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Background: Hip involvement is a life-changing event during spondyloarthritis (SpA) since it’s responsible for significant disability and functional impairment. This study aimed to determine the factors associated with hip involvement in patients with SpA. Methods: This was a retrospective study, including patients with axial and/or peripheral SpA divided into two groups: patients without and with hip involvement. Hip involvement was defined as pain or abnormality on clinical examination of the hip and/or on imaging. We collected clinical and laboratory data, activity and functional scores, and radiographic parameters. We conducted a multivariate analysis to identify the associated factors of hip involvement. Results: We included 165 patients with a mean age of 46.13 ± 13.07 years, 121 patients were male. The mean duration of disease was 10.91 ± 6.94 years. Hip involvement, defined as SpA-related hip pain, joint limitation, and dysfunction and/or imaging involvement (X-ray/MRI), was noted in 60 cases (36.4%). Multivariate analysis indicated that disease duration over 10 years (OR=3.8, 95% confidence interval (CI95%)[1.3-11.2], p=0.013), radiographic sacroiliitis (OR=8.9, CI95%[1.3-63.5], p=0.028), very high disease activity (Ankylosing Spondylitis Disease Activity Score: ASDASCRP≥3,5) (OR=9.4, CI95%[2.6-34.4], p=0.001), higher Bath Ankylosing Spondylitis Functional Index (BASFI) (OR=1.4, CI95%[1.1-1.9], p=0.004) and higher Bath Ankylosing Spondylitis Metrology Index (BASMI) (OR=1.3, CI95%[1.1-1.6], p=0.011) were independently associated with hip involvement in these patients. Regarding extra-articular features, we found that pulmonary involvement and osteoporosis were significantly more frequent in patients with hip involvement, but neither retained significance in multivariate analysis. Conclusion: Disease duration over 10 years, radiographic sacroiliitis, very high disease activity, functional impairment, and limited spine mobility were potential associated factors with hip involvement. Patients with these factors should be closely monitored to detect hip involvement at an early stage. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine femoral cartilage thickness (FCT) in patients with familial Mediterranean fever (FMF) and healthy individuals and to assess the relationship of FCT with the development of amyloidosis and clinical features. Methods: Patients diagnosed with FMF according to the Tel-Hashomer criteria and healthy controls were included in the study. FCT of both knees was measured with a 7-12 MHz linear probe in maximum knee flexion. Three midpoint measurements were obtained from each knee: Lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). The patients' clinic characteristics include disease duration, medications, comorbid conditions, amyloidosis, chronic renal failure (CRF), FMF gene mutation, arthritis, sacroiliitis, PRAS score, and Physical Activity Questionnaire Short Form score were recorded. Results: A total of 46 patients with FMF (36 women) and 20 age-sex-body mass index-matched controls (14 women) were enrolled in this study. The patients and controls' mean age were 37±12.9 and 37.5±8.6 years, respectively. Amyloidosis occurred in 7 patients (15.2%), CRF in 3 (6.5%), and knee arthritis in 8 (17%). Disease activity was mild in 55.8%, moderate in 20.9%, and severe in 23.23% of the patients. The mean FCT in millimeter values in the FMF and control groups was as follows: On the right side, LFC 1.9±0.5 and 2±0.52, ICA 2.2±0.77 and 2.25±0.97, and MFC 2±0.47 and 2.25±0.72; on the left side, LFC 1.9±0.4 and 2.05±0.55, ICA 2.25±0.87 and 2.25±0.87, and MFC 1.85±0.5 and 2.25±0.6. Patients with FMF had decreased cartilage thickness at the lateral condyle of both knees (p<0.05) and medial condyle of the left knee (p<0.05) compared with controls. FCT measurements were similar in patients with or without arthritis, amyloidosis, and CRF (p>0.05). FCT scores were not different among the disease activity groups (p>0.05). Conclusion: These findings suggest that patients with FMF have decreased FCT compared with controls, and there is no significant relationship between the FCT and amyloidosis and disease activity. [ABSTRACT FROM AUTHOR]

Background: Lesions detected by magnetic resonance imaging (MRI) of the sacroiliac joints are critical to the diagnosis of non-radiographic axial spondyloarthritis. However, inflammatory and structural lesions may be encountered in other conditions. Objectives: The objective of this study was to evaluate and compare the frequency and localization of inflammatory and structural lesions on MRIs of the sacroiliac joint of spondyloarthritis (SpA) and non-spondyloarthritis (non-SpA) patients. Design: This is a retrospective study including 200 patients, each having undergone an MRI of the sacroiliac joints. Methods: Two experienced readers evaluated the whole set of images to detect erosions, subchondral sclerosis, fatty lesions, bone marrow edema (BME) and ankylosis according to the definitions established by the ASAS MRI working group. We divided sacroiliac joints into five segments: upper, antero-middle, intermediate-middle, postero-middle and lower. Results: A total of 96 subjects with SpA (mean age 37.4 ± 11.8 years) and 104 without SpA (mean age 39.9 ± 11.6 years) were included. Of the 96 SpA patients, 65% had inflammatory buttock pain compared with 25% in the non-SpA group. BME was seen in 65% of SpA patients, mainly in the intermediate-middle segment, and in 20% of non-SpA patients, predominantly in the antero-middle segment. Subchondral sclerosis occurred in 44% of non-SpA patients, mostly in the antero-middle segment, and in 36% of SpA patients. Fatty lesions were present in 34% of SpA and in 21% of non-SpA patients. Erosions were seen in 25% of non-SpA and in 60% of SpA patients. BME and structural lesions were minimally observed in the postero-middle segment in non-SpA patients. Conclusion: Inflammatory and structural lesions were observed in all segments of the joint in SpA, mainly in the middle segments, while lesions predominantly affected the antero-middle segment in non-SpA, and were uncommon in the postero-middle segment. [ABSTRACT FROM AUTHOR]

Aim The aim of this article was to assess the profile of T2-weighted (T2W) multipoint Dixon sequence and conventional sequences in magnetic resonance imaging (MRI) of sacroiliac joints for the diagnosis of active and chronic sacroiliitis. Settings and Design Prospective observational study. Materials and Methods Thirty-seven patients with sacroiliitis underwent MRI with conventional coronal oblique short tau inversion recovery, T1W sequences, and T2W multipoint Dixon sequences. T1 fat-saturated postcontrast sequences were added in active cases. Comparisons were made between conventional and T2 Dixon sequences both quantitatively and qualitatively. Statistical Analysis Paired t -test was used to study the difference in contrast–noise ratio (CNR) between two groups. Chi-squared analysis with p -value of ≤ 0.05 was used to test the significant association of different sequences. Results Water only images had highest mean CNR (296.35 ± 208.28) for the detection of bone marrow edema/osteitis. T1W (186.09 ± 96.96) and opposed-phase (OP) images (279.22 ± 188.40) had highest mean CNR for the detection of subchondral sclerosis and periarticular fat deposition, respectively. OP images (p -value <0.001) followed by fat-only (FO) images (p -value = 0.001) were superior to T1W sequences in detecting periarticular fat deposition. In-phase (IP) images in detecting subchondral sclerosis and IP and FO images in detecting cortical erosions were comparable to conventional T1W sequences (p -value < 0.001). Conclusions T2 Dixon sequences are superior or comparable to conventional MR sequences in detection of sacroiliitis, except ankylosis. Hence, Dixon can be used as a single sequence to replace the multiple sequences used in conventional imaging protocol of acute sacroiliac joints due to higher image quality. It can be used as an additional sequence in case of chronic sacroiliitis to increase the confidence and accuracy of diagnosis. [ABSTRACT FROM AUTHOR]

