Sacroiliitis to zapalenie stawu krzyżowo-biodrowego.

Sacroiliitis to zapalenie stawu krzyżowo-biodrowego.
Epidemiologia

Sacroiliitis, zapalenie stawu krzyżowo-biodrowego, odpowiada za 10-30% przypadków bólu dolnej części pleców w populacji ogólnej, z wyższą częstością w chorobach zapalnych, takich jak ZZSK (0,2-0,5% częstości w populacji USA) i spondyloartropatie osiowe (~1%). Wśród pacjentów z łuszczycowym zapaleniem stawów sacroiliitis występuje u 34-78%, a w młodzieńczym idiopatycznym zapaleniu stawów (ERA) u 78%. Częstość występowania jest wyższa u kobiet (z wyjątkiem ZZSK, gdzie dominuje mężczyzn), a u pacjentów poniżej 40 roku życia obserwuje się istotnie częstsze zmiany w MRI (p=0,0082). Wysoka częstość fałszywie dodatnich wyników MRI (do 60% u kobiet w okresie poporodowym) wymaga ostrożnej interpretacji obrazów. Genetycznie, 90-95% pacjentów z ZZSK jest HLA-B27+, co znacząco koreluje z obecnością sacroiliitis w MRI.

Epidemiologia Sacroiliitis – zapalenie stawu krzyżowo-biodrowego

Sacroiliitis to zapalenie stawu krzyżowo-biodrowego, które stanowi istotną przyczynę bólu dolnej części pleców. Badania epidemiologiczne wskazują na zróżnicowane wskaźniki występowania tego schorzenia w populacji ogólnej oraz w poszczególnych grupach pacjentów. Dokładna ocena rozpowszechnienia sacroiliitis jest kluczowa dla wczesnego wykrywania i odpowiedniego zarządzania tym schorzeniem¹².

Rozpowszechnienie w populacji ogólnej

Według różnych badań, sacroiliitis jest odpowiedzialny za 10-25% przypadków bólu dolnej części pleców w populacji ogólnej¹²³. Niektórzy eksperci szacują, że 15-30% wszystkich przypadków bólu kręgosłupa lędźwiowego ma swoje źródło w stawie krzyżowo-biodrowym⁴. Schwarzer i współpracownicy stwierdzili, że „częstość występowania bólu stawu krzyżowo-biodrowego wydaje się wynosić co najmniej 13%, a być może nawet 30%” u pacjentów z bólem dolnej części pleców i pośladków⁵.

W przypadku zapalnych spondyloartropatii osiowych, takich jak zesztywniające zapalenie stawów kręgosłupa (ZZSK), częstość występowania sacroiliitis jest znacznie wyższa. Dane populacyjne wskazują, że chorobowość ZZSK w Stanach Zjednoczonych wynosi około 0,2-0,5%⁶⁷. Częstość występowania spondyloartropatii osiowej wynosi około 1%, choć wskaźnik ten różni się w zależności od grupy etnicznej i częstości występowania antygenu HLA-B27 w populacji⁸.

Szacowana częstość występowania infekcyjnego zapalenia stawu krzyżowo-biodrowego wynosi około 12 przypadków na milion osób rocznie⁹.

Rozpowszechnienie w grupach klinicznych

Częstość występowania sacroiliitis różni się znacząco w zależności od choroby podstawowej:

Łuszczycowe zapalenie stawów (ŁZS): Badania wskazują na częstość występowania sacroiliitis u pacjentów z ŁZS na poziomie 34-78%¹⁰. W jednym z badań stwierdzono częstość występowania sacroiliitis w obrazowaniu MRI na poziomie 37,8% u pacjentów z ŁZS, z czego 47% przypadków było jednostronne¹¹.
Młodzieńcze idiopatyczne zapalenie stawów (MIZS): W podtypie związanym z zapaleniem przyczepów ścięgnistych (ERA), sacroiliitis stwierdzono u 78% pacjentów w badaniach radiologicznych, a 73% miało zmiany strukturalne w stawach krzyżowo-biodrowych¹².
Reumatoidalne zapalenie stawów (RZS): Sacroiliitis stwierdzono u 22% pacjentów z RZS w jednym z badań egipskich¹³.
Ostre przednie zapalenie błony naczyniowej oka (AAU): Sacroiliitis zdefiniowane w badaniu MRI stwierdzono u 36% pacjentów z AAU¹⁴.
Choroba Leśniowskiego-Crohna: Częstość występowania sacroiliitis w badaniu MRI wynosiła 20% u dorosłych i 6,7% u pacjentów pediatrycznych¹⁵.

Czynniki demograficzne

Sacroiliitis wykazuje określone wzorce demograficzne:

Płeć: Dysfunkcja stawu krzyżowo-biodrowego występuje częściej u kobiet¹⁶¹⁷. Kobiety mają większą elastyczność w stawie krzyżowo-biodrowym i są bardziej podatne na dysfunkcję stawu ze względu na zwiększony stres, ruch i obciążenie otaczających struktur¹⁸. Jednakże w przypadku zesztywniającego zapalenia stawów kręgosłupa (ZZSK), choroba występuje około dwukrotnie częściej u mężczyzn niż u kobiet¹⁹²⁰.
Wiek: Istnieje bimodalny rozkład występowania z dwoma szczytami: u młodszych dorosłych po urazach sportowych i ciąży oraz u starszych dorosłych z powodu degeneracji²¹. Pacjenci poniżej 40 roku życia wykazują statystycznie wyższą częstość występowania dodatnich wyników MRI wskazujących na sacroiliitis w porównaniu z pacjentami powyżej 40 roku życia (p=0,0082)²²²³. W przypadku ZZSK, wiek początku choroby zwykle osiąga szczyt w drugiej i trzeciej dekadzie życia, przy czym około 80% pacjentów doświadcza objawów w wieku 30 lat, podczas gdy tylko 5% będzie prezentować objawy w wieku 45 lat²⁴.
Ciąża i okres poporodowy: Sacroiliitis jest powszechne u pacjentek w ciąży i w okresie poporodowym²⁵. W badaniu dotyczącym wpływu ciąży na obrazowanie stawów krzyżowo-biodrowych u kobiet z osiową spondyloartropatią nie stwierdzono istotnego wpływu ciąży na wyniki obrazowania²⁶.

