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Objectives: To evaluate lesions of sacroiliac joint (SIJ) by combination of diffusion-weighted imaging (DWI) and magnetization transfer (MT). Methods: A retrospective study was used in this study. Forty-nine ankylosing spondylitis (AS) patients admitted to The China Academy of Chinese Medical Sciences Xiyuan Hospital from May 2020 to October 2020 were collected into active and inactive groups. Twenty-two healthy volunteers were recruited. Apparent diffusion coefficient (ADC) values for bone marrow edema (BME), sclerosis area, fat deposit area, and normal-appearing bone marrow (NABM) (both patients and healthy volunteers) and the magnetization transfer (MT) rate of the cartilage (MTRc) were analyzed in the groups. The above five parameters (ADC (NABM), ADC (BME) and ADC (fat deposit) and MTRc) between the active group and the inactive group were compared. The effectiveness of each parameter in diagnosing sacroiliac arthritis of ankylosing spondylitis were analyzed, and the predictive value of the parameters was compared. Results: ADC(BME), ADC(NABM) and MTRc showed statistically significant differences between the active and inactive groups (P <0.05). ADC (BME) and ADC (NABM) could predict the activity of AS sacroiliac arthritis (P <0.01). ADC (NABM) and MTRc were significantly different between healthy volunteers and the active group (P <0.01). The areas under the ROC curve (AUCs) of ADC (BME)_ADC(NABM), ADC(NABM)_MTR, and ADC(BME)_MTRc were 0.885 (cut-off value=0.69), 0.849 (cut-off value=0.56) and 0.864 (cut-off value=0.60), respectively. The predictive ability of the combined index ADC (BME)_MTRc and ADC(NABM)_MTRc was increased. Conclusion: The ability to diagnose and predict AS might be improved by the combination of diffusion-weighted imaging (DWI) and magnetization transfer (MT). [ABSTRACT FROM AUTHOR]

OBJECTIVE: Because of the immature bone marrow signal in children, assessment of the sacroiliac joint is more difficult than in adults. Aim of this study is to evaluate the efficacy of diffusion-weighted imaging (DWI) in sacroiliac joint magnetic resonance imaging (MRI). METHODS: Sacroiliac joint MRI, including DWI sequences, were evaluated by two pediatric radiologists in 54 patients with sacroiliitis and 85 completely normal controls. In MRI evaluation, subchondral bone marrow edema and contrast enhancement in the sacroiliac joints were considered as active sacroiliitis. Apparent diffusion coefficient (ADC) measurements were made in six areas from each sacroiliac joint. A total of 1668 fields were evaluated retrospectively without their diagnosis being known. RESULTS: When the postcontrast T1W series were referenced, the sensitivity, specificity, positive predictive value, and negative predictive value of short time inversion recovery (STIR) images in the diagnosis of sacroiliitis were 88%, 92%, 83% and 94% respectively, compared to contrast-enhanced images. False positive results in STIR images were observed secondary to the flaring signal in the immature bone marrow. ADC measurements obtained from diffusion-weighted images were recorded in all patients and healthy groups. The ADC values were 1.35x10-3 mm2/s (SD: 0.21) in the areas of sacroiliitis, 0.44x10-3 mm2/s (SD: 0.71) in the normal bone marrow and 0.72x10-3 mm2/s (SD: 0.76) in the immature bone marrow areas. CONCLUSION: Although STIR studies are an effective sequence in the diagnosis of sacroiliitis, they cause false positive results in immature bone marrow in children in inexperienced hands. DWI is an objective method that prevents errors in the assessment of sacroiliitis by means of ADC measurements in the immature skeleton. In addition, it is a short and effective MRI series that makes important contributions to the diagnosis without the need for contrast-enhanced examinations in children. [ABSTRACT FROM AUTHOR]

Local glucocorticoid injections are used in the treatment of isolated sacroiliitis in patients with spondyloarthritis. Sacroiliac joint injections can be performed intraarticularly or periarticularly. Since the accuracy of blind injections is low, fluoroscopy, magnetic resonance imaging, computed tomography, or ultrasonography guidance are used to increase the accuracy of sacroiliac joint injections. Currently, imaging fusion software is successfully used in sacroiliac joint interventions with three-dimensional anatomic information added to ultrasonography. Herein, we present two cases of sacroiliac joint corticosteroid injections under ultrasonography-magnetic resonance imaging fusion guidance. [ABSTRACT FROM AUTHOR]

A 6‐month‐old, male German shepherd dog was presented with a 2‐week history of left pelvic limb lameness. Physical examination revealed severe left pelvic limb lameness, lumbosacral and left pelvic limb pain. Magnetic resonance imaging showed heterogeneous T2‐weighted hyperintensity, T1‐weighted hypointense with marked contrast enhancement in the left sacroiliac joint, consistent with unilateral sacroiliitis. Computed tomography was used to perform image‐guided arthrocentesis and also revealed an irregular left sacroiliac joint. Infectious sacroiliitis, caused by Pasteurella multocida, was confirmed by culture of the synovial fluid of the sacroiliac joint. Infectious sacroiliitis should be considered as a differential diagnosis for young dogs presented with pelvic limb lameness and pain. [ABSTRACT FROM AUTHOR]

Our study aimed to evaluate the association between fetuin-A levels and the presence of radiographic sacroiliitis and syndesmophytes in patients with early axial spondyloarthritis (axSpA) and to identify potential predictors of radiographic damage in the sacroiliac joints (SIJs) after 24 months. Patients diagnosed with axSpA in the Italian cohort of the SpondyloArthritis-Caught-Early (SPACE) study were included. Physical examinations, laboratory tests (including fetuin-A), SIJ,+ and spinal X-rays and MRIs at T0 (diagnosis) and at T24 were considered. Radiographic damage in the SIJs was defined according to the modified New York criteria (mNY). Fifty-seven patients were included in this analysis (41.2% male, median (interquartile range), chronic back pain [CBP] duration of 12 (8–18) months). Fetuin-A levels were significantly lower in patients with radiographic sacroiliitis compared to those without at T0 (207.9 (181.7–215.9) vs. 239.9 (217.9–286.9), respectively, p < 0.001) and at T24 (207.6 (182.5–246.5) vs. 261.1 (210.2–286.6) µg/mL, p = 0.03). At T0, fetuin-A levels were significantly higher in non-smokers, in patients with heel enthesitis and in those with a family history of axSpA; fetuin-A levels at T24 were higher in females, in patients with higher ESR or CRP at T0 and in those with radiographic sacroiliitis at T0. Fetuin-A levels at T0 were independently negatively associated with the likelihood of radiographic sacroiliitis (OR = 0.9 per 10-unit increase (95% CI 0.8, 0.999), p = 0.048); but not with the presence of syndesmophytes. After adjustment for confounders, fetuin-A levels at T0 and T24 were also negatively associated with mNY at T0 (β −0.5, p < 0.001) and at T24 (β −0.3, p < 0.001), respectively. Among other variables at T0, fetuin-A levels did not achieve statistical significance in predicting mNY at T24. Fetuin-A levels were negatively associated with radiographic damage of the SIJs, but not of the spine, in early axSpA and after 2 years of follow-up. Our findings suggest that fetuin-A levels may serve as a biomarker to identify patients with a higher risk of developing severe disease and early structural damage. [ABSTRACT FROM AUTHOR]