Isotretinoin is a retinoid derivative drug used in acne vulgaris treatment. Sacroiliitis has been reported as an uncommon adverse effect following isotretinoin treatment. We report a 30-yearold male patient who developed sacroiliitis after isotretinoin use. Stopping treatment with isotretinoin resulted in a complete disappearance of inflammatory back pain. A literature search was performed to assess the relevance of this association in everyday clinical practice, and to discuss whether the link between isotretinoin and sacroiliitis is causal or coincidental. [ABSTRACT FROM AUTHOR]

Imaging plays a crucial role in diagnosing and forecasting treatment outcomes in axial spondyloarthritis. Conventional radiography may overlook patients in the initial stages of the disease, while MRI is sensitive in identifying inflammation early on. Computed tomography reliably detects structural abnormalities. Practicing rheumatologists must possess a fundamental understanding of interpreting both active inflammatory and structural lesions in axial spondyloarthritis., Competing Interests: Disclosure V. Mohan and M.C. Hwang have no financial or nonfinancial disclosures relevant to the content of this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: This study investigated the utility of low-dose computed tomography (ldCT) compared with magnetic resonance imaging (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. Imaging data from these patients were examined by two blinded pediatric 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 edema on MRI showed relatively high density, measurements in areas with edema on MRI showed relatively low density., Results: MRI revealed bilateral bone marrow edema 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 findings for bone marrow edema., Advances in Knowledge: The present study showed that ldCT is superior to MRI for early structural change detection in pediatric patients. Pixel-based density evaluation in ldCT aligns with MRI findings for bone marrow edema., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology.)

Background: The Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system is a sacroiliitis grading system., Purpose: To develop a deep learning-based pipeline for grading sacroiliitis using the SPARCC scoring system., Study Type: Prospective., Population: The study included 389 participants (42.2-year-old, 44.6% female, 317/35/37 for training/validation/testing). A pretrained algorithm was used to differentiate image with/without sacroiliitis., Field Strength/sequence: 3-T, short tau inversion recovery (STIR) sequence, fast spine echo., Assessment: The regions of interest as ground truth for models' training were identified by a rheumatologist (HYC, 10-year-experience) and a radiologist (KHL, 6-year-experience) using the Assessment of Spondyloarthritis International Society definition of MRI sacroiliitis independently. Another radiologist (YYL, 4.5-year-experience) solved the discrepancies. The bone marrow edema (BME) and sacroiliac region models were for segmentation. Frangi-filter detected vessels used as intense reference. Deep learning pipeline scored using SPARCC scoring system evaluating presence and features of BMEs. A rheumatologist (SCWC, 6-year-experience) and a radiologist (VWHL, 14-year-experience) scored using the SPARCC scoring system once. The radiologist (YYL) scored twice with 5-day interval., Statistical Tests: Independent samples t-tests and Chi-squared tests were used. Interobserver and intraobserver reliability by intraclass correlation coefficient (ICC) and Pearson coefficient evaluated consistency between readers and the deep learning pipeline. We evaluated the performance using sensitivity, accuracy, positive predictive value, and Dice coefficient. A P-value <0.05 was considered statistically significant., Results: The ICC and the Pearson coefficient between the SPARCC scores from three readers and the deep learning pipeline were 0.83 and 0.86, respectively. The sensitivity in identifying BME and accuracy of identifying SI joints and blood vessels was 0.83, 0.90, and 0.88, respectively. The dice coefficients were 0.82 (sacrum) and 0.80 (ilium)., Data Conclusion: The high consistency with human readers indicated that deep learning pipeline may provide a SPARCC-informed deep learning approach for scoring of STIR images in spondyloarthritis., Evidence Level: 1 TECHNICAL EFFICACY: Stage 2., (© 2024 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: To demonstrate the clinical applicability of zero echo time magnetic resonance imaging (ZTE MRI) in bone assessment of the sacroiliac joint in ankylosing spondylitis., Method: Between January 2021 and November 2021, twenty-one ankylosing spondylitis patients underwent clinically indicated MRI including ZTE sequence, in addition, all patients underwent a CT scan covering the sacroiliac joints within 6 months of the MRI examination. The sensitivity, specificity, and accuracy of ZTE MRI were calculated using CT as the reference standard. Cohen's κappa tests were applied to assess the agreement of positive imaging findings (including erosions, osteosclerosis, bony cystic changes, and joint space changes) between MRI and CT as well as the inter-reader agreement for the grading of sacroiliitis in AS patients., Results: There was no statistical significance between ZTE MRI and CT in detecting of ankylosing spondylitis(p＞0.05). The consistency of the diagnosis of positive imaging findings between ZTE MRI and CT was moderate to excellent (ranging from 0.611 to 0.889), and the consistency of the scores of positive imaging was good to excellent (ranging from 0.857 to 0.979)., Conclusions: ZTE MRI provides "CT-like" contrast for bony changes of the sacroiliac joint in ankylosing spondylitis and could simplify and reduce costs for some AS patients when both MRI and CT are typically required., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Dawood Sayed,1 Kevin Balter,2,3 Stephen Pyles,4 Christopher M Lam1 1Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA; 2Midwest Pain Clinics, Omaha, NE, USA; 3Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA; 4Pain Treatment Centers, Ocala, FL, USACorrespondence: Christopher M LamDepartment of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas City, 66160, USATel +1 913 945 9810Fax +1 913-588-3365Email clam2@kumc.eduBackground: Sacroiliac joint (SIJ) pathology is a cause of low back pain that may be difficult to diagnose and challenging to treat. Open and minimally invasive (MI) lateral approach fusions have been used to treat sacroiliitis over the past two decades. A novel MI posterior approach SIJ fusion technique utilizes a posteriorly placed transfixing device with single point S1/S2 level or mid-segment SIJ fixation (LinQ procedure). Current efficacy and safety data for this novel procedure are lacking.Objective: To review multicenter retrospective 12 months or greater outcomes data in patients receiving the LinQ procedure, with sub-analysis of patients with prior lumbar fusions.Methods: Patients with sacroiliitis refractory to conservative care with short-term benefit from diagnostic local anesthetic SIJ injections receiving MI posterior approach SIJ fusion with allograft were included from different centers including both academic and private practice. Numeric rating scale (NRS) scores at baseline (pre-procedural) and most recent follow-up were reviewed across three institutions.Results: Of 110 patients who received MI SIJ fusion, 50 patients had sufficient data for evaluation of outcomes at least 12 months post-implant. The average time out from implant at follow-up was 612.2 days for all unique patients. The average NRS was 6.98 pre-fusion and 3.06 at last follow-up. Twenty-four patients had prior lumbar surgery of which 17 had prior lumbar fusions. Average NRS for this subset was 6.85 at baseline and 2.86 at last follow-up with an average follow-up of 613.2 days out from implant. No major adverse events or complications were associated with any of the 50 implants.Conclusion: Real-world evidence suggests that MI posterior SIJ fusion with the LinQ procedure is a viable approach for medically refractory sacroiliitis management with long-term efficacy and safety. Further prospective studies are needed to fully evaluate this technique.Keywords: sacroiliitis, sacroiliac joint, minimally invasive intervention, allograft, low back pain, buttock pain

Abstract A 5‐month‐old female entire Dachshund presented with an acute onset of left hind limb lameness following intense play. There were concurrent intermittent neurological deficits in the left hind limb, and pain in the lumbosacral region and on dorsal flexion of the tail. Computed tomography (CT) imaging revealed an asymmetric widening of the left sacroiliac joint with loss of cortical margins, accompanied by mild osteolytic changes of the adjacent ilium and sacrum highly suggestive of septic sacroiliitis. There was also perilesional steatitis in the region of the sciatic nerve. An 8‐week course of antimicrobial therapy was prescribed. Complete resolution of all clinical signs was noted at a 7‐month follow up. Sacroiliitis should be considered as a differential for unilateral hind limb lameness with or without intermittent sciatic neuropathy in a puppy in the absence of other orthopaedic conditions.

