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Melekh O, Barajas Ordonez F, Melekh B, Rodríguez-Feria P, Pech M, Flintrop W, Surov A. Association between sacroiliac joint forms and subchondral changes in patients with Crohn's disease. Int J Rheum Dis 2024; 27:e15046. [PMID: 38414165 DOI: 10.1111/1756-185x.15046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024]
Abstract
AIM To assess the relationship between anatomical variants of sacroiliac joint (SIJ) and subchondral changes detected in magnetic resonance enterography (MRE) in patients with Crohn's disease (CD). METHODS This was a retrospective study of 60 CD patients, who were divided into two groups: with (n = 16) and without SIJ (n = 44) involvement, depending on the presence of inflammatory (bone marrow edema) and structural changes (sclerosis and erosions) in MRE. Anatomical variants of SIJ were assessed in CT of the abdomen and/or pelvis, distinguishing typical form with convex iliac surface and atypical forms. Univariate and multivariate analyses were performed to reveal an association between joint changes and forms. RESULTS Our study included 60 patients (38 males; mean age 38.72 years ± 13.33). Patients with SIJ changes were older (p = .044). No significant differences in CD localization and behavior were found. The most common SIJ lesions were structural changes (in 75% of patients); the main atypical form was the iliosacral complex. The univariate and multivariate analyses showed a significant association of atypical forms with total subchondral changes (odds ratio [OR]: 3.429, 95% confidence interval [CI] 1.043-11.268; p = .042; OR: 5.066, 95% CI: 1.273-20.167; p = .021, respectively), and with structural changes (OR: 4.185, 95% CI: 1.155-15.160; p = .029; OR: 5.986, 95% CI: 1.293-27.700; p = .022, respectively). CONCLUSION Atypical forms of SIJ are a risk factor for the occurrence of structural joint changes in CD patients. An association between bone marrow edema and atypical forms was not found.
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Affiliation(s)
- Oksana Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Felix Barajas Ordonez
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH, Aachen, Germany
| | - Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Pablo Rodríguez-Feria
- Department of International Health, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Wiebke Flintrop
- Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Institute for Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital by Muehlenkreiskliniken, Ruhr University Bochum, Minden, Germany
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Iyer P, Hwang M, Ridley L, Weisman MM. Biomechanics in the onset and severity of spondyloarthritis: a force to be reckoned with. RMD Open 2023; 9:e003372. [PMID: 37949613 PMCID: PMC10649803 DOI: 10.1136/rmdopen-2023-003372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
Increasing evidence suggests that there is a pivotal role for physical force (mechanotransduction) in the initiation and/or the perpetuation of spondyloarthritis; the review contained herein examines that evidence. Furthermore, we know that damage and inflammation can limit spinal mobility, but is there a cycle created by altered spinal mobility leading to additional damage and inflammation?Over the past several years, mechanotransduction, the mechanism by which mechanical perturbation influences gene expression and cellular behaviour, has recently gained popularity because of emerging data from both animal models and human studies of the pathogenesis of ankylosing spondylitis (AS). In this review, we provide evidence towards an appreciation of the unsolved paradigm of how biomechanical forces may play a role in the initiation and propagation of AS.
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Affiliation(s)
- Priyanka Iyer
- Division of Rheumatology, Department of Medicine, UC Irvine Healthcare, Orange, California, USA
| | - Mark Hwang
- Rheumatology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
| | - Lauren Ridley
- Rheumatology, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, USA
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Ziegeler K, Ulas ST, Poddubnyy D, Proft F, Rios Rodriguez V, Rademacher J, Hermann KGA, Diekhoff T. Anatomical variation of the sacroiliac joint carries an increased risk for erosion and bone marrow oedema in axial spondyloarthritis. Rheumatology (Oxford) 2023; 62:1117-1123. [PMID: 35532084 DOI: 10.1093/rheumatology/keac282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the impact of joint shape variations on inflammatory lesions on SI joint MRIs in patients with axial spondyloarthritis (axSpA). METHODS A total of 1194 patients from four different prospective cohorts were evaluated, with 684 (57.3%) having sufficient imaging data for inclusion (379 axSpA, 305 controls). All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls. RESULTS Atypical joint forms were common in both axSpA (43.5% [154/354]) and control patients (44.2% [134/303]); both intra-articular variants and a crescent joint shape were significantly more common in axSpA patients (18.4% vs 11.6% and 11.0% vs 5.3.%, respectively; P < 0.001). The axSpA patients with intra-articular joint form variants had 2-fold higher odds of exhibiting erosions [odds ratio (OR) 2.09 (95% CI 1.18, 3.69)] and BMO [OR 1.79 (95% CI 1.13, 2.82)]; this association was not observed in controls. Accessory joints increased the odds for sclerosis in axSpA patients [OR 2.54 (95% CI 1.10, 5.84)] and for sclerosis [OR 17.91 (95% CI 6.92, 46.37)] and BMO [OR 2.05 (95% CI 1.03, 4.07)] in controls. CONCLUSIONS Joint form variations are associated with the presence of inflammatory lesions on SI joint MRIs of axSpA patients. This should be taken into consideration in future research on the interplay of mechanical strain and inflammation in axSpA.