The ability of microwave radiometry (MWR) to detect with high accuracy in-depth temperature changes in human tissues is under investigation in various medical fields. The need for non-invasive, easily accessible imaging biomarkers for the diagnosis and monitoring of inflammatory arthritis provides the background for this application in order to detect the local temperature increase due to the inflammatory process by placing the appropriate MWR sensor on the skin over the joint. Indeed, a number of studies reviewed herein have reported interesting results, suggesting that MWR is useful for the differential diagnosis of arthritis as well as for the assessment of clinical and subclinical inflammation at the individual large or small joint level and the patient level. MWR showed higher agreement with musculoskeletal ultrasound, used as a reference, than with clinical examination in rheumatoid arthritis (RA), while it also appeared useful for the assessment of back pain and sacroiliitis. Further studies with a larger number of patients are warranted to confirm these findings, taking into account the current limitations of the available MWR devices. This may lead to the production of easily accessible and inexpensive MWR devices that will provide a powerful impetus for personalized medicine. [ABSTRACT FROM AUTHOR]

Background: Synthetic computed tomography (sCT) images are magnetic resonance imaging (MRI)-based images, generated using artificial intelligence. This study aimed to determine the prevalence of anatomical variants of sacroiliac joints (SIJ) on sCT images and the correlation with age, sex and body weight. Methods: MRI of the SIJ including sCT images of 215 patients clinically suspected for sacroiliitis were retrospectively analyzed. The presence of anatomical variants of the SIJ was assessed. Age, sex and body mass index at the time of the MRI were recorded. Results: SIJ variants were found in 82.8% (356/430) of the evaluated joints. The most frequent variants were iliosacral complex (27.7%), bipartite iliac bony plate (27.2%) and crescent iliac bony plate (27%). One new variant was identified, consisting of an accessory facet of the SIJ on the superior side. Overall, SIJ variants were slightly more frequent in women (85.8% vs. 77.8%), but iliosacral complex was significantly more frequent in men. Isolated synostosis was more prevalent with advancing age, in contrast to semicircular defect and unfused ossification center. The occurrence of iliosacral complex was associated with higher BMI, while crescent iliac bony plate occurred more in patients with lower BMI. Conclusion: Over 80% of patients in this study, who were all suspected of sacroiliitis, had at least one SIJ variant. These variants may actually represent subtypes of the normal SIJ. sCT enables detection of very small or subtle findings including SIJ variants. Key points: Sacroiliac joints (SIJ) variants are very commonly observed in patients suspected of sacroiliitis. Synthetic CT allows detection of small or subtle findings including SIJ variants. Women have a higher prevalence of SIJ variants. Multiple variants can coexist within one SIJ. High prevalence of variants indicates existence of subtypes of the 'normal' SIJ. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to assess the utility of neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) in predicting radiographic sacroiliitis and active disease in axial spondyloarthritis (SpA) and to explore the association between use of a tumor necrosis factor inhibitor (TNFi) and these laboratory values compared with traditional inflammatory markers. Methods: Observational data from the Program to Understand the Longterm Outcomes in Spondyloarthritis (PULSAR) registry were analyzed. We generated receiver operating characteristic curves to calculate laboratory cutoff values; we used these values in multivariable logistic regression models to identify associations with radiographically confirmed sacroiliitis and active disease. We also used logistic regression to determine the likelihood of elevated laboratory values after initiation of TNFi. Results: Most study participants (n = 354) were White, male, and HLA–B27 positive. NLR (odds ratio [OR] 1.459, P = 0.034), PLR (OR 4.842, P < 0.001), erythrocyte sedimentation rate (OR 4.397, P < 0.001), and C‐reactive protein (CRP) level (OR 2.911, P = 0.001) were independent predictors of radiographic sacroiliitis. Models that included PLR with traditional biomarkers performed better than those with traditional biomarkers alone. NLR (OR 6.931, P = 0.002) and CRP (OR 2.678, P = 0.004) were predictors of active disease, but the model that included both NLR and CRP performed better than CRP alone. TNFi use reduced the odds of elevated NLR (OR 0.172, P < 0.001), PLR (OR 0.073, P < 0.001), erythrocyte sedimentation rate (OR 0.319, P < 0.001), and CRP (OR 0.407, P < 0.001), but models that included NLR or PLR and traditional biomarkers performed best. Conclusions: These findings demonstrate an association between NLR and PLR and sacroiliitis and disease activity, with NLR and PLR showing response after TNFi treatment and adding useful clinical information to established biomarkers, thus perhaps assisting in management of axial SpA. [ABSTRACT FROM AUTHOR]

Objective: The study aims to investigate the prevalence and neglected rate of sacroiliitis on lumbar spine computed tomography (CT) in patients with low back pain. Materials and methods: From January 2016 to December 2020, a total of 4827 patients (mean age: 35.4 ± 9.5 years) who underwent lumbar spine CT examinations were included in this retrospective study. The CT degree of sacroiliitis in all study population were retrospectively reviewed by two radiologists. The independent sample t-test was used to compare the continuous values and chi-squared or Fisher's exact test was used to compare the categorized values. Results: Sacroiliitis was identified in 514 of 4827 patients (10.6%). Patients with sacroiliitis were significantly younger than those without sacroiliitis (32.1 ± 8.9 vs. 35.8 ± 9.5 years, p < 0.001). Moreover, significantly more patients with sacroiliitis had HLA-B27 (p < 0.001) positivity and inflammatory back pain syndrome (p = 0.003) than those without sacroiliitis. Among the 514 patients, sacroiliitis was recognized on primary reading in 386 patients (75.1%) but was neglected in the remaining 128 patients (24.9%). Of the 386 patients, 371 patients were followed up, and finally, 295 patients of them (79.5%) were diagnosed with axSpA. Conclusion: Radiologists should pay careful and more attention to sacroiliac joint on lumbar spine CT for early diagnosis of sacroiliitis in young patients with low back pain, which could result in early diagnosis and treatment of axSpA. [ABSTRACT FROM AUTHOR]

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disorder that is characterized by inflammatory backache, enthesitis, sacroiliitis, peripheral arthritis, and anterior uveitis. Currently, a significant number of studies have been performed to seek markers to monitor disease activity in AS, and no novel markers satisfy the characteristics of use in the clinical setting. Objective: To assess serum Dickkopf -1 (DKK-1) level among AS patients and control individuals and evaluate their possible correlation with disease activity. Patients and Methods: This was a case-control study which comprised 40 AS cases and 40 gender matched healthy controls. ELISA was used in measuring DKK-1 concentration in the serum of studied subjects. Results: Mean ASDAS was 2.4±0.7, ranged from 0.8-4.1, mean BASFI was 3±1.9, ranged from 0.8-6.8, mean BASDI was 3.6±1.3, ranged from 0.9-6.8. AS patients demonstrated significantly greater DKK-1 level in comparison with controls (mean =197.7 vs. 87.1, p<0.001). There were positive significant association between DKK-1 and AS disease activity measures. There were significant positive correlations between ESR, CRP, MS, ASDAS CRP, BASFI, BASDI and DKK-1 values. Conclusion: serum DKK-1 concentration is elevated in cases with AS, and it is significantly accompanied by disease activity and functional impairment. [ABSTRACT FROM AUTHOR]