Objectives: Patients with Crohn's disease (CD) usually undergo magnetic resonance enterography (MRE) for evaluating small bowel involvement. Musculoskeletal symptoms are the most frequent extraintestinal manifestation in inflammatory bowel diseases, especially in CD, with sacroiliitis at imaging occurring in about 6–46% of patients and possibly correlating with axial spondyloarthritis. The primary study aim was to assess the prevalence of sacroiliitis in adult and pediatric patients with CD performing an MRE. We also evaluated the inter-rater agreement for MRE sacroiliitis and the association between sacroiliitis and patients' clinical data. Method: We retrospectively identified 100 adult and 30 pediatric patients diagnosed with CD who performed an MRE between December 2012 and May 2020 in three inflammatory bowel disease centers. Two radiologists assessed the prevalence of sacroiliitis at MRE. We evaluated the inter-rater agreement for sacroiliitis with Cohen's kappa and intraclass correlation coefficient statistics and assessed the correlation between sacroiliitis and demographic, clinical, and endoscopic data (Chi-square and Fisher's tests). Results: The prevalence of sacroiliitis at MRE was 20% in adults and 6.7% in pediatric patients. The inter-rater agreement for sacroiliitis was substantial (k = 0.62, p < 0.001) in the adults and moderate (k = 0.46, p = 0.011) in the pediatric cohort. Age ≥ 50 years and the time between CD diagnosis and MRE (≥ 86.5 months) were significantly associated with sacroiliitis in adult patients (p = 0.049 and p = 0.038, respectively). Conclusions: Sacroiliitis is a frequent and reliable abnormality at MRE in adult patients with CD, associated with the age of the patients ≥ 50 years and CD duration. Key Points •Sacroiliitis incidentally detected at magnetic resonance enterography performed for Crohn's disease is a frequent and reliable finding in adult patients, rarer in the pediatric population. •Clinicians may rely on magnetic resonance enterography to properly evaluate and manage patients for sacroiliitis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the frequency of sacroiliitis in older subjects. Materials and methods: Consecutive MRI examinations of the sacroiliac joints (SIJs) performed for suspected sacroiliitis (2005–2019) in patients ≥ 18 years were retrospectively evaluated for the presence of active/structural lesions and were categorized for the presence/absence of sacroiliitis. Clinical and imaging parameters were compared between subjects with sacroiliitis according to age groups < 40 years, 40–55, and > 55 years. Clinical parameters including inflammatory back pain (IBP) and other spondyloarthritis (SpA) features were retrieved from the medical records. Results: A total of 431 patients with SIJs MRI were evaluated: median age, 44 [IQR 35–54]; female:male 267(62%):164(38%). Sacroiliitis was diagnosed in 89 (20.6%) subjects—median age, 41 years [IQR 32–54], 52% females— and was equally prevalent among the different age groups: > 40 years old, 23.6%; 40–55, 20%; and > 55 years old, 17%, p = 0.43, with active/structural lesions equally dispersed. Older patients (> 55) started suffering from back pain at an older age and had a longer delay in diagnosis. Gender distribution, the presence of IBP, and other SpA features were no different in patients < 45 and > 55 years of age. Conclusions: The frequency of sacroiliitis on SIJs-MRI in subjects > 55 years is similar to its frequency in younger subjects and is associated with the same type and magnitude of active and structural MRI lesions. Clinical parameters such as IBP and additional SpA features are similarly prevalent in older and younger subjects suggesting they suffer from the same disease and differing only in age of presentation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Reactive arthritis (ReA) is a spondyloarthropathic disorder characterized by joint pain and swelling triggered by an infection in another part of the body – most often the intestines, genitals, or urinary tract. This condition usually targets the knees, ankles, and feet. The present study was conducted to study the clinical, microbiological, and laboratory profile of patients with ReA and to determine the outcomes over a duration of 3 months. Aims and Objectives: This study aimed to assess the clinical and laboratory profile of patients with ReA in a tertiary healthcare center. Materials and Methods: This was a prospective analytical study undertaken in the Rheumatology Out Patient Department of a tertiary care center. The study involved 73 participants and was completed over a duration of 18 months. Results: Majority of the subjects belonged to the age group of 18–25 years (54.79%), followed by 26–35 years (23.29%) and 36–45 years (10.96%). The mean age of the study subjects was 28.71 ± 10.72 years (median age –25 years). Most of the patients were male (82.19%). While majority of the subjects showed improvement with Non Steroidal Anti-inflammatory Drugs (NSAIDs) (80.82%), steroids were used among 12.33% subjects, sulfasalazine was used among 15.07%, and methotrexate among 1.37% of the study subjects. Conclusion: Statistically significant association was found between HLA B27 positivity and DAREA score, presence of sacroiliitis and extra-articular manifestation. NSAIDs remain the first line agents for patients with ReA. However, high baseline DAREA and ESR of more than 30 is associated with poor response to NSAIDs. [ABSTRACT FROM AUTHOR]

Background: Streptococcus canis is a group G beta-hemolytic Streptococcus species which normally resides on the skin and mucosal surfaces of dogs. Although it rarely causes infection in humans, our case and review of relevant literature demonstrate that this multi-host pathogen may be responsible for metastatic infection. We present an appropriate management strategy in such cases.Case Presentation: A previously healthy 26-year-old male presented to the emergency department with a 2-day history of erythema, pain, and swelling of the left ankle and foot, consistent with acute cellulitis. The patient was initially discharged home with a plan to complete a course of IV cefazolin as an outpatient, but later recalled after two sets of blood cultures grew gram positive cocci. Blood cultures speciated as Streptococcus canis. This was performed by identifying beta hemolytic strep on blood agar, then typed as Lancefield group G, followed by MALDI-TOF which distinguished S. canis. History was unremarkable except for a 2-week history of lower back pain precipitated by a wrestling injury. There was no canine bite or scratch wound, although the patient lives with a dog. CT spine was obtained which demonstrated right piriformis myositis and S1 osteomyelitis. MRI additionally demonstrated right erector spinae myositis, right sacroiliitis, and multiple collections in the right posterior paraspinal soft tissues. Transthoracic echocardiogram did not demonstrate valvular vegetations. The S. canis isolate was pan-susceptible and the patient was ultimately discharged home and completed a 8-week course of IV penicillin G. After completion of therapy, his symptoms, repeat imaging, and biochemical markers suggested resolution of infection on follow-up.Conclusions: We suggest that management of S. canis bacteremia should involve consideration of screening for metastatic infection and infectious diseases consultation. However, despite its potential for systemic involvement, S. canis is often susceptible to narrow spectrum antibiotics, and may be treated with penicillins. [ABSTRACT FROM AUTHOR]