Fałszywie dodatnie obrazowanie sacroiliitis

Warto zauważyć wysoką częstość występowania fałszywie dodatnich wyników MRI wskazujących na aktywne sacroiliitis w kontekście niezwiązanym ze spondyloartropatią. Według definicji obrazowania Międzynarodowego Towarzystwa Oceny Spondyloartropatii (ASAS), fałszywie dodatnie wyniki MRI stwierdzono u²⁷:

60% kobiet w okresie poporodowym
41% elitarnych hokeistów
30-35% biegaczy rekreacyjnych
23% rekrutów wojskowych

Wśród osób w wieku 30 lat i starszych, 17,2% spełniało definicję dodatniego MRI dla sacroiliitis, ale rzadko występowało to u młodszych osób²⁸.

Czynniki genetyczne

Czynniki genetyczne odgrywają istotną rolę w epidemiologii sacroiliitis, szczególnie w kontekście spondyloartropatii zapalnych:

90-95% pacjentów z ZZSK jest pozytywnych dla HLA-B27²⁹.
Częstość występowania ZZSK wzrasta do około 5% wśród pacjentów, którzy są pozytywni dla HLA-B27³⁰.
U pacjentów ze spondyloartropatią lub ZZSK, HLA-B27 był pozytywny u 35,2% i znacząco korelował z sacroiliitis w MRI³¹.

Narzędzia diagnostyczne i ich wartości predykcyjne

Różne metody obrazowania są wykorzystywane do wykrywania sacroiliitis, każda z określoną czułością i swoistością:

MRI stawów krzyżowo-biodrowych: MRI stał się dominującym narzędziem diagnostycznym i został włączony do kryteriów klasyfikacyjnych osiowej spondyloartropatii, stając się kamieniem węgielnym diagnozy spondyloartropatii³². Czułość i swoistość MRI stawów krzyżowo-biodrowych w diagnostyce zapalenia przyczepów ścięgnistych związanego z zapaleniem stawów (ERA) wynosiły odpowiednio 61,54% i 82,35%³³.
Ilościowa scyntygrafia krzyżowo-biodrowa (QSS): Specyficzność sacroiliitis w oparciu o QSS wzrasta z 73% do 97%³⁴.
Sztuczna inteligencja: Modele uczenia głębokiego osiągają wyniki zbliżone do ekspertów w wykrywaniu obrzęku szpiku kostnego w stawach krzyżowo-biodrowych i określaniu aktywnego sacroiliitis zgodnie z definicją ASAS³⁵³⁶. Sieć neuronowa była w stanie osiągnąć prawie ten sam poziom wydajności zarówno w zbiorach walidacyjnych, jak i treningowych, wskazując na wysoki poziom niezawodności i solidności modelu³⁷.

Nadzór i trendy czasowe

Nadzór nad sacroiliitis jest szczególnie istotny w kontekście wczesnego wykrywania i monitorowania pacjentów z spondyloartropatią osiową:

W USA diagnoza spondyloartropatii jest opóźniona średnio o 14 lat od początku objawów³⁸.
Do 30% pacjentów z sacroiliitis będzie postępować do ZZSK w ciągu 10 lat od diagnozy³⁹.
Dłuższy czas trwania łuszczycy (12,5±9,6 lat) był istotnie związany z obecnością przewlekłych uszkodzeń w sacroiliitis (p=0,006)⁴⁰.

Implikacje kliniczne

Zrozumienie epidemiologii sacroiliitis ma istotne implikacje kliniczne:

Wczesne rozpoznanie i leczenie spondyloartropatii może złagodzić objawy, poprawić jakość życia i zmniejszyć prawdopodobieństwo rozwoju poważnie upośledzonej ruchomości kręgosłupa⁴¹.
Większość pacjentów z sacroiliitis ma doskonały wynik, jednak powrót do zdrowia może trwać 2-4 tygodnie. Nawroty są powszechne, jeśli pacjenci nie zmienią swojego stylu życia, a niektóre serie raportują wskaźnik nawrotów przekraczający 30%⁴².
Badania wskazują, że do 95% pacjentów wraca do zdrowia po bólu stawu krzyżowo-biodrowego dzięki leczeniu nieoperacyjnemu w ciągu 1 do 3 miesięcy⁴³.

Wnioski dla nadzoru

Podsumowując, dane epidemiologiczne dotyczące sacroiliitis wskazują na potrzebę:

Zwiększonej świadomości sacroiliitis jako przyczyny bólu dolnej części pleców, szczególnie wśród lekarzy pierwszego kontaktu⁴⁴.
Wczesnego i dokładnego rozpoznania za pomocą odpowiednich narzędzi obrazowania, szczególnie MRI⁴⁵.
Nadzoru nad wysokimi grupami ryzyka, takimi jak pacjenci z łuszczycowym zapaleniem stawów, zapaleniem błony naczyniowej oka i chorobami zapalnymi jelit⁴⁶⁴⁷.
Dalszych badań nad patofizjologicznymi mechanizmami leżącymi u podstaw atypowych prezentacji klinicznych oraz identyfikacji czynników ryzyka, które mogą predysponować niektóre osoby do atypowych manifestacji klinicznych⁴⁸.

Sacroiliitis pozostaje istotnym wyzwaniem diagnostycznym i terapeutycznym, wymagającym interdyscyplinarnego podejścia do optymalnego zarządzania. Monitorowanie epidemiologiczne tego schorzenia jest kluczowe dla poprawy wyników leczenia i jakości życia pacjentów⁴⁹⁵⁰.

