Bone Marrow Edema in the Sacroiliac Joint—Degenerative Sacroiliac Joint Disease Might Be More Likely Than Spondyloarthritis: Comment on the Article by Turina et al

Effect of neridronate on axial involvement in patients with spondyloarthritis when biologics are not possible. Results of a monocentric study

“…Several questions have been raised about the specificity of BME signal and active SI because these findings could be incidentally found in heathy individuals or athletes or could be related to degenerative diseases. Several reports highlighted that BME related to the degenerative disease is located at the upper and anterior part of the joint, where biomechanical loads are prevalent (30). Another recent report explored the association between BME (defined as SI ASAS) and non-inflammatory spine abnormalities in patients suffering from chronic mechanical back pain.…”

Spine abnormalities associated with bone edema on sacroiliac joints MRI in patients with non-inflammatory chronic back pain

“…BME associated with ax-SpA is usually bilateral unlike BME unrelated to ax-SpA which is almost exclusively unilateral [33,34]. BME at the lower and posterior part of SIJ is often considered specific to inflammatory diseases and particularly ax-SpA whereas BME can also be observed at these locations in non-inflammatory conditions [16].…”

“…Thus, degenerative aetiologies of SIJ BME should be considered, given the high prevalence in patients with CBP [14,15]. SIJ lesions related to degenerative disease are commonly located at the upper and anterior part of the joint, where biomechanical loads are important [16]. Simultaneous involvement of the spine and SIJ is also frequent in degenerative conditions [7].…”

Bone marrow edema of the sacroiliac joint and anatomical variations: Look back the posterior bony excess. Comment on: “Spine abnormalities associated with bone edema on sacroiliac joints MRI in patients with non-inflammatory chronic back pain” by Marnas et al. Joint Bone Spine 2022;89:105436

“…Usually, in case of BME located in the upper and anterior part of the SIJs, the origin is mainly degenerative. If, BME is located in the inferior and central to posterior part of the SIJs, origin is mostly inflammatory [2,3]. Marnas et al showed in an original study that BME of the SIJs in patients with mechanical back pain could be seen in the inferior (56.3%) and posterior parts (52.1%) too.…”