Spondyloarthritis (SpA) is the most common systemic inflammatory disease associated with acute anterior uveitis (AAU). There are many works that have addressed the prevalence of AAU in patients with SpA; however, information on the prevalence of SpA and its individual symptoms in patients with AAU is limited. Our work aimed to unify published data on this topic. According to recent studies, the prevalence of axial SpA (axSpA) in patients with AAU is around 40%, while the prevalence of peripheral forms of SpA is lower. The most common finding is the presence of sacroiliitis, which, however, also occurs in completely asymptomatic patients with AAU. Enthesitis and possibly peripheral arthritis are also common symptoms. At the same time, patients with AAU and associated SpA have higher levels of systemic inflammatory parameters, more frequent back pain, and worse mobility of the spine than patients without associated SpA. No difference in ocular symptomatology was found. AAU as the first clinical symptom of SpA represents the possibility of earlier detection of this potentially disabling disease. Referral strategies for ophthalmologists will be discussed. Due to the close connection between these two diseases, tight cooperation between ophthalmologists and rheumatologists is necessary. [ABSTRACT FROM AUTHOR]

Background: Ankylosing spondylitis (AS) is an immune-mediated chronic inflammatory condition grouped under spondyloarthritis (SpA), which is an umbrella term for a group of interrelated inflammatory rheumatic conditions with characteristic radiographic findings such as erosions and ankylosis of the sacroiliac joint. Unfortunately, there is an average delay of 8-9 years between the onset of the symptoms and diagnosis due to infrequent consideration of this disease in the differential diagnosis of patients with low back pain and unusual or incomplete presenting clinical symptoms. Case Report: We describe the case of a 37-year-old male patient with no significant past medical history and surgical history of bilateral hip arthroplasty secondary to idiopathic aseptic necrosis of the bilateral femoral head and bilateral rotator cuff repaired surgery due to multiple motor vehicle accidents (MVA) with a chief concern of chronic low back pain. In this case of ankylosing spondylitis presenting with low back pain and radicular symptoms, his symptoms were resistant to multiple opioid medications, trigger point injections, and epidural steroid injections. Initiation of adalimumab subsequently relieved the patient's symptoms and restored his ability to perform daily activities. Conclusions: This is an unusual presentation of AS with radiographic evidence of bilateral sacroiliitis. The neurological manifestations in AS are not uncommon, and they can occur during the quiescent stage of the disease. It should be emphasized that early diagnosis is essential to prevent progression of the disease and avoid unnecessary treatment for the patient. [ABSTRACT FROM AUTHOR]

A very rare condition, pyogenic sacroiliitis is responsible for 1-2% of all osteoarticular infections in children. Diagnosis is often delayed in the pediatric population due to non-specific signs and symptoms during presentation, difficulty in assessing the joint, more common differential diagnosis and low yield diagnostic findings in conventional radiography. A delayed diagnosis of this condition can lead to permanent joint damage. A 9-monthold presented to the emergency department with a history of fever, being unsettled and clingy along with refusal to weight bear over the past few days. On initial assessment, she was found to be tachycardic and afebrile with abnormal posture of her left leg held in external rotation at the hip joint. On examination, she refused to weight bear, presented with alternating tenderness of her left and right hip joints and spinal tenderness at the L5 position. Investigations done showed slightly raised inflammatory counts, normal hip and pelvic radiographs, normal hip ultrasound and blood culture growing staphylococcus aureus and Magnetic Resonance Imaging spine showing right sacroiliitis leading the diagnosis of pyogenic sacroiliitis. This case report highlights the importance of examination of the back and the importance of avoiding fixation error by history. Although rare, clinicians should consider the diagnosis of sacroiliitis in children who present with fever, being unsettled with decreased and painful movements around the pelvic region. [ABSTRACT FROM AUTHOR]

Objectives: Fat metaplasia in an erosion cavity, also known as backfill, is an essential intermediary in new bone formation in axial spondyloarthritis (axSpA) patients; however, the predictors of backfill progression are unknown. This longitudinal study aimed to assess the predictors of backfill progression in axSpA patients on magnetic resonance imaging (MRI). Methods: Clinical and MRI data were collected at baseline and follow-up in 52 axSpA patients. Backfill progression was defined as the new or increased T1 hyperintensity within the SI joint space. Logistic regression analyses were performed to identify the predictors of the backfill progression. Results: A total of 19 patients had "backfill" at baseline and 30 patients exhibited the backfill progression after follow-up. The mean disease duration and SPARCC scores at baseline were significantly different between patients with and without backfill progression (P <0.001, P =0.003, respectively). Patients with backfill progression had a higher frequency of backfill at baseline, a higher SSS score of fat metaplasia, and a higher SSS score of backfill than those without (P =0.001, P <0.001, and P =0.002, respectively). A higher fat fraction value in the fat metaplasia area at the baseline was more frequent in patients with, than without, backfill progression (P =0.019). In the univariate logistic regression analyses, a higher SPARCC score for inflammation and a higher SSS score for fat metaplasia at baseline were associated with backfill progression. Conclusions: Severity of sacroiliitis and extensive fat metaplasia at baseline are predictors of the backfill progression in axSpA patients. [ABSTRACT FROM AUTHOR]