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Materiały źródłowe

#1 Sacroiliitis – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK448141/
Reports on the prevalence of sacroiliac pain vary widely. Some studies report the prevalence as 10% to 25% of those with lower back pain. In those with a confirmed diagnosis, the presentation of pain was ipsilateral buttock (94% cases) and midline lower lumbar area (74%). As mentioned previously the presentation can vary. Up to 50% of cases have radiation to the lower extremity: 6% to the upper lumbar area, 4% percent to the groin, and 2% percent to the lower abdomen. […] Sacroiliitis is best managed by an interprofessional team that consists of a physical therapist, physician rheumatologist, and dietitian. Patient education is the key to good outcomes. All patients should be informed that the condition is benign and will improve with conservative measures. The patient should be encouraged to participate in a regular exercise program, lose weight and eat healthily. Home exercises can help prevent deconditioning. The patient should also be asked to quit smoking and abstain from alcohol. There is ample evidence indicating that patients who remain physically active have an excellent quality of life. […] The majority of patients with sacroiliitis have an excellent outcome. However, the recovery may take 2-4 weeks. Recurrences are common if patients do not change their lifestyle. Some series report a recurrence rate of over 30%.
#2 Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC9812593/
Pain arising from the SI joint accounts for up to 25% of cases of lower back pain. The prevalence is higher in lumbosacral fusion surgery patients at 3237%. […] Many cases arise in younger patient populations following sports injuries or trauma and in pregnant or older patients due to joint degeneration. Women have more flexibility in their SI joint and are therefore more susceptible to SI joint dysfunction due to increased stress, movement, and load on the surrounding structures.
#2 Video: What is Sacroiliitis?
https://www.spine-health.com/video/video-what-sacroiliitis
Sacroiliitis typically causes pain in the lower back, buttocks, and legs. Research suggests that 10 to 25% of lower back pain may be caused by SI joint inflammation. […] There are many causes of sacroiliitis. It may be due to injury, infection or autoimmune disorders for example, the joint may develop inflammation after a fall or secondary to ankylosing spondylitis or arthritis, or other conditions that cause inflammation. […] Getting an accurate diagnosis to determine the underlying cause of your lower back pain is essential to finding the right treatment.
#3 Types of Arthritis That Cause Sacroiliac Joint Pain
https://www.arthritis-health.com/blog/types-arthritis-cause-sacroiliac-joint-pain
Experts estimate 15% to 30% of all low back pain cases originate at the sacroiliac joint, or SI joint. […] Inflammation in the SI joint is known as sacroiliitis. […] Medical studies report the prevalence of sacroiliitis in patients with psoriatic arthritis to be between 34% and 78%.
#4 How common is lower back pain caused by the SI Joint? | SI-BONE | SI-BONE
https://si-bone.com/si-joint-faqs/how-common-is-lower-back-pain-caused-by-the-si-joint
Research shows that chronic lower back pain caused by the SI joint is more common than many people even healthcare professionals think. Several published clinical papers noted that 15-30% of people who complained of lower back pain actually had problems in their sacroiliac (SI) joint. […] Studies show the SI joint is a source of pain in about 15%-30% of patients with chronic low back pain. […] It’s important to be proactive in researching the prevalence of SI joint pain so you can be informed when you talk to your doctor about your concerns.
#5 Sacroiliac Joint Injury: Practice Essentials, Epidemiology, Functional Anatomy
https://emedicine.medscape.com/article/96054-overview
The incidence of lower back pain in humans parallels the incidence of the common cold, with a lifetime rate approaching 95%. […] Goldwaith and Osgood first discussed the possibility that SIJ injury could cause low back pain as early as 1905. […] In the decades since then, several attempts have been made to establish the prevalence of SIJ syndrome in persons with back pain, and the results of these reports vary widely. […] Schwarzer et al remarked that „the prevalence of sacroiliac pain would appear to be at least 13% and perhaps as high a 30%” in patients with low back and buttock pain. […] Bernard and Kirkaldy-Willis reported the prevalence rate to be 22.5% in 1293 patients with back pain. […] There is a bimodal distribution with two peaks: younger adults following sporting injury and pregnancy and older adults from degeneration. […] Both genders and people of all races present with SIJ joint dysfunction.
#6 Ankylosing Spondylitis : Symptoms, Diagnosis and Treatment
https://www.hopkinsarthritis.org/arthritis-info/ankylosing-spondylitis/
Recent population estimates indicate that the prevalence of AS in the United States is approximately 0.2-0.5%. […] Based on data from multiple countries, the age- and sex-adjusted incidence of AS is 0.4-14 per 100,000 person-years. […] Prevalence of AS in the population increases to approximately 5% among patients who are HLA-B27 positive. […] AS occurs more frequently in men than women (2:1). […] Age of disease onset usually peaks in the second and third decades of life. […] Approximately 80% of patients with AS experience symptoms at 30 years of age, while only 5% will present with symptoms at 45 years of age. […] Because many patients with early AS may not have radiographic evidence of sacroiliitis, the Assessment of Spondyloarthritis International Society (ASAS) has generated classification criteria for axial SpA.
#7 Ankylosing spondylitis – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/ankylosing-spondylitis/
Epidemiological data refers to the US, unless otherwise specified. […] Lifetime prevalence: 0.5%. […] 90-95% of patients are HLA-B27 positive. […] The majority of patients have sacroiliitis detectable on MRI. […] Up to 30% of affected individuals will progress to AS within 10 years of diagnosis.
#8 Imaging of sacroiliitis: Current status, limitations and pitfalls – Tsoi – Quantitative Imaging in Medicine and Surgery
https://qims.amegroups.org/article/view/22799/html
Sacroiliitis is one cause of inflammatory-type low back pain. The prevalence of axial SpA is about 1%, though this prevalence does vary according to ethnicity and HLA-B27 population prevalence. Early recognition and treatment of SpA can ameliorate symptoms, improve quality of life and reduce the likelihood of developing seriously impaired spinal mobility. In the USA, the diagnosis of SpA is delayed on average 14 years from symptom onset. SpA is diagnosed using a combination of clinical, serological and imaging criteria. About half of the patients diagnosed initially with axial SpA have radiographic evidence of SpA while the remainder have non-radiographic SpA with no radiographic features of SpA. As disease activity and functional impairment is similar for patients with radiographic and non-radiographic SpA, the distinction does not affect prognosis or treatment, though one should nevertheless be aware that about 50% of SpA patients will not have radiographic features of the disease at presentation. In patients with radiographic SpA, sacroiliitis may take many years to become radiographically apparent. As a result, magnetic resonance imaging (MRI) is increasingly utilized to enable recognition of sacroiliitis at a much earlier stage than which