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Affiliation(s)
| | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin.,Berlin Institute of Health, Berlin, Germany
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Axial Spondyloarthritis and Diagnostic Challenges: Over-diagnosis, Misdiagnosis, and Under-diagnosis. Curr Rheumatol Rep 2023; 25:47-55. [PMID: 36602692 DOI: 10.1007/s11926-022-01096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW This article aims to review the challenges in axial spondyloarthritis diagnosis and identify the possible contributing factors. RECENT FINDINGS The inability to reach an accurate diagnosis in a timely fashion can lead to treatment delays and worse disease outcomes. The lack of validated diagnostic criteria and the misuse of the currently available classification criteria could be contributing. There is also significant inter-reader variability in interpreting images, and the radiologic definitions of axial spondyloarthritis continue to be re-defined to improve their positive predictive value. The role of inflammatory back pain features, serologic biomarkers, genetics, and their diagnostic contribution to axial spondyloarthritis continues to be investigated. There is still a significant amount of delay in the diagnosis of axial spondyloarthritis. Appreciating the factors that contribute to this delay is of utmost importance to close the gap. It is similarly important to recognize other conditions that may present with symptoms that mimic axial spondyloarthritis so that misdiagnosis and wrong treatment can be avoided.
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Ulas ST, Diekhoff T, Ziegeler K. Sex Disparities of the Sacroiliac Joint: Focus on Joint Anatomy and Imaging Appearance. Diagnostics (Basel) 2023; 13:diagnostics13040642. [PMID: 36832130 PMCID: PMC9955570 DOI: 10.3390/diagnostics13040642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The sacroiliac joint (SIJ) is an anatomically complex joint which, as a functional unit with the pelvis and spine, is of decisive biomechanical importance for the human body. It is also a commonly overlooked source of lower back pain. Like the entire bony pelvis, the SIJ exhibits major sexual dimorphisms; thus, the sex-dependent evaluation of this joint is becoming increasingly important in clinical practice, both anatomically with joint shape variations and biomechanical differences as well as in terms of image appearance. The influence of the SIJ shape, which differs in women and men, is crucial for the different biomechanical joint properties. These differences are important in the development of joint diseases at the SIJ, which shows a specific difference between the sexes. This article aims to provide an overview of sex disparities of the SIJ regarding different anatomical and imaging appearances to further understand the insights into the interplay of sex differences and SIJ disease.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
- Correspondence: ; Tel.: +0049-30-450-627044
| | - Torsten Diekhoff
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité–Universitätsmedizin Berlin, Campus Mitte, Humboldt–Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
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Lynch PJ, Tubic G, Foster JM, Puri S, Burnette CA, Block JE. Minimally Invasive Inferior Intra-Articular Sacroiliac Joint Fusion: Successful Application of Osseous Stabilization Using Allograft Bone. Orthop Res Rev 2022; 14:429-435. [DOI: 10.2147/orr.s387104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022] Open
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Unexpected Sex Differences in the Relationship of Sacroiliac Joint and Lumbar Spine Degeneration. Diagnostics (Basel) 2022; 12:diagnostics12020275. [PMID: 35204366 PMCID: PMC8870885 DOI: 10.3390/diagnostics12020275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
The relationship between degenerative changes of the sacroiliac joints and the lumbar spine on CT has not been studied yet. The aim of this analysis is to determine the nature of their association as well as the influence of fixed anatomical spinopelvic parameters on sacroiliac joint degeneration. For this institutional review-board-approved investigation, imaging datasets as well as electronic medical records of 719 patients without back pain from the clinical routine of our department of radiology were included. Age, sex, weight category (slim, normal, obese), parity in women and indication for imaging were noted for all patients. The presence of degenerative lesions of the lumbar spine (disc degeneration, endplate degeneration, spondylophytes, and facet joint osteoarthritis) was noted separately at each lumbar segment (L1 to L5). Sacroiliac joints were assessed for sclerosis and osteophytes. Fixed anatomical spinopelvic parameters were measured: pelvic radius = PR; pelvic incidence = PI; sacral table angle = STA. Correlation as well as regression analyses were performed; data were analyzed for males and females separately. PI increased significantly with age in both women and men, while STA decreased and PR remained constant; neither of them was associated with SIJ degeneration. SIJ degeneration correlated with disc degeneration (tau = 0.331; p < 0.001), spondylophytes (tau = 0.397; p < 0.001), and facet joint degeneration (tau = 0.310; p < 0.001) in men, but with no parameter of spinal degeneration in women. Lumbar spinal degeneration increased the risk of sacroiliac joint degeneration in men significantly (OR 7.2; 95%CI 2.8–19.0), but it was not a significant covariable in women. Fixed spinopelvic parameters have little impact on sacroiliac joint degeneration. The degeneration of the sacroiliac joints and the lumbar spine appear to be parallel processes in men, but are largely unrelated in women.
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Badr S, Jacques T, Lefebvre G, Boulil Y, Abou Diwan R, Cotten A. Main Diagnostic Pitfalls in Reading the Sacroiliac Joints on MRI. Diagnostics (Basel) 2021; 11:diagnostics11112001. [PMID: 34829349 PMCID: PMC8624408 DOI: 10.3390/diagnostics11112001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
Magnetic resonance imaging of the sacroiliac joints is now frequently performed to help identify patients with early axial spondyloarthritis. However, differential diagnoses exist and should be recognized. The aim of this article is to review the most frequent differential diagnoses that may mimic inflammatory sacroiliitis in clinical practice.
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Affiliation(s)
- Sammy Badr
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
- MABLab-Marrow Adiposity and Bone Lab ULR4490, University of Lille, 59000 Lille, France
| | - Thibaut Jacques
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
- Lille University School of Medicine, 59000 Lille, France
| | - Guillaume Lefebvre
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
| | - Youssef Boulil
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
| | - Ralph Abou Diwan
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Lille University Hospital, 59000 Lille, France; (S.B.); (T.J.); (G.L.); (Y.B.); (R.A.D.)
- Lille University School of Medicine, 59000 Lille, France
- Correspondence:
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