Background/aim: The etiology of Behçet’s disease (BD) is not clearly known, however, abnormal activity in T helper (Th) 1, Th 17, and regulatory T cells (Treg) has critical importance in pathogenesis. It has been shown that the intestinal microbiome can be effective in the modulation of these immune abnormalities in BD patients. Breastfeeding increases the maturation of the infant’s intestinal permeability by affecting the newborn’s immature intestinal microbiome and metagenome. We aimed to examine the effects of breastfeeding on disease related symptoms, organ involvements and course of the disease in BD patients. Materials and methods: This study was designed as a cross-sectional study in Ankara City Hospital rheumatology clinic between December 2021 and March 2022. Patients who were diagnosed with BD by meeting the criteria of the ‘International Study Group’ and whose information we could access by agreeing to participate in the study were enrolled. The mothers of the patients were also contacted and asked whether these patients were breastfed, the duration of breastfeeding, and the mode of birth. Demographic and clinical data of the patients, comorbid diseases, and drugs used for BD were collected from the records in the hospital database. The presence of sacroiliitis in patients was evaluated with sacroiliac X-ray and/or magnetic resonance imaging (MRI), which was requested because of low back pain symptoms and only patients with previous sacroiliac imaging for low back pain were included in the study. BD-related organ damage was measured by the Vasculitis Damage Index (VDI) and Behçet’s syndrome Overall Damage Index (BODI) scores. Results: A total of 304 patients were included in the study. The percentage of patients who were reported to have ever breastfed (median duration (IQR): 12(12) months, 33.5% < 6 months, 66.4% ≥ 6 months, and 59.6% ≥ 12 months) is 92%. When the breastfed and nonbreastfed patients were compared, 6.8% of the breastfed patients needed TNF-i against 18.2% of the nonbreastfed patients (p = 0.052). While the rate of having at least one comorbidity was 26.4% for those who were breastfed, this rate was 50% for those who had never been breastfed. When the organ and system involvements of the patients were compared, the incidence of sacroiliitis was statistically significantly higher in the nonbreastfed group (p = 0.025). Patients who were breastfed for less than 6 months were diagnosed with BD at an earlier age than those who were breastfed for more than 6 months, and those who were breastfed for less than 12 months compared to those who were breastfed for more than 12 months (respectively, p = 0.039, p = 0.035). Conclusion: Our results imply that history of breastfeeding may have some positive effects on the course of the disease in BD patients. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) of the axial skeleton, spine, and sacroiliac (SI) joints is critical for the early detection and follow-up of inflammatory rheumatologic disorders such as axial spondyloarthritis, rheumatoid arthritis, and SAPHO/CRMO (synovitis, acne, pustulosis, hyperostosis, and osteitis/chronic recurrent multifocal osteomyelitis). To offer a valuable report to the referring physician, disease-specific knowledge is essential. Certain MRI parameters can help the radiologist provide an early diagnosis and lead to effective treatment. Awareness of these hallmarks may help avoid misdiagnosis and unnecessary biopsies. A bone marrow edema-like signal plays an important role in reports but is not disease specific. Age, sex, and history should be considered in interpreting MRI to prevent overdiagnosis of rheumatologic disease. Differential diagnoses—degenerative disk disease, infection, and crystal arthropathy—are addressed here. Whole-body MRI may be helpful in diagnosing SAPHO/CRMO. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the demographic, clinical and laboratory characteristics of patients with enthesitis‐related arthritis (ERA), familial Mediterranean fever (FMF) and inflammatory bowel disease (IBD), which are inflammatory diseases that may develop sacroiliitis. Thus, it was aimed to reveal various findings that may indicate primary disease in patients with sacroiliitis. Methods: Pediatric patients aged 6–18 years, who were being followed with a diagnosis of ERA (n = 62), FMF (n = 590), and IBD (n = 56) over the period 2013–2021 were included in the study. Sacroiliitis (n = 55) was diagnosed by magnetic resonance imaging of the sacroiliac joint, obtained from clinically suspected patients. Results: Sacroiliitis was detected in 54.8% of ERA patients, 2.3% of FMF patients, and 12.5% of IBD patients. The mean follow‐up period was 4.1 ± 2.8 years (10 months‐8 years) for the entire study group. The most common MRI finding for sacroiliitis was bone marrow edema. Peripheral joint involvement (73.5%) and HLA B27 positivity (64.7%) was significantly higher in ERA patients, and ERA was diagnosed more frequently in patients presenting with sacroiliitis. Non‐steroidal anti‐inflammatory drugs (NSAIDs) were the first choice of treatment agent when sacroiliitis developed in all three patient groups. Conclusions: The clinical and laboratory findings of ERA, FMF and IBD can sometimes be intertwined or can even coexist. Treatment may differ depending on the disease associated with sacroiliitis, although NSAIDs may be used in the first‐line treatment of all three diseases. Sacroiliitis patients with HLA B27 positivity and peripheral arthritis may need to be addressed as ERA. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to develop a computer-aided diagnosis method to assist physicians in evaluating sacroiliac radiographs. Methods: Convolutional neural networks, a deep learning method, were used in this retrospective study. Transfer learning was implemented with pre-trained VGG-16, ResNet-101 and Inception-v3 networks. Normal pelvic radiographs (n = 290) and pelvic radiographs with sacroiliitis (n = 295) were used for the training of networks. Results: The training results were evaluated with the criteria of accuracy, sensitivity, specificity and precision calculated from the confusion matrix and AUC (area under the ROC curve) calculated from ROC (receiver operating characteristic) curve. Pre-trained VGG-16 model revealed accuracy, sensitivity, specificity, precision and AUC figures of 89.9%, 90.9%, 88.9%, 88.9% and 0.96 with test images, respectively. These results were 84.3%, 91.9%, 78.8%, 75.6 and 0.92 with pre-trained ResNet-101, and 82.0%, 79.6%, 85.0%, 86.7% and 0.90 with pre-trained inception-v3, respectively. Conclusions: Successful results were obtained with all three models in this study where transfer learning was applied with pre-trained VGG-16, ResNet-101 and Inception-v3 networks. This method can assist clinicians in the diagnosis of sacroiliitis, provide them with a second objective interpretation and also reduce the need for advanced imaging methods such as magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Osteoarticular infections in pediatric patients are associated with significant morbidity and the risk of functional and/or anatomical sequelae, often requiring surgical interventions. Pyogenic sacroiliitis is a rare bacterial infection affecting the osteoarticular region, accounting for a small percentage of all septic arthritis cases. The symptomatology is imprecise, leading to delayed diagnosis and potential complications such as abscesses, sepsis and joint deformities. Currently, nuclear magnetic resonance is the most useful diagnostic method due to its relatively easy accessibility and high sensitivity. Initiating appropriate antibiotic treatment results in a rapid regression of symptoms. We present the clinical case of a school-aged patient treated at a hospital in Bogotá, Colombia. The patient exhibited symptoms indicative of pyogenic sacroiliitis, suspected based on the anamnesis and physical examination, and later confirmed through imaging and microbiological culture. [ABSTRACT FROM AUTHOR]

Sacroiliitis is a rare pathology recently reported in the veterinary literature, mainly in large-breed dogs. The main associated clinical signs are lumbosacral pain and/or lameness of one or both hindlimbs. However, it is a nonspecific presentation and can be mistaken for other clinical disorders with a higher prevalence, such as caudal lumbar disc herniation or degenerative lumbosacral stenosis, among others. The present report describes the MRI findings in a German shepherd dog with unilateral sacroiliitis secondary to a possible trauma and the relevance of advanced imaging techniques in these patients., (© 2025 American College of Veterinary Radiology.)

