Utility of magnetic resonance imaging in Crohn's associated sacroiliitis: A cross‐sectional study

Abstract

Objective Prevalence of sacroiliitis in Crohn's disease (CD) is variable depending on defining criteria. This study utilized standardized sacroiliac joint (SIJ) magnetic resonance imaging (MRI) to identify sacroiliitis in CD patients and its association with clinical and serological markers. Methods Consecutive adult subjects with CD prospectively enrolled from an inflammatory bowel disease clinic underwent SIJ MRI. Data collected included CD duration, history of joint/back pain, human leukocyte antigen‐B27 status, Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index, Harvey Bradshaw Index (HBI) for activity of CD, Ankylosing Spondylitis Disease Activity Score, and various serologic markers of inflammation. Three blinded readers reviewed MRIs for active and structural lesions according to the Spondyloarthritis Research Consortium of Canada modules. Results Thirty‐three CD patients were enrolled: 76% female, 80% White, median age 36.4 years (interquartile range 27.2‐49.0), moderate CD activity (mean HBI 8.8 ± SD 4.5). Nineteen subjects (58%) reported any back pain, 13 of whom had inflammatory back pain. Four subjects (12%) showed sacroiliitis using global approach and 6 (18%) met Assessment of SpondyloArthritis international Society MRI criteria of sacroiliitis. Older age (mean 51.2 ± SD 12.5 vs. 37.2 ± 14; P = .04), history of dactylitis (50.0% vs. 3.4%, P = .03) and worse BASMI (4.1 ± 0.7 vs. 2.4 ± 0.8, P ≤ .001) were associated with MRI sacroiliitis; no serologic measure was associated. Conclusion There were 12%‐18% of CD patients who had MRI evidence of sacroiliitis, which was not associated with back pain, CD activity or serologic measures. This data suggests that MRI is a useful modality to identify subclinical sacroiliitis in CD patients.

Association between sacroiliac joint forms and subchondral changes in patients with Crohn's disease

“…The further studies showed a feasibility of MRE to detect BME, sclerosis, fatty deposits, and also to some extent erosions with ankylosis 6,13,14,34 . However, studies in patients with inflammatory bowel disease, especially with CD, based either on MRE or on MRI, found no significant association between SIJ changes and clinical parameters such as disease duration, behavior, bowel involvement, and BMI 6,13,14,34–37 . We also did not find any significant difference in the abovementioned clinical parameters between CD patients with and without SIJ changes.…”

Sacroiliitis in inflammatory bowel disease

“…Kelly et al [17] reported association of sacroiliitis with male sex, history of peripheral arthritis and Crohn's disease inflammatory phenotype [17]. Standardized MRI of sacroiliac joint (SIJ) showed sacroiliitis in 12-39% of patients with IBD [23][24][25][26] and this wide range was again due to differences in MRI interpretations in these studies (e.g. ASAS definition of MRI positivity vs. inclusion/exclusion of structural lesions).…”

“…These findings might suggest that subclinical gut inflammation in axSpA patients is similar to Crohn's disease. Conversely, only 4% of patients with IBD develop AS with higher incidence associated with longer duration of IBD and up to 40% Crohn's disease patients were found to have sacroiliitis on MRI-based studies [24,25].…”