is possible radiographically. Even if the radiographs are normal and axial SpA is strongly suspected clinically, MRI examination is still usually performed to detect sacroiliitis. MRI is the most sensitive imaging technique to detect sacroiliitis. It is the only imaging modality that can reliably reveal bone marrow oedema and inflammation around the sacroiliac joints and is comparable to low dose CT for demonstrating erosions and ankyloses. Imaging, and in particular MRI, has greatly helped in the diagnosis and understanding of early SpA. It is important to remember that reactive abnormalities on MRI similar to those seen with sacroiliitis, but not due to sacroiliitis, are quite common, especially in patients with non-SpA inflammatory back pain and in athletes. There are also several other diseases that can mimic sacroiliitis on MR imaging. While it is important to make a correct early diagnosis of inflammatory sacroiliitis and SpA in patients who have the disease, it is equally important to recognize the entities that may mimic sacroiliitis. Incorrectly over-diagnosing inflammatory sacroiliitis and labelling the patient as having SpA can have a significant negative impact on lifestyle, job prospects, health insurance, etc. Potential mimics of sacroiliitis include stress-related changes, infective sacroiliitis, osteoarthritis, stress fracture, insufficiency fracture and osteitis condensans ilii. Bone marrow oedema is a marker of inflammation and needs to be significant in degree before a diagnosis of sacroiliitis can be made. MRI is only one biomarker in a diagnostic process also encompassing clinical and serological testing. As stressed, a diagnosis of SpA should only be made after careful consideration of the clinical picture, serological tests and, where necessary, MRI findings.
#9 Sacroiliitis and endocarditis in the absence of fever: an unusual clinical presentation following diarrhea in a young patient | The Egyptian Journal of Internal Medicine | Full Text
https://ejim.springeropen.com/articles/10.1186/s43162-025-00405-0
We present a case of a 23-year-old woman who developed afebrile left-sided sacroiliitis and tricuspid valve endocarditis caused by Staphylococcus aureus, one week after experiencing a bout of diarrhea. […] The prevalence of sacroiliitis is variable and contingent upon the underlying etiology. Spondyloarthropathies, including ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, constitute the most common etiologies of sacroiliitis, with a prevalence ranging from 0.1 to 1.4% in the general population. […] The incidence of infectious sacroiliitis is estimated to be approximately 12 cases per million individuals per year. […] This case highlights the importance of considering infectious etiologies in patients presenting with musculoskeletal complaints, even in the absence of fever, and underscores the potential for hematogenous spread of infection from one site to another.
#10 Types of Arthritis That Cause Sacroiliac Joint Pain
https://www.arthritis-health.com/blog/types-arthritis-cause-sacroiliac-joint-pain
Experts estimate 15% to 30% of all low back pain cases originate at the sacroiliac joint, or SI joint. […] Inflammation in the SI joint is known as sacroiliitis. […] Medical studies report the prevalence of sacroiliitis in patients with psoriatic arthritis to be between 34% and 78%.
#11 Prevalence of sacroiliitis and acute and structural changes on MRI in patients with psoriatic arthritis | Scientific Reports
https://www.nature.com/articles/s41598-020-68456-7
Sacroiliitis on MRI was highly prevalent in our sample of PsA patients. […] The prevalence of sacroiliitis was 37.8% (n=17), 47% of which was unilateral. […] Only 5 (29.4%) of the 17 patients with sacroiliitis on MRI had back pain. […] The most prevalent acute and chronic changes on MRI were, respectively, subchondral bone edema (26.7%) and enthesitis (20%), periarticular erosions (26.7%) and fat metaplasia (13.3%). […] CRP levels were higher among sacroiliitis patients (p=0.028), and time of psoriasis was positively associated with chronic lesions (p=0.006). […] Raised CRP levels were significantly associated with sacroiliitis, and longer time of psoriasis was predictive of chronic sacroiliitis lesions. […] The agreement between the two radiologists regarding the diagnosis of sacroiliitis was strong (kappa=0.640).
#12 High prevalence of sacroiliitis and early structural changes in the sacroiliac joint in children with enthesitis-related arthritis: findings from a tertiary centre in Hong Kong | Pediatric Rheumatology | Full Text
https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-023-00825-8
Epidemiological studies have demonstrated a wide, unexplained disparity in the prevalence of juvenile idiopathic arthritis (JIA) subtypes depending on geographical location, ethnicity and other factors. […] Enthesitis-related arthritis (ERA) is more prevalent in Southeast Asia. […] Axial involvement was frequently reported in our cohort of ERA patients. 78% demonstrated radiological evidence of sacroiliitis. […] Among the ERA patients, 73% had structural changes of the SIJ. […] We found that a high proportion of ERA patients had sacroiliitis and a significant number of them had radiological structural changes during early disease. […] Our findings illustrate the importance of prompt diagnosis and early treatment in these children. […] The most common JIA subtype was ERA in our cohort, with male preponderance and high HLA-B27 positivity.
#13 Frequency of inflammatory back pain and sacroiliitis in Egyptian patients with rheumatoid arthritis | Egyptian Journal of Radiology and Nuclear Medicine | Full Text
https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0019-6
Sacroiliitis was found in 22% of rheumatoid arthritis patients. […] Frequencies of inflammatory back pain and sacroiliitis in Egyptian rheumatoid arthritis patients were high. […] The present study revealed higher frequencies of IBP and radiographic (sacroiliitis) SI in RA patients. IBP was found in 52% of patients and definite radiographic SI was found in 22%. […] In patients with SpA or AS, HLA-B27 was positive in 35.2% and significantly correlated with MRI SI. […] The frequencies of inflammatory back pain and radiographic sacroiliitis in RA patients were high.
#14 The Prevalence of MRI-Defined Sacroiliitis and Classification of Spondyloarthritis in Patients with Acute Anterior Uveitis: A Longitudinal Single-Centre Cohort Study
https://www.mdpi.com/2075-4418/12/1/161
MRI-defined sacroiliitis (highly suggestive BME) was found in 36% of AAU patients. […] Follow-up examination after two years in 55 initially MRI-negative patients revealed two patients who developed axSpA with active sacroiliitis. These findings raise the question of whether all patients with AAU should undergo a targeted rheumatological examination to rule out SpA. […] AAU patients with sacroiliitis were significantly more often HLA-B27-positive and had worse disease activity measures compared to those without sacroiliitis, which is congruent with previous findings comparing axSpA and non-axSpA subsets. […] Therefore, according to our results, even the absence of chronic back pain does not guarantee the absence of sacroiliitis; thus, it is important to search for additional SpA features and to follow up with these patients.
#15
https://link.springer.com/article/10.1007/s10067-022-06143-w