Background: Sacroiliitis is a hallmark of ankylosing spondylitis (AS), and early detection plays an important role in managing the condition effectively. MRI is commonly used for diagnosing sacroiliitis, traditional methods often depend on subjective interpretation or limited automation which can introduce variability in diagnoses. The integration of semi-supervised segmentation and radiomics features may reduce reliance on expert interpretation and the need for large annotated datasets, potentially enhancing diagnostic workflows., Purpose: To develop a diagnostic model for sacroiliitis and bone marrow edema (BME) using semi-supervised segmentation and radiomics analysis of MRI images., Study Type: Retrospective cohort study., Population: A total of 257 patients (161 males, 93 females; age 11-74 years), including 155 sacroiliitis and 175 BME patients. A total of 514 sacroiliac joint (SIJ) MRI images are analyzed, with 359 used for training and 155 for testing., Field Strength/sequence: 3.0 T, spin echo T1-weighted imaging (T1WI) and short-tau inversion recovery (STIR)., Assessment: SIJ segmentation is automated using the semi-supervised segmentation-based Unimatch framework. Manual delineation of SIJ regions of interest (ROIs) on T1WI images by an experienced radiologist (W.M., 10-year experience) served as the reference standard for segmentation performance evaluation. Radiomics features from T1WI and STIR are used to train machine learning models, including support vector machine (SVM), logistic regression (LR), and light gradient boosting machine (LightGBM), for sacroiliitis and BME detection. Performance is assessed using area under the curve (AUC), sensitivity, specificity, and accuracy. The Dice coefficient is used to assess the performance of the semi-supervised segmentation model on SIJ segmentation., Statistical Tests: Performance is evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA)., Result: The Unimatch model achieves an average Dice coefficient of 0.859 for SIJ segmentation. AUCs for sacroiliitis detection are 0.84 (LR), 0.86 (SVM), and 0.78 (LightGBM), while for BME detection, AUCs are 0.73 (LR), 0.76 (SVM), and 0.70 (LightGBM)., Data Conclusion: This study demonstrates that semi-supervised segmentation combined with radiomics features and machine learning models provides a promising approach for diagnosis of sacroiliitis and BME., Plain Language Summary: This study aimed to improve the diagnosis of sacroiliitis and bone marrow edema in patients with ankylosing spondylitis. The researchers used a method that automatically segments MRI images and analyzes features from those images. By applying machine learning, they created models to help detect sacroiliitis and bone marrow edema more accurately. The results show that this approach can effectively assist in identifying these conditions, with the best accuracy for sacroiliitis and bone marrow edema reaching 81.2% and 74.2%, respectively. This method could help doctors make better decisions, offering a promising tool for improving diagnosis in clinical settings., Level of Evidence: 3 TECHNICAL EFFICACY: Stage 2., (© 2025 International Society for Magnetic Resonance in Medicine.)

Objectives: We wished to compare the diagnostic performance of texture analysis (TA) against that of a visual qualitative assessment in identifying early sacroiliitis (nr-axSpA). Methods: A total of 92 participants were retrospectively included at our university hospital institution, comprising 30 controls and 62 patients with axSpA, including 32 with nr-axSpA and 30 with r-axSpA, who underwent MR examination of the sacroiliac joints. MRI at 3T of the lumbar spine and the sacroiliac joint was performed using oblique T1-weighted (W), fluid-sensitive, fat-saturated (Fs) T2WI images. The modified New York criteria for AS were used. Patients were classified into the nr-axSpA group if their digital radiography (DR) and/or CT results within 7 days from the MR examination showed a DR and/or CT grade < 2 for the bilateral sacroiliac joints or a DR and/or CT grade < 3 for the unilateral sacroiliac joint. Patients were classified into the r-axSpA group if their DR and/or CT grade was 2 to 3 for the bilateral sacroiliac joints or their DR and/or CT grade was 3 for the unilateral sacroiliac joint. Patients were considered to have a confirmed diagnosis if their DR or CT grade was 4 for the sacroiliac joints and were thereby excluded. A control group of healthy individuals matched in terms of age and sex to the patients was included in this study. First, two readers independently qualitatively scored the oblique coronal T1WI and FsT2WI non-enhanced sacroiliac joint images. The diagnostic efficacies of the two readers were judged and compared using an assigned Likert score, conducting a Kappa consistency test of the diagnostic results between two readers. Texture analysis models (the T1WI-TA model and the FsT2WI-TA model) were constructed through feature extraction and feature screening. The qualitative and quantitative results were evaluated for their diagnostic performance and compared against a clinical reference standard. Results: The qualitative scores of the two readers could significantly distinguish between the healthy controls and the nr-axSpA group and the nr-axSpA and r-axSpA groups (both p < 0.05). Both TA models could significantly distinguish between the healthy controls and the nr-axSpA group and the nr-axSpA group and the r-axSpA group (both p < 0.05). There was no significant difference in the differential diagnoses of the two TA models between the healthy controls and the nr-axSpA group (AUC: 0.934 vs. 0.976; p = 0.1838) and between the nr-axSpA and r-axSpA groups (AUC: 0.917 vs. 0.848; p = 0.2592). In terms of distinguishing between the healthy control and nr-axSpA groups, both the TA models were superior to the qualitative scores of the two readers (all p < 0.05). In terms of distinguishing between the nr-axSpA and r-axSpA groups, the T1WI-TA model was superior to the qualitative scores of the two readers ( p = 0.023 and p = 0.007), whereas there was no significant difference between the fsT2WI-TA model and the qualitative scores of the two readers ( p = 0.134 and p = 0.065). Conclusions: Based on MR imaging, the T1WI-TA and fsT2WI-TA models were highly effective for the early diagnosis of sacroiliac joint arthritis. The T1WI-TA model significantly improved the early diagnostic efficacy for sacroiliac arthritis compared to that of the qualitative scores of the readers, while the efficacy of the fsT2WI-TA model was comparable to that of the readers.

Objective: This study investigated the utility of low-dose CT (ldCT) compared with MRI in diagnosing sacroiliitis in enthesitis-related arthritis (ERA) patients., Methods: Thirty patients diagnosed with ERA were evaluated, with a median follow-up of 1.47 years. Images from patients were examined by two paediatric radiologists. For each patient, we assessed the density changes on ldCT at corresponding locations, employing the signal intensity observed on MRI across each joint surface as a reference. While measurements in areas without oedema on MRI showed relatively high density, measurements in areas with oedema on MRI showed relatively low density., Results: MRI revealed bilateral bone marrow oedema in 22 (73.3%) patients. During the ldCT evaluation of the right iliac crest, lower density was identified on ldCT in regions displaying heightened signal intensity on MRI in 20 (66.6%) patients. On the right sacral side, lower density was observed in the ldCT of 22 (73.3%) patients. Moving to the left iliac crest, 18 (60%) patients displayed a lower density. On the left sacral side, lower density was identified on ldCT in 22 (73.3%) patients. Erosion was detected in 23 patients on ldCT, whereas only 11 patients showed erosion on MRI., Conclusions: This study suggests that ldCT is superior to MRI for early structural change detection. Pixel-based density evaluation in ldCT aligns with MRI for bone marrow oedema., Advances in Knowledge: The present study showed that ldCT is superior to MRI for early structural change detection. Pixel-based density evaluation in ldCT aligns with MRI findings for bone marrow oedema., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology.)