Objectives To assess the influence of psoriasis on spinal/pelvic radiographic progression and MRI features in early-stage axial spondyloarthritis (axSpA). Methods Analysis of baseline data from the Italian SPACE cohort, including patients with chronic back pain (CBP; duration ≥3 months and ≤2 years; onset <45 years) was performed. Patients underwent a diagnostic work-up, including MRI and X-rays of the sacroiliac joints (SIJ), to establish diagnosis of axSpA (Assessment of Spondyloarthritis International Society criteria). Clinical features, disease activity and functional indices, imaging were collected at baseline and yearly during 48 months. Spinal and SIJ X-rays and MRIs were scored by two readers following Spondyloarthritis Research Consortium of Canada score, Stoke Ankylosing Spondylitis Spinal Score System modified by Creemers and modified New York criteria. Characteristics of axSpA patients with/without psoriasis were compared over time with descriptive statistics; multivariate logistic regression model was constructed to assess predictors of spinal/pelvic radiographic progression. Results Eighty-eight patients had axSpA (84.1% non-radiographic; 15.9% radiographic); 36.4% had psoriasis. Patients with psoriasis were older; less frequently had HLA-B27+ and radiographic sacroiliitis with unilateral/asymmetric pattern and more signs of spondylitis. Functional and disease activity indices decreased with slightly higher BASDAI and BASFI in axSpA with psoriasis. All patients showed slight spinal/pelvic radiographic progression. Patients without psoriasis showed increased sacroiliitis progression and low-grade spinal progression. More inflammatory corner lesions on cervical/thoracic MRI-spine were observed in patients with psoriasis. A significant downtrend of SPARCC SIJ/spine scores in all patients was found. Psoriasis was a predictor of increased spinal progression (odds ratio = 0.18; 95% CI: 0.04, 0.78). Conclusions Psoriasis was associated with distinct axSpA features, increased spinal radiographic progression and low-grade radiographic sacroiliitis. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the frequency of musculoskeletal adverse effects in acne vulgaris patients receiving systemic isotretinoin treatment. Patients and methods: Between January 2016 and December 2017, a total of 200 severe acne patients (22 males, 178 females; mean age: 21.8±0.4 years; range, 15 to 53 years) who were on isotretinoin treatment were retrospectively analyzed. Data including age, sex, body mass index (BMI), duration of disease, diagnosis, and comorbidities were recorded. Back pain severity was evaluated with the Visual Analog Scale (VAS). Results: The treatment period was mean 8.5±0.1 (range, 6 to 12) months. The dose of isotretinoin was mean 0.6±0.1 (range, 0.5 and 1) mg/kg. Musculoskeletal side effects were seen in 99 (49.5%) patients. Back pain was reported during the treatment period in 78 (78.7%) patients. The diagnosis was mechanical back pain in 31 (39.7%) and inflammatory back pain in 47 (60.3%) patients. The moderate-severe back pain group received higher cumulative isotretinoin doses than the mild back pain group (p=0.003). The BMI values did not show a significant difference between the patients with and without back pain (p=0.55). There was no significant correlation between the BMI and VAS scores (p=0.06). The VAS scores were found to be correlated with age (p=0.04). Sacroiliitis was diagnosed in four (4%) patients. One (1%) patient was diagnosed with enthesitis. Creatine kinase elevation was reported in 18 (18.1%) patients, while three (3%) patients described myalgia of mild severity. Conclusion: Low back pain is one of the most common musculoskeletal side effects of isotretinoin treatment that usually resolves with dose reduction. The cumulative dose of isotretinoin does not seem to play a role in the development of back pain, but can determine pain severity. Pain severity is directly correlated with the increasing age. Evaluation of the patients for musculoskeletal side effects during isotretinoin use is important in clinical practice, as it is a common occurrence. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic performance of zero echo time (ZTE) MRI in the depiction of structural lesions of sacroiliac joints (SIJs) in patients with the suspicion of sacroiliitis compared with T1-weighted fast spin echo (T1 FSE), using CT as the reference standard. Methods: Forty patients with suspicion of sacroiliitis underwent both CT and MR scans of SIJs with 80 SIJs (160 bone articular surfaces) included for analysis. Two readers independently scored SIJs for structural lesions on CT and MR images. The diagnostic capability of ZTE MRI and T1 FSE were compared by the McNemar test, using CT as the reference standard. Agreements of diagnosis and sum scores of lesions between MR sequences and CT as well as between readers were also investigated using Cohen's κappa tests and intraclass correlation coefficients. Results: Diagnostic accuracy of ZTE MRI was higher than that of T1 FSE for erosions, sclerosis, and joint space changes (e.g., joint space changes: 91.3% vs 75.0%). ZTE MRI also improved sensitivity for detection of erosions and sclerosis (e.g., erosions at the joint level: 98.2% vs 80.0%) as well as specificity for detection of joint space changes (93.0% vs 67.4%). ZTE MRI had more consistency with CT than T1 FSE for both diagnosis and sum scores. Inter-reader agreements were higher for CT and ZTE MRI than those for T1 FSE. Conclusions: ZTE MRI showed superior diagnostic performance in the depiction of SIJ structural lesions compared with routine T1-weighted MRI and had reliability comparable to CT. Key Points: • ZTE MRI can provide CT-like bone contrast for the depiction of osseous structural lesions of the sacroiliac joints. • ZTE MRI showed superior diagnostic performance than conventional T1 FSE in the detection of osseous structural lesions of sacroiliitis, using CT as the reference standard. • In terms of inter-reader reliability, ZTE MRI performed comparably to CT and better than conventional T1 FSE. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose of Review: Recent technical advances in computed tomography (CT) such as low-dose CT and dual-energy techniques open new applications for this imaging modality in clinical practice and for research purposes. This article will discuss the latest innovations and give a perspective on future developments. Recent Findings: Low-dose CT has increasingly been used for assessing structural changes at the sacroiliac joints and the spine. It has developed into a method with similar or even lower radiation exposure than radiography while outperforming radiography for lesion detection. Despite being incompatible with low-dose scanning, some studies have shown that dual-energy CT can provide additional information that is otherwise only assessable with magnetic resonance imaging (MRI). However, it is unclear whether this additional information is reliable enough and if it would justify the additional radiation exposure, i.e. whether the performance of dual-energy CT is close enough to MRI to replace it in clinical practice. Summary: While the role of dual-energy CT in patients with axial spondyloarthritis remains to be established, low-dose CT has developed to an appropriate modality that should replace radiography in many circumstances and might supplement MRI. [ABSTRACT FROM AUTHOR]

The article discusses one of the variants of overlap syndrome – a combination of symptoms of ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Three clinical cases are described, in these cases characteristic signs of both diseases were noted and the criteria of both diseases were met. The genetic factors and immunopathogenetic mechanisms underlying AS and RA are analyzed. A review of the literature on the combination of AS and RA is presented.

Background/Aims Sacroiliitis is a frequent extraintestinal manifestation of inflammatory bowel diseases (IBDs). This study aimed to assess the prevalence of sacroiliitis using a validated screening tool based on abdominopelvic computed tomography (APCT) in Korean patients with Crohn’s disease (CD) and examine potential associations between clinical characteristics and sacroiliitis. Methods One hundred five patients with CD undergoing APCT for any indication at an IBD clinic were matched 1:1 for age and sex with 105 controls without underlying chronic illnesses. Using a validated APCT screening tool that defines sacroiliitis as either ankylosis or a total erosion score (TES) ≥ 3, all computed tomography scans were assessed by two independent, blinded radiologists. We compared the prevalence of sacroiliitis between CD patients and controls and clinical characteristics between CD patients with and without sacroiliitis. Results The prevalence of sacroiliitis was significantly higher in CD patients than in controls (13.3% vs. 4.8%, p = 0.030). All subjects with sacroiliitis had a TES ≥ 3, but no ankylosis. The assessment of sacroiliitis in APCT showed excellent interreader reliability (Cohen’s kappa = 0.933 for presence of sacroiliitis). Sacroiliitis in CD patients was bilateral and asymptomatic. There were no significant associations between sacroiliitis and any demographic data or clinical characteristics in these patients. Conclusions The prevalence of APCT-detected sacroiliitis in CD patients was higher than that in controls, but the condition was asymptomatic. The clinical significance of asymptomatic sacroiliitis in Korean CD patients remains unclear.

Abstract Background Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent episodes of fever and serositis. Sacroiliitis can be observed in some FMF patients. This study aimed to compare the demographic, clinical, and laboratory findings, and treatment in children with FMF and sacroiliitis, and children with juvenile spondyloarthropathy (JSpA). Methods In total, 1687 pediatric FMF patients that were followed-up between May 2010 and June 2020 were evaluated retrospectively. Among them, those with sacroiliitis (n = 63) were included in the study and compared to patients with JSpA (n = 102). Results The study included 63 FMF patients with sacroiliitis (38 males [60.3%] and 25 females [39.7%]) with a mean age of 15.2 ± 4.1 years. Mean age at symptom onset was 7.2 ± 5.05 years and mean age at diagnosis was 9.74 ± 4.67 years. The most common mutation in the FMF patients was M694V/M694V (n = 22). Patients were diagnosed with sacroiliitis with a mean of 12 months (range: 6–36 months) after the diagnosis of FMF. Among the FMF patients, 28 (44.4%) had enthesitis, 23 (36.5%) had heel pain, and 11 (17.4%) had low back pain. The study also included 102 JSpA patients (90 males [88.2%] and 12 females [11.8%]). Mean age of patients with JSpA was 16.1 ± 2.8 years. As compared to 102 JSpA patients, patients with FMF and sacroiliitis had higher acute phase reactants, whereas HLA-B27 positivity rate was lower. In addition, axial involvement rate was higher in the JSpA patients. Conclusion Sacroiliitis is a common co-morbidity in FMF patients. The phenotypic features of these patients are different from patients with JSpA.