Patients with Crohn’s disease (CD) usually undergo magnetic resonance enterography (MRE) for evaluating small bowel involvement. Musculoskeletal symptoms are the most frequent extraintestinal manifestation in inflammatory bowel diseases, especially in CD, with sacroiliitis at imaging occurring in about 646% of patients and possibly correlating with axial spondyloarthritis. The primary study aim was to assess the prevalence of sacroiliitis in adult and pediatric patients with CD performing an MRE. […] The prevalence of sacroiliitis at MRE was 20% in adults and 6.7% in pediatric patients. […] Sacroiliitis is a frequent and reliable abnormality at MRE in adult patients with CD, associated with the age of the patients50 years and CD duration. […] Sacroiliitis incidentally detected at magnetic resonance enterography performed for Crohn’s disease is a frequent and reliable finding in adult patients, rarer in the pediatric population. […] Clinicians may rely on magnetic resonance enterography to properly evaluate and manage patients for sacroiliitis.
#16 Sacroiliac Joint Dysfunction: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0300/p239.html
The prevalence of sacroiliac (SI) joint dysfunction is approximately 25% in adult patients with chronic low back pain. […] Women are more likely to present with SI joint dysfunction than men. […] SI joint dysfunction is common in pregnant and postpartum patients. […] SI joint dysfunction can be associated with osteoarthritis or inflammatory conditions such as ankylosing spondylitis, posttraumatic arthritis, and other spondyloarthropathies. […] SI joint manipulation is also effective in treating generalized low back pain, suggesting that the SI joint influences loading of the lumbar spine. […] If sacroiliitis or other spondyloarthropathies are suspected, referral to an orthopedist, interventional radiologist, or pain physician to provide an intra-articular corticosteroid injection may be appropriate.
#17 Sacroiliac Dysfunction
https://fpnotebook.com/Ortho/L-Spine/ScrlcDysfnctn.htm
Prevalence: 25% of Low Back Pain in adults. […] More common in women. […] Septic Sacroiliitis (emergency) presents with fever, limp and SI joint region pain. […] Most common in children 0.5 to 4 years old and in adolescents.
#18 Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC9812593/
Pain arising from the SI joint accounts for up to 25% of cases of lower back pain. The prevalence is higher in lumbosacral fusion surgery patients at 3237%. […] Many cases arise in younger patient populations following sports injuries or trauma and in pregnant or older patients due to joint degeneration. Women have more flexibility in their SI joint and are therefore more susceptible to SI joint dysfunction due to increased stress, movement, and load on the surrounding structures.
#19 Ankylosing Spondylitis : Symptoms, Diagnosis and Treatment
https://www.hopkinsarthritis.org/arthritis-info/ankylosing-spondylitis/
Recent population estimates indicate that the prevalence of AS in the United States is approximately 0.2-0.5%. […] Based on data from multiple countries, the age- and sex-adjusted incidence of AS is 0.4-14 per 100,000 person-years. […] Prevalence of AS in the population increases to approximately 5% among patients who are HLA-B27 positive. […] AS occurs more frequently in men than women (2:1). […] Age of disease onset usually peaks in the second and third decades of life. […] Approximately 80% of patients with AS experience symptoms at 30 years of age, while only 5% will present with symptoms at 45 years of age. […] Because many patients with early AS may not have radiographic evidence of sacroiliitis, the Assessment of Spondyloarthritis International Society (ASAS) has generated classification criteria for axial SpA.
#20 Ankylosing Spondylitis: Symptoms and Treatment | Doctor
https://patient.info/doctor/ankylosing-spondylitis-pro
The prevalence of AS is believed to range from 0.05% to 0.23%. […] Estimates of the prevalence vary between countries, with mean prevalence per 10,000 of 31.9 in North America, 23.8 in Europe, 16.7 in Asia, 10.2 in Latin America and 7.4 in Africa. […] Around twice as many men have AS compared with women. […] AS most commonly begins between 20 and 30 years of age, with 90-95% of people aged less than 45 years at disease onset. […] More than 90% heritability has been estimated for axial spondyloarthritis. The most important genetic risk factor is human leukocyte antigen B27 (HLA-B27). The prevalence of HLA-B27 usually reflects the prevalence of axial spondyloarthritis within a population. However axial spondyloarthritis can occur in people without HLA-B27.
#21 Sacroiliac Joint Injury: Practice Essentials, Epidemiology, Functional Anatomy
https://emedicine.medscape.com/article/96054-overview
The incidence of lower back pain in humans parallels the incidence of the common cold, with a lifetime rate approaching 95%. […] Goldwaith and Osgood first discussed the possibility that SIJ injury could cause low back pain as early as 1905. […] In the decades since then, several attempts have been made to establish the prevalence of SIJ syndrome in persons with back pain, and the results of these reports vary widely. […] Schwarzer et al remarked that „the prevalence of sacroiliac pain would appear to be at least 13% and perhaps as high a 30%” in patients with low back and buttock pain. […] Bernard and Kirkaldy-Willis reported the prevalence rate to be 22.5% in 1293 patients with back pain. […] There is a bimodal distribution with two peaks: younger adults following sporting injury and pregnancy and older adults from degeneration. […] Both genders and people of all races present with SIJ joint dysfunction.
#22
https://link.springer.com/article/10.1007/s00256-021-03885-7
To determine the prevalence of sacroiliitis among patients who have been referred for MR arthrography. […] Patients less than 40 years of age demonstrated a statistically higher prevalence of positive MRI findings of sacroiliitis when compared to patients older than 40 (p=0.0082). […] Overall prevalence of MRI signal alteration suggestive of sacroiliitis as defined by the Assessment of SpondyloArthritis international Society was 4.8%. […] Hip pain may be a presenting symptom of spondyloarthritis and attention should be paid to the sacroiliac joints during screening examinations, particularly in patients less than 40 years of age.
#23
https://scholars.duke.edu/individual/pub1495645
OBJECTIVE: To determine the prevalence of sacroiliitis among patients who have been referred for MR arthrography. […] RESULTS: Patients less than 40 years of age demonstrated a statistically higher prevalence of positive MRI findings of sacroiliitis when compared to patients older than 40 (p=0.0082). Overall prevalence of MRI signal alteration suggestive of sacroiliitis as defined by the Assessment of SpondyloArthritis international Society was 4.8%. […] CONCLUSION: Hip pain may be a presenting symptom of spondyloarthritis and attention should be paid to the sacroiliac joints during screening examinations, particularly in patients less than 40 years of age.
#24 Ankylosing Spondylitis : Symptoms, Diagnosis and Treatment
https://www.hopkinsarthritis.org/arthritis-info/ankylosing-spondylitis/
Recent population estimates indicate that the prevalence of AS in the United States is approximately 0.2-0.5%. […] Based on data from multiple countries, the age- and sex-adjusted incidence of AS is 0.4-14 per 100,000 person-years. […] Prevalence of AS in the population increases to approximately 5% among patients who are HLA-B27 positive. […] AS occurs more frequently in men than women (2:1). […] Age of disease onset usually peaks in the second and third decades of life. […] Approximately 80% of patients with AS experience symptoms at 30 years of age, while only 5% will present with symptoms at 45 years of age. […] Because many patients with early AS may not have radiographic evidence of sacroiliitis, the Assessment of Spondyloarthritis International Society (ASAS) has generated classification criteria for axial SpA.