Objectives. The first objective of our study was to determine the radiation exposure received by patients during tin-filtrated ultra-low-dose computed tomography (TFULDCT) of sacroiliac joints and to compare those to conventional X-ray doses. For comparison, we added a cohort examined by low-dose CT (LDCT) without tin filtration. The second objective was to compare the results of TFULDCT and X-ray in the detection of sacroiliitis. Methods. Our retrospective study covered 45 patients, who were examined for suspected axial spondyloarthritis (AxSpA). The first group underwent TFULDCT as well as conventional radiography (CR); the second group underwent LDCT only without tin filtration. Effective doses of TFULDCT, LDCT and CR were calculated by an experienced medical physicist. TFULDCT and CR were independently evaluated by three investigators, who decided on the presence or absence of rheumatoid inflammatory bone changes. The results were statistically evaluated. Results. In our cohort, the median effective dose for TFULDCT was 0.11 mSv, range (0.06-0.40 mSv), for LDCT 0.5 mSv (0.29-0.89 mSv), and for CR 0.25 mSv (0.06-1.87 mSv). We proved that TFULDCT produces a significantly lower percentage of uncertain results (23.3%; 95% CI: 11.3-41.6%) than CR (66.7%; 95% CI: 48.3-81.1%). Conclusions. Tin filtration helps to reduce CT radiation exposure to values lower than those resulting from CR. TFULDCT offers better overall diagnostic performance than CR. Our results prove that TFULDCT can replace CR in the diagnosis of sacroiliitis in the radiographical stage of AxSpA.

Abstract Background Group A streptococcus infection during pregnancy can be concerning. It may cause toxic shock syndrome, which can be fatal. Here, we report a rare case of a pregnant woman who developed infectious sacroiliitis due to group A streptococcus infection. To the best of our knowledge, this case is the first of its kind to be reported. Case presentation A 32-year-old multiparous Japanese woman presented with fever and right buttock pain at 28 weeks of gestation. Based on our clinical findings and investigations, she was diagnosed with group A streptococcus bacteremia and infectious sacroiliitis caused by group A streptococcus. A cardiotocography performed to assess the fetal status showed fetal tachycardia. To prevent the patient from progressing to toxic shock syndrome caused by group A streptococcus, we performed an emergency cesarean section. The patient and her infant had a good course after the cesarean section. Conclusion A pregnant woman diagnosed with group A streptococcus infection needs to be monitored closely because a timely decision to deliver the fetus before rapid deterioration to toxic shock syndrome is crucial.

Brucellosis is the most common zoonosis globally, and it is endemic to the Indian subcontinent. It can mimic a number of febrile illnesses and inflammatory disease conditions. An 18-year-old boy presented with low back pain and a fever of three-month duration. Magnetic resonance imaging revealed a unilateral sacroiliitis, which was being treated as an inflammatory spondyloarthropathy. Because of non-resolving symptoms, a biopsy was performed, which showed a granulomatous inflammation that was consistent with tuberculosis or brucellosis infection. A history of exposure to livestock and consumption of unpasteurized milk led to a clinical suspicion of brucellosis, which was confirmed on a positive serology. He was treated with antibiotics with improvement in symptoms and complete resolution of the sacroiliitis. A high index of suspicion must be maintained for brucellosis, especially in patients with a rural residence, exposure to livestock, and febrile illness with a clinically suspected unilateral sacroiliitis.

Background: Axial spondyloarthropathy is a type of disease which affects the axial skeleton affecting productive years. Methods: This was a cross-sectional, observational study in which 28 consecutive patients more than 16 years of age, fulfilling the Assessment of SpondyloArthritis International Society (ASAS) criteria for axial spondyloarthropathy were included. They were further sub-grouped into radiographic and non-radiographic axial spondyloarthropathy. Clinical features, joint involvement, measurements, HLA-B27 serology, and disease activity were evaluated. Data was entered into Microsoft Excel, and SPSS (Statistical Package for Social Sciences) software 2.0 was used for analyzing the data. Results: Mean age was 28.5 ± 6.3 years. 85.7% were males. Inflammatory low back pain was the most common clinical feature at presentation (89.2%). Enthesitis was the most common extra-articular feature seen in 35.7% of patients. 42.8% were non-radiographic axial spondyloarthritis. 85.7% of patients were HLA-B27 positive. 50% of patients had bone marrow edema on MRI, and only one patient had ankylosis indicating predominantly early disease. 50%–70% of our patients had high disease activity and 89.3% were responding well to non-steroidal anti-inflammatory drugs (NSAIDs). There was no significant difference between the radiographic axial spondyloarthritis group and the non-radiographic group except for elevated C-reactive protein (CRP). Conclusion: Ankylosing spondylitis in western India occurs mostly in the age group of 20–30 years, suggesting affection of productive age group. There was a delay of diagnosis for approximately three years from the onset of symptoms. There was a positive association with HLA-B27 in majority of the patients. Most of our patients had early disease based on radiological findings, suggesting that there was room for therapeutic intervention before irreversible ankylosis had set in.

Sacroiliitis has long been thought to be a fiefdom of the spondyloarthritides. We present 5 different cases of Immune mediated inflammatory disorders (IMIDs) presenting with sacroilitis. Though sacroilitis on Imaging can be seen in postpartum women, Athletes and even normal people, erosions in sacroiliac joint and deep SI joint edema are likely to favour a pathological cause of sacroilitis seen on imaging. We also review the prevalence of sacroilitis in different IMIDs from the available literature.

Enthesitis-related arthritis (ERA) represents 5–30% of all cases of juvenile idiopathic arthritis (JIA) and belongs to the spectrum of the disorders included in the group of juvenile spondyloarthritis. In the last decade, there have been considerable advances in the classification, diagnosis, monitoring, and treatment of ERA. New provisional criteria for ERA have been recently proposed by the Paediatric Rheumatology INternational Trials Organisation, as part of a wider revision of the International League of Associations for Rheumatology criteria for JIA. The increased use of magnetic resonance imaging has shown that a high proportion of patients with ERA present a subclinical axial disease. Diverse instruments can be used to assess the disease activity of ERA. The therapeutic recommendations for ERA are comparable to those applied to other non-systemic JIA categories, unless axial disease and/or enthesitis are present. In such cases, the early use of a TNF-alpha inhibitor is recommended. Novel treatment agents are promising, including IL-17/IL-23 or JAK/STAT pathways blockers.