Introduction: Spondyloarthropathies (SpAs) are inflammatory diseases with symptoms such as spinal pain, sacroiliac, and peripheral involvement. The prevalence of SpAs is reported from 0.2% to 1.6%. SpAs can cause significant disabilities for patients. Its medical treatment is mainly with non-steroidal anti-inflammatory (NSAIDs) and anti-TNF drugs. Objectives: The primary purpose of this study is to carefully detect the clinical manifestations of patients, demographic characteristics, and the effectiveness of common medications in this disease. Patients and Methods: The present study is a retrospective descriptive study. The statistical population is 101 patients with SpA who have demographic information and items related to clinical conditions, radiographic findings and response to treatment. Results: One hundred one patients with SpA [46 (45.5%) female] with the age of 36.83± 10.45 years were studied. Around 66 patients (64.7%) had ankylosing spondylitis (AS), with the highest prevalence of AS. The most common clinical symptoms in patients were axial and peripheral/ extra-articular symptoms. The response to patients’ treatment were 61 patients (60.4%) had responded to the first stage of treatment, since only one patient needed to change the treatment steps in five times. Conclusion: We found, most patients with SpA were young patients. The most common radiological finding was Sacroiliitis. The most common clinical finding was extra-articular manifestations. Peripheral manifestations of the disease in women and axial images in men were common. The highest response to treatment was observed with the combination of indomethacin, sulfasalazine (SSZ) and indomethacin (alone).

ObjectivesFat metaplasia in an erosion cavity, also known as backfill, is an essential intermediary in new bone formation in axial spondyloarthritis (axSpA) patients; however, the predictors of backfill progression are unknown. This longitudinal study aimed to assess the predictors of backfill progression in axSpA patients on magnetic resonance imaging (MRI).MethodsClinical and MRI data were collected at baseline and follow-up in 52 axSpA patients. Backfill progression was defined as the new or increased T1 hyperintensity within the SI joint space. Logistic regression analyses were performed to identify the predictors of the backfill progression.ResultsA total of 19 patients had “backfill” at baseline and 30 patients exhibited the backfill progression after follow-up. The mean disease duration and SPARCC scores at baseline were significantly different between patients with and without backfill progression (P

Abstract Background Radiographs of the sacroiliac joints are commonly used for the diagnosis and classification of axial spondyloarthritis. The aim of this study was to develop and validate an artificial neural network for the detection of definite radiographic sacroiliitis as a manifestation of axial spondyloarthritis (axSpA). Methods Conventional radiographs of the sacroiliac joints obtained in two independent studies of patients with axSpA were used. The first cohort comprised 1553 radiographs and was split into training (n = 1324) and validation (n = 229) sets. The second cohort comprised 458 radiographs and was used as an independent test dataset. All radiographs were assessed in a central reading session, and the final decision on the presence or absence of definite radiographic sacroiliitis was used as a reference. The performance of the neural network was evaluated by calculating areas under the receiver operating characteristic curves (AUCs) as well as sensitivity and specificity. Cohen’s kappa and the absolute agreement were used to assess the agreement between the neural network and the human readers. Results The neural network achieved an excellent performance in the detection of definite radiographic sacroiliitis with an AUC of 0.97 and 0.94 for the validation and test datasets, respectively. Sensitivity and specificity for the cut-off weighting both measurements equally were 88% and 95% for the validation and 92% and 81% for the test set. The Cohen’s kappa between the neural network and the reference judgements were 0.79 and 0.72 for the validation and test sets with an absolute agreement of 90% and 88%, respectively. Conclusion Deep artificial neural networks enable the accurate detection of definite radiographic sacroiliitis relevant for the diagnosis and classification of axSpA.

Extensive use of magnetic resonance imaging (MRI) in clinical practice revolutionized our understanding of the pathogenesis of axis spondyloarthritis (aSpA) and treatment approaches. The use of MRI to diagnose non-radiographic aSpA is well established. At the same time, the possibility of its use for follow-up and treatment assessment is actively discussed.Objective: To present comparative analysis of clinical and laboratory data, reflecting the activity of the disease, and analysis of MRI results in patients with ankylosing spondylitis (AS) receiving biological disease modifying anti-rheumatic drugs therapy (bDMARDs).Patients and methods. The study included 39 patients with AS, mainly men (74.3%), 24 patients (61.5%) had late and 15 (38.5%) – advanced stage of the disease. The average age was 41.0 [34.0; 48.0] years. All patients were administered bDNARDs; inhibitors of the tumor necrosis factor α or inhibitors of interleukin 17 were drug of choice. The median of treatment duration was 1.5 [1.0; 4,5] year. All patients had sacroiliac (SI) and spinal MRI. The activity of the disease was estimated using BASDAI and ASDAS-CRP/ESR indexes, functional disorders – using the BASFI questionnaire. Results and discussion. There was no significant difference in disease activity between patients with osteitis in the SI/spine or without it: BASDAI – 4.7 [2.7; 5,5] and 4.2 [2.9; 8,1], respectively (p=0.533); ASDAS-ESR – 2.6 [2.2; 3,0] and 2.6 [2.2; 3,2], respectively (p=0.725); ASDAS-CRP – 2.5 [2.1; 3,4] and 3.1 [2.8; 3.9], respectively (p=0.172). There was no significant difference in the number of osteitis foci between group of patients who have achieved the therapeutic target (ASDAS < 2.1) and those who have not (ASDAS ≥2.1) – 1.0 [0.0; 3.5] and 1.0 [1.0; 4.0], respectively, (p=0.376), and no difference in amount of inflammatory changes – 1.0 [0.2; 1.7] and 0.1 [0.0; 1,1] cm3, respectively (p=0.124). Conclusion. The data suggests a limited MRI informative value as a method for managing the efficacy of bDMARDs treatment in patients with the advanced / late stage of the AS.