#25 Sacroiliac Joint Dysfunction: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2022/0300/p239.html
The prevalence of sacroiliac (SI) joint dysfunction is approximately 25% in adult patients with chronic low back pain. […] Women are more likely to present with SI joint dysfunction than men. […] SI joint dysfunction is common in pregnant and postpartum patients. […] SI joint dysfunction can be associated with osteoarthritis or inflammatory conditions such as ankylosing spondylitis, posttraumatic arthritis, and other spondyloarthropathies. […] SI joint manipulation is also effective in treating generalized low back pain, suggesting that the SI joint influences loading of the lumbar spine. […] If sacroiliitis or other spondyloarthropathies are suspected, referral to an orthopedist, interventional radiologist, or pain physician to provide an intra-articular corticosteroid injection may be appropriate.
#26 Impact of Pregnancy on Sacroiliac Imaging in Women with Axial Spondyloarthritis: Results of the Analysis of the DESIR Cohort – ACR Meeting Abstracts
https://acrabstracts.org/abstract/impact-of-pregnancy-on-sacroiliac-imaging-in-women-with-axial-spondyloarthritis-results-of-the-analysis-of-the-desir-cohort/
When focusing on incident pregnancies, these patients had more sacroiliitis on X-ray and MRI at baseline than patients nulligravidae at the end of follow-up and patients with past pregnancy, but had lower BASFI and ASDAS-CRP. Only left SIJ was statistically different after delivery, with mean scores of 0.67 and 0.95 before and after delivery. No impact of pregnancy on continuous imaging score was found with the different mixed models. […] Conclusion: Pregnancy does not seem to aggravate imaging of axSpA women when comparing imaging according to the antecedent of pregnancy. Following axSpA patients who had first pregnancy showed mild increase of left sacroiliitis score on X-ray after delivery, but not enough to be considered as worsening.
#27 Sacroiliitis on MRI: axSpA or Another Cause? – The Rheumatologist
https://www.the-rheumatologist.org/article/sacroiliitis-on-mri-axspa-or-another-cause/
Magnetic resonance imaging (MRI) is the gold standard imaging modality for the detection of sacroiliitis, a hallmark of axial spondyloarthritis (axSpA). […] Using the Assessment of SpondyloArthritis International Society (ASAS) imaging definitions, a high prevalence of MRIs showing active sacroiliitis was found in a non-SpA context. […] These false positives occurred in postpartum women (60%), elite ice hockey players (41%), recreational runners (30-35%) and military recruits (23%). […] Of the subjects 30 years and older, 17.2% fulfilled the definition of a positive MRI for sacroiliitis, but this occurred rarely in younger subjects. […] Nonetheless, only one subject had 3 corner inflammatory lesions. […] Especially in older subjects, the high occurrence of inflammatory and structural MRI-detected lesions affects their specificity for SpA, which has important implications for the interpretation of MRIs in patients with a clinical suspicion of SpA.
#28 Sacroiliitis on MRI: axSpA or Another Cause? – The Rheumatologist
https://www.the-rheumatologist.org/article/sacroiliitis-on-mri-axspa-or-another-cause/
Magnetic resonance imaging (MRI) is the gold standard imaging modality for the detection of sacroiliitis, a hallmark of axial spondyloarthritis (axSpA). […] Using the Assessment of SpondyloArthritis International Society (ASAS) imaging definitions, a high prevalence of MRIs showing active sacroiliitis was found in a non-SpA context. […] These false positives occurred in postpartum women (60%), elite ice hockey players (41%), recreational runners (30-35%) and military recruits (23%). […] Of the subjects 30 years and older, 17.2% fulfilled the definition of a positive MRI for sacroiliitis, but this occurred rarely in younger subjects. […] Nonetheless, only one subject had 3 corner inflammatory lesions. […] Especially in older subjects, the high occurrence of inflammatory and structural MRI-detected lesions affects their specificity for SpA, which has important implications for the interpretation of MRIs in patients with a clinical suspicion of SpA.
#29 Ankylosing spondylitis – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/ankylosing-spondylitis/
Epidemiological data refers to the US, unless otherwise specified. […] Lifetime prevalence: 0.5%. […] 90-95% of patients are HLA-B27 positive. […] The majority of patients have sacroiliitis detectable on MRI. […] Up to 30% of affected individuals will progress to AS within 10 years of diagnosis.
#30 Ankylosing Spondylitis : Symptoms, Diagnosis and Treatment
https://www.hopkinsarthritis.org/arthritis-info/ankylosing-spondylitis/
Recent population estimates indicate that the prevalence of AS in the United States is approximately 0.2-0.5%. […] Based on data from multiple countries, the age- and sex-adjusted incidence of AS is 0.4-14 per 100,000 person-years. […] Prevalence of AS in the population increases to approximately 5% among patients who are HLA-B27 positive. […] AS occurs more frequently in men than women (2:1). […] Age of disease onset usually peaks in the second and third decades of life. […] Approximately 80% of patients with AS experience symptoms at 30 years of age, while only 5% will present with symptoms at 45 years of age. […] Because many patients with early AS may not have radiographic evidence of sacroiliitis, the Assessment of Spondyloarthritis International Society (ASAS) has generated classification criteria for axial SpA.
#31 Frequency of inflammatory back pain and sacroiliitis in Egyptian patients with rheumatoid arthritis | Egyptian Journal of Radiology and Nuclear Medicine | Full Text
https://ejrnm.springeropen.com/articles/10.1186/s43055-019-0019-6
Sacroiliitis was found in 22% of rheumatoid arthritis patients. […] Frequencies of inflammatory back pain and sacroiliitis in Egyptian rheumatoid arthritis patients were high. […] The present study revealed higher frequencies of IBP and radiographic (sacroiliitis) SI in RA patients. IBP was found in 52% of patients and definite radiographic SI was found in 22%. […] In patients with SpA or AS, HLA-B27 was positive in 35.2% and significantly correlated with MRI SI. […] The frequencies of inflammatory back pain and radiographic sacroiliitis in RA patients were high.
#32 Sacroiliitis – early diagnosis is key | JIR
https://www.dovepress.com/sacroiliitis-early-diagnosis-is-key-peer-reviewed-fulltext-article-JIR
It should be remembered that many patients with AxSpA, particularly at early stages of the disease, can present with atypical acute, intermittent or unilateral pain originating from the SIJ, which may be misinterpreted as secondary to a mechanical cause. […] MRI of the SIJs and of the spine has revolutionized diagnosis of early SpA. […] MRI was rapidly embraced as a dominant diagnostic tool and at the same time included into the classification criteria for AxSpA, becoming the cornerstone of SpA diagnosis. […] The presence of characteristic structural lesions on MRI improves diagnostic accuracy and was therefore advocated as a consideration in the ASAS classification criteria update. […] The report of negative imaging should not replace clinical considerations and a reasoned approach to the diagnosis. […] Accordingly, the 2009 ASAS classification criteria allow classification of patients with AxSpA without any imaging evidence of sacroiliitis.
