160 in all cases and blood cultures were positive in twelve cases. The most commonly affected site was the spine (57.3%), wherein lumbar vertebrae were found to be most commonly affected. The second most common affected site was sacroiliac joint (26.4%), whereas peripheral joints were affected in 11 cases (16.1%). Conclusion: Brucellosis may affect various sites in musculoskeletal system. The spine was the most frequently affected site in our study. Sacroiliac joints and the other peripheral joints were less commonly involved sites. Brucellosis should be included in the differential diagnosis of a patient with arthralgia or symptoms of musculoskeletal system disorders especially in endemic areas [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To determine the prevalence of clinically relevant non-inflammatory disease on MRI of the sacroiliac (SI) joints in patients suspected of sacroiliitis. To assess the added value of axial imaging of the pelvis in these patients. Methods: In a retrospective study of 691 patients undergoing MRI of the SI joints from January 2006 to December 2012 for inflammatory back pain the prevalence of sacroiliitis and non-inflammatory disease was recorded. Results: In 285 (41%) patients MRI did not show any abnormal findings. In 36% of patients MRI features of sacroiliitis were present. Spinal degenerative changes were the most common non-inflammatory finding in 305 patients (44.1%) and consisted of disc degeneration in 222 (32%) patients, facet joint arthrosis in 58 (8.4%) patients and disc herniation in 25 (3.6%) patients. Hip joint disease in 44 (6.4%) patients, lumbosacral transitional anomaly in 41 (5.9%) patients, SI joint degenerative changes in 25 (3.6%) patients and diffuse idiopathic skeletal hyperostosis in 24 (3.5%) patients were also common. Osteitis condensans ilii in 17 (2.5%) patients, tumour in 11 (1.6%) patients, fracture in 8 (1.2%) patients, infection in 4 (0.6%) patients and acute spondylolysis in 2 patients (0.3%) were less frequently seen. Conclusion: Our study shows that non-inflammatory disease is more common than true sacroiliitis on MRI of the SI joints in patients with inflammatory type back pain. Axial pulse sequences may demonstrate unexpected findings that remain undetected if only coronal images are obtained. Clinical relevance statement:, MRI of the SI joints may demonstrate conditions that clinically mimic sacroiliitis. Axial imaging of the pelvis may help detect these unexpected findings. [Copyright &y& Elsevier]

Abstract: Purpose: Sacroiliitis is one of the diagnostic criteria of seronegative SpA. The purpose of our study is to show the signal characteristics of the sacral and iliac surfaces by DWI which may contribute in early diagnosis of sacroiliitis and investigate the correlation between ADC values and clinical and laboratory parameters. Materials and methods: 62 patients with inflammatory low back pain, with a history or suspect of seronegative SpA are enrolled into the study. 40 age and sex-matched subjects without SpA constituted the control group. After obtaining routine T1 and T2 weighted sequences, echo planar imaging at b values of 0, 400 and 800 was performed. ADC values on both surfaces of the both sacroiliac joints were measured in all subjects. The CRP and sedimentation results and the presence of arthritis and enthesitis were also correlated with the ADC values. Results: ADC values on both surfaces of the both sacroiliac joints were found 0.23×10−3 mm2/sn in the control group. In the patient group, mean ADC value of 0.48×10−3 mm2/sn was obtained (p <0.001), which was statistically significant, compatible with the increased diffusion due to medullary edema in early sacroiliitis. There was a slight correlation between CRP and ADC values; presumed to be showing the relation between the activity of the disease and the active inflammation on DWI. There was no correlation between arthritis and enthesitis and the ADC values (p >0.001). Conclusion: DWI, by measuring ADC values, adds significant information in the early diagnosis of sacroiliitis and may help to evaluate the efficiency of the treatment. [Copyright &y& Elsevier]

Highlights: [•] Few osteoarticular sequelae of smallpox are described in paleopathological literature. [•] Our case represents a late stage of the disease affecting the elbows. [•] Well preserved bones supply osteologists with useful pathological data. [•] Our mediaeval case is the oldest known. [•] It holds great interest for paleoepidemiology. [Copyright &y& Elsevier]

Abstract: Objectives: We assessed fluorine-18 (18F)-labelled fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) findings in patients with seronegative spondyloarthritis (SpA), polymyalgia rheumatica (PMR), and rheumatoid arthritis (RA). Methods: We studied 53 patients with SpA (n =21), PMR (n =16), or RA (n =16) admitted to our hospital between 2006 and 2011. Disease activity in the ischial tuberosities, greater trochanters, spinous processes, vertebral bodies, and sacroiliac joints (SIJ) were evaluated by determining FDG accumulation using maximum standardized uptake values (SUVmax) and FDG scores. Results: SUVmax for ischial tuberosities was significantly higher in PMR than SpA or RA. SUVmax for greater trochanters and spinous processes was significantly higher in PMR than RA (P <0.001) and significantly higher in SpA than in PMR or RA for SIJ (P =0.01). No significant difference in vertebral scores was observed among groups (P =0.488). FDG scores yielded similar results. X-ray findings were consistent with PET/CT findings in 3/15 (20%) patients with sacroiliitis, whereas magnetic resonance imaging findings were consistent with PET/CT findings in 4/7 (57.1%) patients. Conclusions: PET/CT detection of inflammation in the ischial tuberosities, greater trochanters, and spinous processes discriminated between PMR and RA, but not between SpA and PMR. PET/CT findings can distinguish SpA from RA and PMR and are useful for the early diagnosis of sacroiliitis. [Copyright &y& Elsevier]

Today ultrasound in spondyloarthritis is being developed in three main areas. Joint ultrasound is similar to that described in rheumatoid arthritis and other synovitis, with extensive literature on the matter. Enthesis ultrasound has a growing number of publications that describe the main elementary lesions. Several ultrasound enthesis scores have been developed that provide an overall view of the patient status and this information is useful both in the field of diagnosis and in assessing disease activity. The sacroiliac joints have also received attention and the published sensitivity and specificity could be useful in clinical practice. The future is unknown, but ultrasound has many possibilities that include improving the reliability, the incorporation of enthesis ultrasound assessment to the diagnostic classification criteria as well as the likelyhood developing simplified scores. [ABSTRACT FROM AUTHOR]