Purpose: To determine the performance of T2* cartilage mapping in diagnosing and assessing disease activity in early axial spondyloarthritis (axSpA), and to investigate the interaction of cartilage damage with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics.This prospective study included 83 axSpA patients and 37 no-axSpA patients. Clinical characteristics, the Assessment of SpondyloArthritis International Society-defined active sacroiliitis on MRI, and T2* SIJs values were recorded. In axSpA, disease activity was evaluated using the ankylosing spondylitis disease activity score-C-reactive protein; active sacroiliitis was evaluated using Spondyloarthritis Research Consortium of Canada, intravoxel incoherent motion, and diffusion kurtosis imaging; chronic sacroiliitis was assessed using composite structural damage score (CSDS) and structural score fat. Mann–Whitney U-test, Kruskal–Wallis test with false discovery rate (FDR), ROC curve, and linear regression were used for statistical analysis.AxSpA patients had significantly higher T2*SIJs values than no-axSpA patients. (22.86 ± 2.42 ms vs 20.36 ± 1.30 ms, p < 0.001). The combination of T2*SIJs values and active sacroiliitis on MRI had the highest AUC for identifying axSpA. T2*SIJs values were significantly different between the inactive and very high, moderate and very high, high and very high, as well as inactive and high disease activity groups (all pFDR < 0.05). Dk (β = 0.48) and CSDS (β = 0.48) were independently associated with T2*SIJs values.T2* values may be a promising biomarker for diagnosing and differentiating disease activity in early axSpA. Both acute and chronic sacroiliitis influence cartilage properties.Sacroiliac joint cartilage abnormalities can be quantified with T2* relaxation time and allow better characterization of early axSpA.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.Materials and methods: To determine the performance of T2* cartilage mapping in diagnosing and assessing disease activity in early axial spondyloarthritis (axSpA), and to investigate the interaction of cartilage damage with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics.This prospective study included 83 axSpA patients and 37 no-axSpA patients. Clinical characteristics, the Assessment of SpondyloArthritis International Society-defined active sacroiliitis on MRI, and T2* SIJs values were recorded. In axSpA, disease activity was evaluated using the ankylosing spondylitis disease activity score-C-reactive protein; active sacroiliitis was evaluated using Spondyloarthritis Research Consortium of Canada, intravoxel incoherent motion, and diffusion kurtosis imaging; chronic sacroiliitis was assessed using composite structural damage score (CSDS) and structural score fat. Mann–Whitney U-test, Kruskal–Wallis test with false discovery rate (FDR), ROC curve, and linear regression were used for statistical analysis.AxSpA patients had significantly higher T2*SIJs values than no-axSpA patients. (22.86 ± 2.42 ms vs 20.36 ± 1.30 ms, p < 0.001). The combination of T2*SIJs values and active sacroiliitis on MRI had the highest AUC for identifying axSpA. T2*SIJs values were significantly different between the inactive and very high, moderate and very high, high and very high, as well as inactive and high disease activity groups (all pFDR < 0.05). Dk (β = 0.48) and CSDS (β = 0.48) were independently associated with T2*SIJs values.T2* values may be a promising biomarker for diagnosing and differentiating disease activity in early axSpA. Both acute and chronic sacroiliitis influence cartilage properties.Sacroiliac joint cartilage abnormalities can be quantified with T2* relaxation time and allow better characterization of early axSpA.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.Results: To determine the performance of T2* cartilage mapping in diagnosing and assessing disease activity in early axial spondyloarthritis (axSpA), and to investigate the interaction of cartilage damage with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics.This prospective study included 83 axSpA patients and 37 no-axSpA patients. Clinical characteristics, the Assessment of SpondyloArthritis International Society-defined active sacroiliitis on MRI, and T2* SIJs values were recorded. In axSpA, disease activity was evaluated using the ankylosing spondylitis disease activity score-C-reactive protein; active sacroiliitis was evaluated using Spondyloarthritis Research Consortium of Canada, intravoxel incoherent motion, and diffusion kurtosis imaging; chronic sacroiliitis was assessed using composite structural damage score (CSDS) and structural score fat. Mann–Whitney U-test, Kruskal–Wallis test with false discovery rate (FDR), ROC curve, and linear regression were used for statistical analysis.AxSpA patients had significantly higher T2*SIJs values than no-axSpA patients. (22.86 ± 2.42 ms vs 20.36 ± 1.30 ms, p < 0.001). The combination of T2*SIJs values and active sacroiliitis on MRI had the highest AUC for identifying axSpA. T2*SIJs values were significantly different between the inactive and very high, moderate and very high, high and very high, as well as inactive and high disease activity groups (all pFDR < 0.05). Dk (β = 0.48) and CSDS (β = 0.48) were independently associated with T2*SIJs values.T2* values may be a promising biomarker for diagnosing and differentiating disease activity in early axSpA. Both acute and chronic sacroiliitis influence cartilage properties.Sacroiliac joint cartilage abnormalities can be quantified with T2* relaxation time and allow better characterization of early axSpA.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.Conclusion: To determine the performance of T2* cartilage mapping in diagnosing and assessing disease activity in early axial spondyloarthritis (axSpA), and to investigate the interaction of cartilage damage with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics.This prospective study included 83 axSpA patients and 37 no-axSpA patients. Clinical characteristics, the Assessment of SpondyloArthritis International Society-defined active sacroiliitis on MRI, and T2* SIJs values were recorded. In axSpA, disease activity was evaluated using the ankylosing spondylitis disease activity score-C-reactive protein; active sacroiliitis was evaluated using Spondyloarthritis Research Consortium of Canada, intravoxel incoherent motion, and diffusion kurtosis imaging; chronic sacroiliitis was assessed using composite structural damage score (CSDS) and structural score fat. Mann–Whitney U-test, Kruskal–Wallis test with false discovery rate (FDR), ROC curve, and linear regression were used for statistical analysis.AxSpA patients had significantly higher T2*SIJs values than no-axSpA patients. (22.86 ± 2.42 ms vs 20.36 ± 1.30 ms, p < 0.001). The combination of T2*SIJs values and active sacroiliitis on MRI had the highest AUC for identifying axSpA. T2*SIJs values were significantly different between the inactive and very high, moderate and very high, high and very high, as well as inactive and high disease activity groups (all pFDR < 0.05). Dk (β = 0.48) and CSDS (β = 0.48) were independently associated with T2*SIJs values.T2* values may be a promising biomarker for diagnosing and differentiating disease activity in early axSpA. Both acute and chronic sacroiliitis influence cartilage properties.Sacroiliac joint cartilage abnormalities can be quantified with T2* relaxation time and allow better characterization of early axSpA.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.Clinical relevance statement: To determine the performance of T2* cartilage mapping in diagnosing and assessing disease activity in early axial spondyloarthritis (axSpA), and to investigate the interaction of cartilage damage with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics.This prospective study included 83 axSpA patients and 37 no-axSpA patients. Clinical characteristics, the Assessment of SpondyloArthritis International Society-defined active sacroiliitis on MRI, and T2* SIJs values were recorded. In axSpA, disease activity was evaluated using the ankylosing spondylitis disease activity score-C-reactive protein; active sacroiliitis was evaluated using Spondyloarthritis Research Consortium of Canada, intravoxel incoherent motion, and diffusion kurtosis imaging; chronic sacroiliitis was assessed using composite structural damage score (CSDS) and structural score fat. Mann–Whitney U-test, Kruskal–Wallis test with false discovery rate (FDR), ROC curve, and linear regression were used for statistical analysis.AxSpA patients had significantly higher T2*SIJs values than no-axSpA patients. (22.86 ± 2.42 ms vs 20.36 ± 1.30 ms, p < 0.001). The combination of T2*SIJs values and active sacroiliitis on MRI had the highest AUC for identifying axSpA. T2*SIJs values were significantly different between the inactive and very high, moderate and very high, high and very high, as well as inactive and high disease activity groups (all pFDR < 0.05). Dk (β = 0.48) and CSDS (β = 0.48) were independently associated with T2*SIJs values.T2* values may be a promising biomarker for diagnosing and differentiating disease activity in early axSpA. Both acute and chronic sacroiliitis influence cartilage properties.Sacroiliac joint cartilage abnormalities can be quantified with T2* relaxation time and allow better characterization of early axSpA.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.Key Points: To determine the performance of T2* cartilage mapping in diagnosing and assessing disease activity in early axial spondyloarthritis (axSpA), and to investigate the interaction of cartilage damage with clinical characteristics, sacroiliitis MRI scorings, and diffusion metrics.This prospective study included 83 axSpA patients and 37 no-axSpA patients. Clinical characteristics, the Assessment of SpondyloArthritis International Society-defined active sacroiliitis on MRI, and T2* SIJs values were recorded. In axSpA, disease activity was evaluated using the ankylosing spondylitis disease activity score-C-reactive protein; active sacroiliitis was evaluated using Spondyloarthritis Research Consortium of Canada, intravoxel incoherent motion, and diffusion kurtosis imaging; chronic sacroiliitis was assessed using composite structural damage score (CSDS) and structural score fat. Mann–Whitney U-test, Kruskal–Wallis test with false discovery rate (FDR), ROC curve, and linear regression were used for statistical analysis.AxSpA patients had significantly higher T2*SIJs values than no-axSpA patients. (22.86 ± 2.42 ms vs 20.36 ± 1.30 ms, p < 0.001). The combination of T2*SIJs values and active sacroiliitis on MRI had the highest AUC for identifying axSpA. T2*SIJs values were significantly different between the inactive and very high, moderate and very high, high and very high, as well as inactive and high disease activity groups (all pFDR < 0.05). Dk (β = 0.48) and CSDS (β = 0.48) were independently associated with T2*SIJs values.T2* values may be a promising biomarker for diagnosing and differentiating disease activity in early axSpA. Both acute and chronic sacroiliitis influence cartilage properties.Sacroiliac joint cartilage abnormalities can be quantified with T2* relaxation time and allow better characterization of early axSpA.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage.T2* mapping may have value in evaluating axSpA.The combination of T2* values and active sacroiliitis on MRI enhances diagnostic performance for axSpA.Abnormalities measured with T2* values correlate with disease activity, acute sacroiliitis, and degree of structural damage. [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]