#33 Does sacroiliitis is a mandatory criterion for enthesitis-related arthritis diagnosis? | ReumatologÃa ClÃnica
https://www.reumatologiaclinica.org/en-does-sacroiliitis-is-mandatory-criterion-articulo-S2173574324000492
Does sacroiliitis is a mandatory criterion for enthesitis-related arthritis diagnosis? […] Our study showed that sacroiliac joint MRI has good specificity and positive predictive value in the diagnosis of ERA patients among JIA patients. This underlines the usefulness of sacroiliac joint MRI in the early diagnosis of ERA patients. […] Sacroiliitis in MRI is frequent in ERA patients. Its prevalence varies between 20% and 88% of the patients in the literature. […] Interestingly, we found that sensitivity and specificity of the sacroiliac joints MRI in the diagnosis of ERA were 61.54% and 82.35%, respectively. Positive predictive value was also good. […] Sacroiliac joints MRI lesions were associated with clinical active enthesitis, hip joint limitation, increased CRP level, higher ESR, higher JADAS, and lower BMI. […] Even if both of the classification criteria were shown to have great specificity, sacroiliac joints MRI should be helpful in the early diagnosis of ERA patients especially in litigious cases.
#34 A Worthwhile Measurement of Early Vigilance and Therapeutic Monitor in Axial Spondyloarthritis: A Literature Review of Quantitative Sacroiliac Scintigraphy – European Medical Journal
https://www.emjreviews.com/rheumatology/article/a-worthwhile-measurement-of-early-vigilance-and-therapeutic-monitor-in-axial-spondyloarthritis-a-literature-review-of-quantitative-sacroiliac-scintigraphy-j170121/
Sacroiliitis is an inflammation of the sacroiliac joint. Bone scan with quantitative sacroiliac scintigraphy (QSS) has been a useful inflammation indicator for sacroiliac joints. […] The specificity of sacroiliitis based on QSS increases from 73% to 97%. […] Nuclear medicine bone scan with QSS has been a useful inflammation indicator for SI joint for the last 50 years. […] QSS is typically done following an intravenous injection of about 750 MBq Tc-99m MDP. […] In 1977, Buell et al. were the first to report higher SI ratios in patients with SI disease. […] The use of QSS is the first of its kind to detect active SI joint disorder in the studies of PSRA. […] The use of QSS is the first of its kind to monitor active SI joint disorder before and after the treatment of OCI. […] The use of QSS is the first of its kind to monitor SI joint dysfunction before and after the studies of periostitis-induced sacroiliac pain. […] Bone scan using QSS is a good screening and follow-up measurement in scintigraphy rehabilitation for early detection and vigilance of SpA and raises awareness for physicians to adopt the SI ratio in the next steps towards diagnosis.
#35 A deep learning model for the diagnosis of sacroiliitis according to Assessment of SpondyloArthritis International Society classification criteria with magnetic resonance imaging – Cnam – Conservatoire national des arts et mÃ©tiers
https://cnam.hal.science/hal-04083189v1
A total of 256 patients with 362 MRI examinations from the DESIR cohort were included, with 27% meeting the ASAS definition for experts. […] The deep learning model achieves performance close to those of experts for BME detection in sacroiliac joints and determination of active sacroiliitis according to the ASAS definition.
#36 A deep learning model for the diagnosis of sacroiliitis according to Assessment of SpondyloArthritis International Society classification criteria with magnetic resonance imaging – Inria – Institut national de recherche en sciences et technologies du nu
https://inria.hal.science/hal-04083189
Purpose The purpose of this study was to develop and evaluate a deep learning model to detect bone marrow edema (BME) in sacroiliac joints and predict the MRI Assessment of SpondyloArthritis International Society (ASAS) definition of active sacroiliitis in patients with chronic inflammatory back pain. […] A total of 256 patients with 362 MRI examinations from the DESIR cohort were included, with 27% meeting the ASAS definition for experts. […] The deep learning model achieves performance close to those of experts for BME detection in sacroiliac joints and determination of active sacroiliitis according to the ASAS definition.
#37 Deep learning for detection of radiographic sacroiliitis: achieving expert-level performance | Arthritis Research & Therapy | Full Text
https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-021-02484-0
The neural network was able to achieve almost the same level of performance in both the validation and training sets, indicating a high level of reliability and robustness of the model. Our model can therefore be used as an additional diagnostic aid in clinical practice and as a classification tool in research projects involving patients with axSpA. […] Convolutional neural networks can detect radiographic sacroiliitis on pelvic radiographs with at least the same level of accuracy as a human expert. Utilisation of the proposed computer vision model could thus enable highly accurate detection of definite radiographic sacroiliitis, even in non-specialised sites.
#38 Imaging of sacroiliitis: Current status, limitations and pitfalls – Tsoi – Quantitative Imaging in Medicine and Surgery
https://qims.amegroups.org/article/view/22799/html
Sacroiliitis is one cause of inflammatory-type low back pain. The prevalence of axial SpA is about 1%, though this prevalence does vary according to ethnicity and HLA-B27 population prevalence. Early recognition and treatment of SpA can ameliorate symptoms, improve quality of life and reduce the likelihood of developing seriously impaired spinal mobility. In the USA, the diagnosis of SpA is delayed on average 14 years from symptom onset. SpA is diagnosed using a combination of clinical, serological and imaging criteria. About half of the patients diagnosed initially with axial SpA have radiographic evidence of SpA while the remainder have non-radiographic SpA with no radiographic features of SpA. As disease activity and functional impairment is similar for patients with radiographic and non-radiographic SpA, the distinction does not affect prognosis or treatment, though one should nevertheless be aware that about 50% of SpA patients will not have radiographic features of the disease at presentation. In patients with radiographic SpA, sacroiliitis may take many years to become radiographically apparent. As a result, magnetic resonance imaging (MRI) is increasingly utilized to enable recognition of sacroiliitis at a much earlier stage than which is possible radiographically. Even if the radiographs are normal and axial SpA is strongly suspected clinically, MRI examination is still usually performed to detect sacroiliitis. MRI is the most sensitive imaging technique to detect sacroiliitis. It is the only imaging modality that can reliably reveal bone marrow oedema and inflammation around the sacroiliac joints and is comparable to low dose CT for demonstrating erosions and ankyloses. Imaging, and in particular MRI, has greatly helped in the diagnosis and understanding of early SpA. It is important to remember that reactive abnormalities on MRI similar to those seen with sacroiliitis, but not due to sacroiliitis, are quite common, especially in patients with non-SpA inflammatory back pain and in athletes. There are also several other diseases that can mimic sacroiliitis on MR imaging. While it is important to make a correct early diagnosis of inflammatory sacroiliitis and SpA in patients who have the disease, it is equally important to recognize the entities that may mimic sacroiliitis. Incorrectly over-diagnosing inflammatory sacroiliitis and labelling the patient as having SpA can have a significant negative impact on lifestyle, job prospects, health insurance, etc. Potential mimics of sacroiliitis include stress-related changes, infective sacroiliitis, osteoarthritis, stress fracture, insufficiency fracture and osteitis condensans ilii. Bone marrow oedema is a marker of inflammation and needs to be significant in degree before a diagnosis of sacroiliitis can be made. MRI is only one biomarker in a diagnostic process also encompassing clinical and serological testing. As stressed, a diagnosis of SpA should only be made after careful consideration of the clinical picture, serological tests and, where necessary, MRI findings.
