Sacroiliac joint edema by MRI: Far more often mechanical than inflammatory?

Berthelot, Jean‐Marie; Goff, Benoît Le; Maugars, Yves; Laredo, Jean‐Denis

doi:10.1016/j.jbspin.2015.08.013

Cited by 23 publications

(12 citation statements)

References 15 publications

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“…Since structural damage is a hallmark sign of fulminant late‐stage SpA, extensive BME seems more likely to be associated with SpA, while low BME levels may be more reflective of axial stress or degenerative changes . Previous studies investigating possible non–SpA‐related causes of SI joint BME are sparse, but a number of factors have been suggested to be associated with BME, including pregnancy/birth‐related stress, obesity, extensive physical activity, and age‐related degeneration . In a study by Weber et al that investigated physically active healthy young individuals, the authors found that, when present, BME was primarily seen at low levels and clustered topographically in distinct SI joint regions .…”

Section: Discussionmentioning

confidence: 99%

What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four‐Year Magnetic Resonance Imaging Follow‐Up Study of Low Back Pain Patients

Arnbak

Jensen

Schiøttz‐Christensen

et al. 2019

Arthritis & Rheumatology

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Objective. Sacroiliac (SI) joint bone marrow edema (BME) is considered to be pivotal in the detection of early spondyloarthritis. However, the link between BME and development of spondyloarthritis-related bone remodeling remains unclear. This study was undertaken to investigate the evolution of BME and structural lesions in the SI joints over time.Methods. Baseline and 4-year follow-up magnetic resonance imaging scans were conducted in 604 patients ages 18-40 years who were referred with low back pain to an outpatient spine clinic. Eight SI joint regions were scored for BME and categorized as absent, limited (<25% of subcortical bone region), intermediate (25-50%), or extensive (>50%). Structural lesions including erosions and fat lesions were scored as absent or present.Results. SI joint BME was seen at either time point (baseline or at 4 years) in 41% of participants but was persistent at both time points in only 16% of participants. Structural SI joint lesions developed according to the extent of BME at baseline: limited, intermediate, and extensive BME (as compared to absent BME) were independently associated with erosion at follow-up with odds ratios (ORs) of 3, 5, and 46, respectively, and with fat lesions (ORs 3, 7, and 33, respectively). In regions with limited and intermediate BME at baseline, 60% and 50% had resolved by follow-up, respectively, while only 2% and 7% had evolved into extensive BME by follow-up.Conclusion. While extensive SI joint BME was a strong independent predictor of development of structural lesions, limited and intermediate BME were mostly transient and only rarely evolved into extensive BME or structural lesions. These findings enhance our understanding of the natural development of SI joint lesions and indicate different progression patterns for limited/intermediate versus extensive BME, possibly due to different etiologies.

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Section: Discussionmentioning

confidence: 99%

What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four‐Year Magnetic Resonance Imaging Follow‐Up Study of Low Back Pain Patients

Arnbak

Jensen

Schiøttz‐Christensen

et al. 2019

Arthritis & Rheumatology

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“…It was advanced that sacral stress fracture and mechanical SIJ disease are probably underestimated. [ 2 , 9 ] This could be explained by the lack of specificity of symptoms of these conditions and the physician unfamiliarity with sacral stress fractures during pregnancy. Sacroiliitis in the postpartum has been reported to be of infectious or inflammatory origin and in some cases pregnancy was considered as a predisposing factor.…”

Section: Discussionmentioning

confidence: 99%

Postpartum sacral stress fracture associated with mechanical sacroiliac joint disease

et al. 2018

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Rationale:Stress fractures of the sacrum and mechanical sacroiliac joint disease can occur not only during pregnancy but also postpartum. Mechanical sacroiliac joint disease is common in patients with low back pain but often misdiagnosed by practitioners. The association of the 2 conditions has not been studied yet.Patient concerns:A 37-year-old woman physiatrist presented with 8-week history of persistent low back and left buttock pain that started in the third trimester of her pregnancy.Diagnoses:Laboratory investigation, dual-energy x-ray absorptiometry, magnetic resonance imaging, and CT of the pelvic region were performed. The patient was diagnosed with postpartum sacral stress fracture associated with mechanical sacroiliac joint disease.Interventions:Treatment consisted in pain killers and tailored to a nonweight-bearing period of 3 months.Outcomes:Painful symptoms disappeared and the patient was able to walk and perform other daily activities normally.Lessons:Clinician should be aware of the clinical context and the possible association of these 2 conditions in order to undertake an early and appropriate treatment.

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“…For decades many authors have always been concerned with SIJ lesions in an attempt to give a definite aetiopathogenesis to the bone changes. Currently SI disease is a topic intensively discussed in the literature due to the scientific studies that report major prevalence of non-rheumatic origin of the alterations [ 9 ]. Degenerative pathology of SIJ is an underestimated condition and has remained largely outside the research spotlight.…”

Section: Discussionmentioning

confidence: 99%

All that glitters is not gold: sacroiliitis

Tarantino¹,

Jablonska²,

D’Aprile³

2018

Reumatologia

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ObjectivesThe aim of this study was to determine the prevalence of „rheumatic” and „non-rheumatic” changes of the sacro-iliac joints (SIJ).Material and methodsWe performed MRI in 210 patients with suspected inflammatory low back pain. We sorted and analysed the characteristics of sacroiliac bone lesions in „rheumatic” and „non-rheumatic” patients and assessed the diagnostic values of their extent and location. SIJ lesions were classified on the basis of their location into two categories: unilateral and bilateral. Their extent was then measured and assigned to one of two groups: <1 cm or ≥ 1 cm.ResultsIn 45 cases (21%), the MRI findings matched the clinical diagnosis of „rheumatic” sacroiliitis. Interestingly, in 99 cases (47%) the SIJ changes were classified as „non-rheumatic”. L5–S1 degenerative changes, scoliosis and pelvic asymmetry were most frequently encountered as concomitant phenomena in our study.ConclusionsMRI of the sacroiliac joints in patients suspected of inflammatory low back pain demonstrated more often “non-rheumatic” changes.

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Sacroiliac joint edema by MRI: Far more often mechanical than inflammatory?

Cited by 23 publications

References 15 publications

What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four‐Year Magnetic Resonance Imaging Follow‐Up Study of Low Back Pain Patients

What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four‐Year Magnetic Resonance Imaging Follow‐Up Study of Low Back Pain Patients

Postpartum sacral stress fracture associated with mechanical sacroiliac joint disease

All that glitters is not gold: sacroiliitis

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