Background: The aim of this study was to assess the diagnostic value of dual gradient-echo T1-weighted sequence (in phase and out of phase) and the related Dixon images in evaluation of structural changes observed in sacroiliac joint in patients diagnosed with ankylosing spondylitis. Forty patients with low back pain were included in the study; they underwent T1-Dixon and routine MRI study on the sacroiliac joint in addition to pelvic CT. Results: This study was carried out on forty patients, 27 (67.5%) males and 13 (32.5%) females, their mean age was 34.93 ± 11.21 years, and mean duration of symptoms was 8.1 ± 7.4 years. The mean Ankylosing Spondylitis Disease Activity Score ASDAS value was 4.03 ± 0.85 years. The most common structural change was subchondral fat deposition. Dixon MRI was significantly superior to T1WI in simple quantification of the amount of fat with P = 0.036 and excellent inter-rater reliability (96%), P = 0.0001. The number of erosions/backfills detected on Dixon was higher than that detected in T1WI with higher accuracy (97.5%) and excellent inter-rater reliability (95%), P = 0.0001. ASDAS showed significant positive correlation with erosion/backfill (r = 69, P = 0.0001) and with maximal fat deposition detected on Dixon (r = 32, P = 0.044). There were significant difference between the patients having high ASDAS and others having very high ASDAS scores regarding the sub-articular sclerosis (P = 0.013). Conclusion: 3D T1-based Dixon is a helpful imaging technique in proper assessment of different structural changes in sacroiliitis, its integration into routine MR protocol is recommend as it could yield a better depiction of erosive/backfill and fat deposition. [ABSTRACT FROM AUTHOR]

Pregnancy-associated sacroiliitis is infrequent during the peripartum period. Although pregnancy-associated pyogenic sacroiliitis rarely occurs, it is associated with significant morbidity and mortality. A timely diagnosis of the disease is challenging due to its nonspecific clinical symptoms. We reviewed a case that experienced an acute illness during pregnancy. The illness was manifested by localized pain in the hips or buttocks, sacroiliac joint tenderness, and debilitating hip pain during ambulation. Magnetic resonance imaging revealed little joint involvement, and the patient was treated with antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids. The patient responded well to the therapy with marked improvement in her ambulation. Septic sacroiliitis should be considered in peripartum patients presenting with increased inflammatory markers and severe localized pain. Medical management is usually curative and without an adverse effect on pregnancy. Although we could not perform a biopsy to verify the cause of the disease, the patient's excellent response to the treatment confirmed our diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease that can present with various forms of arthritis. This retrospective study aims to evaluate the characteristics of patients with arthritis in a large pediatric cohort of FMF patients. Methods: The demographic and clinical data were extracted from electronic medical records. Patients with arthritis were grouped as arthritis of FMF and arthritis of FMF-associated diseases. Results: A total of 541 patients were followed with a diagnosis of FMF in the last 5 years. Acute arthritis of FMF (n: 138) was the most common cause. It showed a recurrent course in the majority with a longer duration than other attack symptoms. Significantly higher frequencies of biallelic exon 10 and M694V mutations, erysipelas-like erythema, and protracted febrile myalgia were detected in these patients, particularly in those older than 2 years of age. Sacroiliitis of FMF was the second most common cause (n: 19). Patients with acute arthritis and sacroiliitis of FMF needed higher doses of colchicine. One patient with neonatal-onset FMF and M694V homozygosity was diagnosed with protracted arthritis. Arthritides of FMF-associated diseases including IgA vasculitis (n: 10), juvenile idiopathic arthritis (n: 9), chronic nonbacterial osteomyelitis (n: 5), and inflammatory bowel disease (n: 2) were detected in 26 patients. Conclusions: Arthritis is an important clinical finding of FMF mostly associated with M694V mutations. The frequency of protracted arthritis is declined, whereas sacroiliitis of FMF and arthritis of associated diseases expand the spectrum of arthritis. This study represents the changing face and current perspectives of arthritis in FMF. Key Points • Arthritis is an important clinical finding of familial Mediterranean fever (FMF) that can present in various forms • Arthritis is most likely associated with M694V mutations • The frequency of protracted arthritis is declined whereas sacroiliitis of FMF and arthritis of associated diseases expand the spectrum of arthritis in FMF [ABSTRACT FROM AUTHOR]

Objective The aim was to assess clinical improvement after US-guided injection of CSs into the SI joint of patients with SpA. Methods This was an observational, descriptive, retrospective study of patients with SpA and sacroiliitis who received an US-guided injection into the SI joint between 1 June 2020 and 31 May 2021. Means were compared using Student's paired t -test for the variables visual analog scale (VAS), BASDAI, ASDAS, CRP and ESR before and after the procedure. We evaluated the association between these variables and the clinical response using the odds ratio. Results We analysed 32 patients with SpA [age 42.69 (8.19) years; female sex, 56.25%], with a VAS score of 7.88 (0.79), BASDAI of 5.43 (1.48) and ASDAS of 3.27 (0.86) before the procedure. At 2–3 months, 75% of patients had improved: VAS 3.81 (2.33) (−4.07, P  < 0.0001) and BASDAI 3.24 (1.6) (−2.19, P  < 0.0001). At 5–6 months, 59.37% had improved: VAS 4.63 (2.31) (−3.25, P  < 0.0001), BASDAI 3.57 (1.67) (−1.86, P  < 0.0001) and ASDAS 2.27 (0.71) (−1.0, P  < 0.0001). Bone marrow oedema resolved in 87.5% of cases compared with the previous MRI scan. No significant association was identified with the clinical response to the injection. Conclusion US-guided injection of CSs into the SI joint of patients with SpA and active sacroiliitis leads to an improvement in symptoms that is maintained at 5–6 months. The procedure is effective, safe, inexpensive and easy to apply. [ABSTRACT FROM AUTHOR]