Rheumatoid arthritis (RA) and spondyloarthritis(SpA) are chronic inflammatory disorders with unique symptoms and pathologies. Misclassification of these two entities is prevalent due to overlapping clinical features and the presence of typical symptoms for both disorders. Rheumatoid nodules are one of the most common extra articular manifestations in rheumatoid arthritis, usually associated with severe disease activity. Herein, we describe a case of rheumatoid arthritis with bilateral sacroiliitis, an uncommon joint involvement of rheumatoid arthritis, and accelerated subcutaneous nodulosis after treatment with adalimumab. Introduction RA is a chronic, autoimmune disorder that primarily affects peripheral synovial joints [1]. The axial skeleton is usually spared other than the cervical spine, particularly C1 to C2 [1]. Though sacroiliitis is a paramount sign of SpA, it can be rarely observed in RA [2]. The commonest extra-articular manifestation of RA is subcutaneous nodules, which can be accelerated with RA treatments [3]. Herein, we describe a patient presented with bilateral sacroiliitis, along with the diagnostic and therapeutic challenges we surmounted. Case presentation A-45-years-old female presented with a one-year history of inflammatory arthritis of bilateral metacarpophalangeal, wrist, and ankle joints. She also had inflammatory-type back pain with buttock pain and plantar fasciitis. The Left-sided Faber test was positive. The laboratory investigations revealed elevated inflammatory markers, negative RF and HLA-B27. MRI-SI joints revealed bilateral active sacroiliitis. She was treated as SpA with NSAIDS at first, followed by subcutaneous adalimumab due to inadequate response. Though arthritis improved following adalimumab, multiple firm subcutaneous nodules occurred in the extensor surface of the elbow and hands after six-doses of adalimumab. Biopsy was compatible with rheumatoid nodule and anti-cyclic citrullinated peptide was positive. Based on the presence of rheumatoid nodules and positive anti-CCP antibodies, the patient was diagnosed with seropositive RA and bilateral sacroiliitis, an unusual joint involvement in RA. Discussion Sacroiliitis is the paramount clinical sign in SpA [2]. However, it can be seen in a wide range of disease conditions [4]. Misclassification between SpA and RA can occur due to overlapping clinical manifestations [4].  The Rheumatoid nodule is the most common cutaneous manifestation of RA and often seen in seropositive RA and more severe disease [3]. There have been case reports of accelerated subcutaneous nodulosis in patient with RA, treated with MTX, leflunomide, azathioprine, TNF alfa inhibitors and tocilizumab [3].  Though Inflammatory back pain, active sacroiliitis, and plantar fasciitis mislead the diagnosis, rheumatoid nodules and positive anti-CCP antibodies aid the classification of RA. [ABSTRACT FROM AUTHOR]

Background: Unlike axial spondyloarthritis (axSpA), no classification criteria are currently available for axial psoriatic arthritis (axPsA). This study aimed to evaluate the performance of the proposed cut-offs from the Assessment of Spondyloarthritis International Society (ASAS) data-driven definitions for active and structural magnetic resonance imaging (MRI) lesions typical of axSpA in distinguishing axial involvement in patients with psoriatic arthritis (PsA). Methods: Seventy-two consecutive PsA patients (67% male, aged 45± 14 years) meeting the CASPAR classification criteria, regardless of the presence of back pain, were included. All patients underwent radiography of the pelvis and spine, as well as sacroiliac joint (SIJ) MRI, while 52 (72%) of 72 patients also underwent whole-spine MRI. The final diagnosis of axPsA was ascertained by two experienced rheumatologists. One rheumatologist with expertise in imaging and one trained reader evaluated the radiography and MRI images. Results: AxPsA was diagnosed in 27/72 (38%) patients. The proposed cut-offs for active sacroiliitis demonstrated high specificity (95.6%) but relatively low sensitivity (51.9%) in distinguishing patients with and without axPsA. When structural lesions of the SIJ were included in addition to active lesions, the sensitivity significantly improved (96.3% vs. 51.9%) with a modest decrease in specificity (86.7% vs. 95.6%). Incorporating MRI spine lesions (using the proposed cut-offs for positive spine MRI from the SPACE cohort) alongside SIJ lesions did not further change sensitivity or specificity compared with assessing SIJ alone. Conclusion: The ASAS-proposed cut-offs for identifying active and structural lesions of SIJ demonstrated satisfactory performance in discriminating axial involvement in PsA patients. [ABSTRACT FROM AUTHOR]

Introduction. Sacroiliitis is an inflammation of one or both of the sacroiliac (SI) joints, most often resulting pain in the lower back that can extend down the legs. Pain arising from the SI joint can be difficult to diagnose and treat due to the intricate surrounding ligamentous structure, nerve innervation, and its role in transferring weight from the upper body to the lower limbs. SI joint dysfunction accounts for up to 25% of cases of lower back pain and has a debilitating effect on patient functionality. This review aims to provide comprehensive coverage of all aspects of SI joint pain, with a specific focus on differential diagnosis and treatment. Methods. Current literature on SI joint pain and inflammation, other etiologies of lower back pain, and new treatment options were compiled using the databases PubMed and Cochrane and used to write this comprehensive review. There were no restrictions when conducting the literature search with regard to publication date, study language, or study type. Results. The diagnosis protocol of SI joint pain arising from sacroiliitis usually begins with the presentation of lower back pain and confirmatory diagnostic testing through fluoroscopy joint block. Reduction in pain following the anesthetic is considered the golden standard for diagnosis. The treatment begins with the conservative approach of physical therapy and analgesics for symptom relief. However, refractory cases often require interventional methods such as corticosteroid injections, prolotherapy, radiofrequency ablation, and even SI joint fusion surgery. Conclusion. SI joint pain is a complex problem that can present with varying patterns of pain due to uncertainty regarding its innervation and its prominent surrounding structure. It is therefore especially important to obtain a thorough history and physical on top of diagnostic tests such as a diagnostic block to properly identify the source of pain. Conservative treatment options with physical therapy and analgesics should be attempted first before interventional strategies such as ablation, injections, and prolotherapy can be considered. SI joint fusion surgery is a solution to cases in which previous methods do not provide significant relief. [ABSTRACT FROM AUTHOR]

Background: To describe the clinical characteristics and explore the factors related to the MRI remission of sacroiliitis in patients with enthesitis-related arthritis (ERA).Methods: Patients with ERA from 2018-2022 in our medical center were retrospectively reviewed, which identified according to Pediatric Rheumatology International Trials Organization (PRINTO) criteria. Demographics, clinical characteristics, examinations, and treatments were described. Univariate and multivariate logistic regression models were used to analyze the factors related to MRI remission of sacroiliitis in ERA.Results: This retrospective study included 160 ERA patients (51.9% male) with a mean onset age of 9.2 ± 3.0 years. There were 144 cases (81.9%) with peripheral arthritis, and the hip, knee, and ankle joints were the most commonly involved joints. Enthesitis occurred in 48 cases (30.0%), and sacroiliitis occurred in 142 cases (88.5%) at diagnosis. Human leukocyte antigen (HLA)-B27 was positive in 33 cases (17.1%), and acute uveitis occurred in 3 cases (1.9%). The majority of patients (93.7%) were treated with disease-modifying anti-rheumatic drugs (DMARDs), and 60% with biologics. Among 62 patients with MRI-defined sacroiliitis, 27 (43.5%) cases showed improvement in the sacroiliac joint lesion after treatment. Multivariate logistic regression analysis showed that duration from onset to diagnosis of less than 3 months (OR = 3.609, 95% CI: 1.068-12.192) and active joints of more than 4 (OR = 4.916, 95% CI: 1.006-24.037) were independent factors.Conclusion: We highlighted differences in ERA clinical characteristics. Patients with a shorter diagnosis time and more joint involvement improved more significantly in sacroiliac joint lesions after treatment. [ABSTRACT FROM AUTHOR]

Various pain generators can lead to low backpain. It includes conditions affecting the muscles, lumbar spine, joints, traversing and exiting nerve roots etc. The IASP named 2021 the year as the Global Year About Back Pain, highlighting its importance. Multiple modalities exist for the treatment of conditions causing low-back pain, including non-pharmacological therapies, drugs, percutaneous minimally invasive techniques and surgeries. This review aims at providing a cursory view of the common ailments causing low backache and its corresponding minimally invasive techniques. [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]

