Objectives Osteitis condensans ilii (OCI) has become an important differential diagnosis for axial spondyloarthritis (axSpA). The objective of this matched case–control study was to investigate demographic, clinical, laboratory and MRI characteristics of OCI as compared with axial spondyloarthritis (axSpA). Methods A total of 60 patients diagnosed with OCI were included in the final analysis. From 27 of these patients, MRIs of the sacroiliac joints were available. OCI patients were matched with a 1:1 ratio by back pain duration to patients with definite axSpA in order to compare clinical, laboratory and MRI characteristics. Results The OCI patients were nearly all females (96.7 vs 46.7%), had a significantly lower prevalence of inflammatory back pain (39.5 vs 88.9%), a significantly lower percentage of HLA-B27 positives (35.2 vs 80.0%) and a lower prevalence of the majority of other SpA features as compared with axSpA patients. Interestingly, there was no difference in the prevalence of osteitis in the sacroiliac joints (92.6 vs 85.2% in OCI and axSpA, respectively, P = 0.44), but there was a difference in the prevalence of erosions (7.4 vs 66.7%, respectively, P = 0.0001). In addition, in OCI nearly all lesions were localized in the anterior part of the sacroiliac joints while in axSpA lesions were localized predominantly in the middle part of the joint (for osteitis: 96 vs 4% in OCI and 28.6 vs 71.4% in axSpA; P = 0.0002 for the inter-group difference). Conclusion Clinical and imaging features of OCI compared with axSpA are described that should help in differential diagnosis.
BackgroundOsteitis condensans ilii (OCI) is regarded as a non-inflammatory disorder that is believed to be induced, for example, by mechanical stress and mechanical instability of the sacroiliac joints (SIJ) related to pregnancy/delivery. OCI is being increasingly recognised as an important differential diagnosis for axial spondyloarthritis (axSpA), due to onset at young age, possible inflammatory character of back pain and recently described presence of subchondral bone marrow oedema on magnetic resonance imaging (MRI) of the SIJ. So far, no systematic comparison of MRI changes in the sacroiliac joints in patients with OCI and axSpA has been performed.ObjectivesTo compare active and chronic inflammatory lesions of the SIJ as detected by MRI in patients with OCI and axSpA.MethodsUsing medical database search we identified n=103 patients aged ≥18 years who were diagnosed with OCI upon presentation with chronic back pain in the Early Spondyloarthritis Clinic of the rheumatology department in the Charité University Hospital between January 2010 and May 2015. These patients were contacted in order to obtain an informed consent and to complete a survey on the disease-related history. A total of 27 patients had evaluable MRIs of the SIJ in STIR and T1-weighted sequences, which were used for the current study. These patients were matched to 27 patients with definite axSpA according to the back pain duration. MRIs were scored according to the Berlin scoring system for osteitis, fatty degeneration, erosions, sclerosis and ankylosis independently by 3 trained and calibrated readers who were blinded for all clinical data including diagnosis. In addition, the preferential localization of lesions (ventral, mid, or dorsal part of the SIJ) was recorded.ResultsThere were no differences either in the osteitis score or in the proportion of patients with presence of osteitis on MRI of the SIJ between OCI and axSpA patients (table 1). The fatty degeneration score was significantly lower in OCI as compared to axSpA, although the difference in the prevalence of the fatty lesions did not reach the level of statistical significance. There was a non-significant trend towards a higher sclerosis score in OCI patients. Importantly, there was a highly significant difference in the erosion score and in the prevalence of erosions: only 2 (7.4%) OCI vs. 18 (66.7%) axSpA patients had at least one erosion (table 1). Importantly, none of the OCI patients had high-grade (>5 erosions) erosive changes.There were substantial differences concerning localization of the lesions: in OCI, ventral localization was recorded in 96% of the cases for osteitis, in 100% for fatty degeneration, and in 96% for sclerosis, while in axSpA, osteitis was preferentially localised in the ventral part only in 29% of the cases, fatty degeneration in 25%, sclerosis in 29%. Ankylosis and erosions were localised in the mid part in almost all cases.Abstract FRI0173 – Table 1Active and chronic lesions of the sacroiliac joints as detected by MRI in patients with osteitis condensan...
BackgroundOsteitis condensans ilii (OCI) is regarded as a non-inflammatory disorder, which is considered to be induced by mechanical stress (e.g., by pregnancy and delivery). The diagnosis is normally based on wide spread sclerosis of the sacroiliac joint without erosions or ankyloses on imaging. More recently, paraarticular bone marrow oedema has been described on MRI, which can occur early but also intermittently later in the course of the disease. The clinical characteristics of OCI patienst have not been well described. To date, there are no published systematic data on the characteristics of OCI as compared to axial spondyloarthritis (axSpA).ObjectivesThe objective of this matched case-control study was to investigate demographic, clinical, and lab characteristics of OCI as compared to axSpA.MethodsUsing medical database search we have identified n=103 patients aged ≥18 years who were diagnosed with OCI upon presentation with chronic back pain in the Early Spondyloarthritis Clinic of the rheumatology department in the Charité University Hospital between January 2010 and May 2015. These patients were contacted in order to obtain an informed consent and to complete a survey on the disease-related history. n=60 OCI patients who provided an informed consent and completed the survey were included in the final analysis. These patients were matched with a 1:2 ratio according to the back pain duration to patients with definite axSpA diagnosed in the same setting in order to compare demographic, clinical and lab characteristics.Abstract FRI0191 – Table 1Demographic, clinical and lab characteristic of OCI as compared to axSpA in the rheumatology setting.ResultsThe main characteristics of the two groups are presented in the table. Most importantly, all but 2 patients with OCI were females and had a significantly lower prevalence of inflammatory back pain, lower level of CRP stressing a rather non-inflammatory nature of this condition. All patients were referred because of possible axial SpA, therefore SpA features, although being lower than in axSpA patients (table 1), were higher than can normally expected in OCI patients. This is probably the reason why a statistical significance in comparison to axSpA was observed for uveitis only. There was no difference in age of back pain onset (but age <45 years was a referral parameter). Signs of sacroiliitis at physical examination were only slightly more frequent in axSpA; there were no differences in spinal mobility. The level of symptoms (BASDAI) and the perceived level of functional disability (BASFI) were comparable between groups. 83% of female patients with OCI reported a history of at least one pregnancy with a mean number of pregnancies of 3 (median=3, range 1–8).ConclusionsOCI manifesting with chronic back pain starting prior to 45 years of age represents an important differential diagnosis for axSpA. A constellation of a female sex (with a history of pregnancies), negative HLA-B27 and negative CRP seems to be of differential diagnostic value as compared to axSpA.Disc...
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