Purpose: We performed this research to report the clinical characteristics and clinical therapeutic strategies of acute postpartum inflammatory sacroiliitis. Methods: We retrospectively analyzed the data of patients diagnosed with acute postpartum inflammatory sacroiliitis from 2014 to 2020. All their clinical details including clinical symptoms and signs, laboratory tests, radiologic examination, diagnosis and treatment process and clinical outcomes were obtained and analyzed in this retrospective analysis. Results: Eleven patients diagnosed with acute postpartum inflammatory sacroiliitis complain of low back pain. Magnetic resonance imaging (MRI) is useful in diagnosing acute postpartum inflammatory sacroiliitis. The systemic non-steroidal anti-inflammatory drugs (NSAIDs) administration, sacroiliac joint injection, and physical therapy effectively alleviated the pain with symptoms disappearing, and the abnormal signal reduced in MRI. Conclusion: Acute postpartum inflammatory sacroiliitis is an uncommon disease with atypical symptoms. MRI examination may be the best diagnostic method. General NSAIDs and sacroiliac joint injections of local anesthetic plus corticosteroid under the guidance of fluoroscopy or ultrasound can achieve safe and effective treatment. This retrospective study was approved by the Committee on the Ethics of our hospital (No. 202101023). Trial registry: Trial registration was performed in the Chinese Clinical Trial Registry (http://www.chictr.org.cn, No. ChiCTR2100045656). [ABSTRACT FROM AUTHOR]

Purpose: We compared the feasibility of quantitative analysis methods using bone SPECT/CT with those using planar bone scans to assess active sacroiliitis. Methods: We retrospectively reviewed whole-body bone scans and pelvic bone SPECT/CTs of 8 patients who had clinically confirmed sacroiliitis and enrolled 24 patients without sacroiliitis as references. The volume of interest of each sacroiliac joint, including both the ilium and sacrum, was drawn. Active arthritis zone (AAZ) was defined as the zone of voxels with higher SUV than sacral mean SUV within the VOI of SI joint. Then, the following SPECT/CT quantitative parameters, SUVmax (maximum SUV), SUV50% (mean SUV in highest 50% of SUV), and SUV-AAZ, and the ratio of those values to sacral mean SUV (SUVmax/S, SUV50%/S, SUV-AAZ/S) were calculated. For the planar bone scan, the mean count ratio of SI joint/sacrum (SI/S) was conventionally measured. Results: Most of the SPECT/CT parameters of the sacroiliitis group were significantly higher than the normal group, whereas SI/S of the planar bone scan was not significantly different between the two groups. In receiver operating characteristic curve analysis, SUV-AAZ/S showed the highest AUC of 0.992, followed by SUV50%/S and SUVmax/S. All ratio parameters of the SPECT/CT showed higher AUC values than the SUV parameters of SI joint or SI/S of the planar scan. Conclusions: The quantitative analyses of bone SPECT/CT showed better performance in assessing active sacroiliitis than the planar bone scan. SPECT/CT parameters using the ratio of the SI joint to sacrum showed more favorable results than SUV parameters such as SUVmax, SUV50%, and SUV-AAZ. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Recurrent Multifocal Osteomyelitis (CRMO) is an autoinflammatory bone disorder with predominantly paediatric onset. Children present with multifocal osteolytic lesions accompanied by bone pain and soft tissue swelling. Patients often exhibit extraosseous co-morbidities such as psoriasis, inflammatory bowel disease, and arthritis. Objectives: Comparison of children with two different phenotypes of CRMO defined by presence or absence of extraosseous co-morbidities. Methods: Children diagnosed with CRMO at the Motol University Hospital between 2010 and 2020 were retrospectively reviewed, and according to the absence or presence of extraosseous manifestations divided into two cohorts – bone limited CRMO and complex CRMO. The two groups were compared in terms of demographic data, age at disease onset, number and site of bone lesions, laboratory biomarker values, and need of escalation to a second-line therapy. Results: Thirty-seven children (30 female, 7 male) with confirmed CRMO were included in the analysis. The mean age at disease onset was 10 years. All but 3 patients presented with multifocal disease. Twenty-three children (62%) had at least one extraosseous manifestation (13 sacroiliitis, 8 inflammatory bowel disease, 6 skin disease [acne, pustulosis, or psoriasis], 7 arthritis). Complex CRMO was associated with a significantly higher ESR rate (p = 0.0064) and CRP level (p = 0.018). The groups did not differ in number of foci or in age at disease onset. Bone lesion distribution differed between the two groups with significantly more frequent involvement of clavicle (p = 0.011) and pelvis (p = 0.038) in patients with complex CRMO. Children with complex CRMO more often needed escalation of therapy to DMARDs and biologic agents. Conclusion: Our data suggest that CRMO affecting solely the skeleton has milder course compared to complex CRMO with extraskeletal features. Further studies are needed to explore the clinical as well as the patient reported outcomes and promote individually tailored therapeutic strategies in both CRMO phenotypes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose is to demonstrate the existence of the parallel line sign (PLS), a dark line parallel to the sacroiliac joint (SIJ), and determine its prevalence, characteristics, and associations. Methods: 200 consecutive SIJ MRIs referred by rheumatologists were retrospectively reviewed for the presence of the PLS. Presence and extent of imaging features of sacroiliitis (bone marrow edema, fatty infiltration, erosions, sclerosis, and ankylosis) were evaluated. Results: Prevalence of PLS was 11.5% (23/200), with 9 subjects having bilateral PLS, resulting in 32 SIJs showing a PLS. Every PLS involved the synovial portion of the SIJ, and almost all (31/32, 96.9%) involved the iliac (rather than sacral) side of the SIJ. Every PLS occurred with at least one established imaging feature of sacroiliitis. Presence of a PLS was associated with higher prevalence of erosions (78.3% vs 36.7% in those without PLS, P <.001), greater extent of SIJ involvement by erosions (3.6 ± 1.3 vs 2.3 ± 1.1 quadrants of the SIJ involved, P <.001), and higher density of erosions per centimeter (88.9% vs 46.2% with >2 erosions/cm, P =.001). There was higher prevalence of bone marrow edema, fatty infiltration, and sclerosis in those with PLS compared to those without PLS (P =.001, P <.001, and P =.006, respectively). Extent of involvement by any of these features was not significantly different between the two groups (P =.22, P =.16, and P =.46, respectively). Conclusions: The PLS is associated with imaging features of chronic sacroiliitis, especially erosions. Knowledge of the existence of the PLS may help avoid misdiagnosis of an insufficiency fracture and increase confidence in the diagnosis of sacroiliitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sacroiliac or pelvic region pain must be differentiated from lumbar pain in patients who present with low back pain. Patients with Crohn's disease are often treated with immunosuppressant medication which raises the risk of infection. CASE PRESENTATION: A 24-year-old woman with Crohn's disease presented directly to a physical therapist after receiving a diagnosis of mechanical low back pain during 2 emergency department visits. The subsequent evaluation raised suspicion of nonmusculoskeletal pathology in the sacroiliac joint region. The physical therapist referred the patient to the emergency department a third time with a recommendation for magnetic resonance imaging of the pelvis. OUTCOME AND FOLLOW-UP: Pelvic magnetic resonance imaging and lab tests revealed infectious sacroiliitis. Several bouts of intravenous and oral antibiotics were administered to the patient, resulting in a resolution of the condition over the course of 6 months. DISCUSSION: Infectious sacroiliitis is associated with a high risk of fatal complications, which require urgent antibiotic intervention. This case demonstrates the importance of thorough clinical reasoning and differential diagnosis for proper patient management. [ABSTRACT FROM AUTHOR]

Sacroiliac joint (SIJ) disease has been described as one of the possible causes of lumbosacral (LS) region pain in dogs. However, published information is currently lacking for the computed tomographic (CT) and magnetic resonance imaging (MRI) characteristics of canine SIJ disease. The objectives of this retrospective, observational study were to describe and quantify CT and MRI SIJ findings in a sample of large breed dogs and test associations between the numbers of SIJ findings and other variables. Data archives for a veterinary teaching hospital were searched for large breed dogs (≥ 22.7 kg) that had CT or MRI scans of the LS and pelvic regions in 2015–2019. Dogs with a history of acute trauma or scans with incomplete SIJs were excluded. A veterinary student recorded medical record findings. A veterinary radiologist and graduate student recorded CT and MRI findings based on previously published criteria in dogs and humans. Fifty‐three dogs were sampled (20 CT, 33 MRI). Categories of findings with the highest prevalence were subchondral erosion (100% CT, 100% MRI) and subchondral sclerosis (95% CT, 97% MRI). The total numbers of SIJ findings per dog were not associated with dog age, sex, weight, or concurrent findings in the LS or pelvic regions. The total number of MRI SIJ findings per dog differed between German Shepherds and Labrador Retrievers (P = 0.0237) as well as between Labrador Retrievers and other breeds (P = 0.0414). These results indicated that CT and MRI findings reported in humans with SIJ disease are common in large breed dogs. [ABSTRACT FROM AUTHOR]

Introduction: Isotretinoin has been reported to induce inflammatory back pain (IBP) and sacroiliitis in the patients with acne vulgaris. The aim of this study is to investigate the incidence of IBP and sacroiliitis in patients receiving isotretinoin treatment compared with oral antibiotics for acne vulgaris. Materials and Methods: A total of 201 patients with moderate‐to‐severe acne vulgaris who received isotretinoin (n = 100) or oral antibiotics (n = 101) were included in the study. All patients were monthly questioned for IBP symptoms during their treatment. Patients described IBP were also evaluated for sacroiliitis by c‐reactive protein, sedimentation rate, HLAB27, and sacroiliac magnetic resonance imaging (MRI). Isotretinoin was discontinued in all patients diagnosed as sacroiliitis, and these patients were reevaluated after 3 months. Results: IBP was observed in 21 (10.4%), and sacroiliitis was detected in 11 (11%) patients on isotretinoin treatment; in oral antibiotic group, we did not observe IBP or sacroiliitis. The incidence of IBP and sacroiliitis differed significantly between the isotretinoin and oral antibiotic groups (p < 0.0001, p = 0.02). Complete regression was observed in the great majority of patients following cessation of isotretinoin. Conclusions: Our study is the largest prospective controlled study that investigated the incidence of sacroiliitis in patients receiving isotretinoin and compared with patients using oral antibiotics. [ABSTRACT FROM AUTHOR]

Objectives: To assess short- and long-term outcomes of ERA in a large monocentric cohort in Singapore. Methods: Children diagnosed with ERA according to ILAR criteria from 2002 to 2021 were recruited. Nonparametric statistics were used to describe the data. Outcomes were defined according to modified Wallace criteria, and probabilities and predictors were determined using Kaplan–Meier survival and logistic regression analyses. Results: One hundred fifty-one ERA patients (male 86%; Chinese 81%) were included. The median age at onset was 11.9 years (IQR: 9.4–13.9), and disease duration was 5.3 years (IQR: 2.9–8.4). At diagnosis, 39% of the patients had sacroiliitis. HLA-B27 was positive in 83%, and biologics were used in 72% of the patients. Clinical inactive disease (CID) was achieved in 92% of the patients, of which 27% achieved within 6 months. Sacroiliitis at diagnosis is an unfavorable predictor of early CID at 6 months. Medication was discontinued in one-third of the patients. Favorable predictor of medication withdrawal includes male gender, while unfavorable predictors include positive HLA-B27 and ANA. Two-thirds of the patients with CID had at least one disease flare. Sacroiliitis at diagnosis is a protective predictor of flare after stopping medication. Conclusion: Despite a high proportion of ERA patients achieving CID, only one-third could stop medication with high rates of disease flare. Unfavorable predictors include older age at onset, HLA-B27, and ANA positivity. While sacroiliitis at diagnosis is a negative predictor of CID at 6 months, it is associated with less disease flare after discontinuing medication. Key Points • Majority of the ERA patients achieved clinical inactive disease with treatment. • Only one-third of the patients could discontinue all medications with high rates of disease flare after. • Favorable outcome predictors include male gender and sacroiliitis at diagnosis, while unfavorable predictors include positive HLA-B27 and ANA. [ABSTRACT FROM AUTHOR]

Aim: Sacroiliac joint (SJ) imaging is the key point in the diagnosis of ankylosing spondylitis (AS). The curved anatomy of the SJ makes the interpretation of imaging difficult. The aim of this study is to evaluate the interclass and intraclass reliability of specific lesions (bone marrow edema [BME], joint space narrowing, erosions, effusion, ankylosis, bridging, sclerosis, fat deposition, and other additional pathologies) on SJ magnetic resonance imaging (MRI). Method: In a total of 310 randomly chosen patients, 620 SJs were evaluated by three different radiologists with different radiology experiences of specialties other than musculoskeletal radiology. Results: The agreement between readers for BME was fair to substantial, for active sacroiliitis was moderate to substantial, for sacroiliac narrowing was fair at best, for erosions was fair to moderate, for SJ sclerosis was none to slight, for chronic sacroiliitis was slight to fair, for degenerative sacroiliitis was none to slight, for normal SJ was slight, for SJ effusion was none to slight, and for fatty deposition was none. Intraclass correlation for readers 1 and 3 was usually good to excellent and for reader 2 was poor to fair. Conclusion: This study was designed to assess the agreement between radiologists who were not familiar with SJ MRI. The agreement between readers was usually fair to substantial and even intraclass correlation was poor to fair for reader 2. Future studies can be designed for standardization and validation of each MRI lesion for better interpretation of SJ MRI. [ABSTRACT FROM AUTHOR]

Familial Mediterranean fever (FMF) and spondyloarthritis (SpA) may show several common signs. This study aimed to evaluate the frequency of SpA and its manifestations in FMF, the impact of SpA on FMF, and the associations of non-episodic findings (heel enthesitis, protracted arthritis, and sacroiliitis) with the FMF features. Demographic, clinical, imaging, and genetic data were retrieved from medical records of the patients with adult FMF. To identify patients who met the classification criteria for SpA, data including rheumatologic inquiry were recorded. Patients with SpA and those who did not meet the criteria were compared in terms of FMF features. Regression analyses were performed to determine the factors that were most associated with sacroiliitis, enthesitis, and protracted arthritis. Of the 283 patients with FMF, 74 (26.1%) met the SpA criteria (64 axial, 10 peripheral); and 65 (22.9%) patients had sacroiliitis, 27 (9.5%) protracted arthritis, and 61 (21.6%) heel enthesitis. Patients with SpA were older and had more FMF severity, and heel pain rate than those without; however, genetic features, CRP, resistance to colchicine, and heel enthesitis did not differ. A meaningful number of patients without SpA had also displayed heel enthesitis, protracted arthritis, inflammatory back pain, heel pain, family history of SpA, and elevated CRP. Age was found to be the main predictor of heel enthesitis and protracted arthritis was linked with FMF severity. A significant number of patients with FMF meet the peripheral SpA classification criteria as well as axial SpA. SpA and its shared manifestations with FMF may have an impact on FMF. [ABSTRACT FROM AUTHOR]