#39 Ankylosing spondylitis – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/ankylosing-spondylitis/
Epidemiological data refers to the US, unless otherwise specified. […] Lifetime prevalence: 0.5%. […] 90-95% of patients are HLA-B27 positive. […] The majority of patients have sacroiliitis detectable on MRI. […] Up to 30% of affected individuals will progress to AS within 10 years of diagnosis.
#40 Prevalence of sacroiliitis and acute and structural changes on MRI in patients with psoriatic arthritis | Scientific Reports
https://www.nature.com/articles/s41598-020-68456-7
The prevalence of sacroiliitis on MRI in our sample of PsA patients (37.8%) matches studies reporting prevalences of axial disease in PsA between 25 and 50%. […] Interestingly, inflammatory lumbar pain was only observed in 29.4% of the patients with sacroiliitis and the most prevalent findings on MRI were subchondral bone edema and enthesitis (acute changes) and periarticular erosions and fat metaplasia (chronic changes), proving that changes on MRI may occur in the absence of clinical symptoms. […] In our sample, the time of psoriasis (12.5Â±9.6 years) was significantly associated with the presence of chronic sacroiliitis damage (p=0.006).
#41 Imaging of sacroiliitis: Current status, limitations and pitfalls – Tsoi – Quantitative Imaging in Medicine and Surgery
https://qims.amegroups.org/article/view/22799/html
Sacroiliitis is one cause of inflammatory-type low back pain. The prevalence of axial SpA is about 1%, though this prevalence does vary according to ethnicity and HLA-B27 population prevalence. Early recognition and treatment of SpA can ameliorate symptoms, improve quality of life and reduce the likelihood of developing seriously impaired spinal mobility. In the USA, the diagnosis of SpA is delayed on average 14 years from symptom onset. SpA is diagnosed using a combination of clinical, serological and imaging criteria. About half of the patients diagnosed initially with axial SpA have radiographic evidence of SpA while the remainder have non-radiographic SpA with no radiographic features of SpA. As disease activity and functional impairment is similar for patients with radiographic and non-radiographic SpA, the distinction does not affect prognosis or treatment, though one should nevertheless be aware that about 50% of SpA patients will not have radiographic features of the disease at presentation. In patients with radiographic SpA, sacroiliitis may take many years to become radiographically apparent. As a result, magnetic resonance imaging (MRI) is increasingly utilized to enable recognition of sacroiliitis at a much earlier stage than which is possible radiographically. Even if the radiographs are normal and axial SpA is strongly suspected clinically, MRI examination is still usually performed to detect sacroiliitis. MRI is the most sensitive imaging technique to detect sacroiliitis. It is the only imaging modality that can reliably reveal bone marrow oedema and inflammation around the sacroiliac joints and is comparable to low dose CT for demonstrating erosions and ankyloses. Imaging, and in particular MRI, has greatly helped in the diagnosis and understanding of early SpA. It is important to remember that reactive abnormalities on MRI similar to those seen with sacroiliitis, but not due to sacroiliitis, are quite common, especially in patients with non-SpA inflammatory back pain and in athletes. There are also several other diseases that can mimic sacroiliitis on MR imaging. While it is important to make a correct early diagnosis of inflammatory sacroiliitis and SpA in patients who have the disease, it is equally important to recognize the entities that may mimic sacroiliitis. Incorrectly over-diagnosing inflammatory sacroiliitis and labelling the patient as having SpA can have a significant negative impact on lifestyle, job prospects, health insurance, etc. Potential mimics of sacroiliitis include stress-related changes, infective sacroiliitis, osteoarthritis, stress fracture, insufficiency fracture and osteitis condensans ilii. Bone marrow oedema is a marker of inflammation and needs to be significant in degree before a diagnosis of sacroiliitis can be made. MRI is only one biomarker in a diagnostic process also encompassing clinical and serological testing. As stressed, a diagnosis of SpA should only be made after careful consideration of the clinical picture, serological tests and, where necessary, MRI findings.
#42 Sacroiliitis – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK448141/
Reports on the prevalence of sacroiliac pain vary widely. Some studies report the prevalence as 10% to 25% of those with lower back pain. In those with a confirmed diagnosis, the presentation of pain was ipsilateral buttock (94% cases) and midline lower lumbar area (74%). As mentioned previously the presentation can vary. Up to 50% of cases have radiation to the lower extremity: 6% to the upper lumbar area, 4% percent to the groin, and 2% percent to the lower abdomen. […] Sacroiliitis is best managed by an interprofessional team that consists of a physical therapist, physician rheumatologist, and dietitian. Patient education is the key to good outcomes. All patients should be informed that the condition is benign and will improve with conservative measures. The patient should be encouraged to participate in a regular exercise program, lose weight and eat healthily. Home exercises can help prevent deconditioning. The patient should also be asked to quit smoking and abstain from alcohol. There is ample evidence indicating that patients who remain physically active have an excellent quality of life. […] The majority of patients with sacroiliitis have an excellent outcome. However, the recovery may take 2-4 weeks. Recurrences are common if patients do not change their lifestyle. Some series report a recurrence rate of over 30%.
#43 All About Sacroiliitis
https://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/all-about-sacroiliitis
Sacroiliitis may affect one or both the SI joints. The condition is often characterized by some combination of the following symptoms and signs: Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Research suggests that 10% to 25% of lower back pain may be caused by SI joint inflammation. […] Sacroiliitis can be caused by inflammatory, mechanical, postural, and traumatic causes. Inflammatory conditions most commonly cause sacroiliitis, but the condition can also occur due to trauma or prolonged stress on the SI joint. […] Most cases of sacroiliitis can be treated with non-surgical treatments. Research indicates that up to 95% of patients recover from sacroiliac joint pain with non-surgical treatments within 1 to 3 months.
#44 How common is lower back pain caused by the SI Joint? | SI-BONE | SI-BONE
https://si-bone.com/si-joint-faqs/how-common-is-lower-back-pain-caused-by-the-si-joint
Research shows that chronic lower back pain caused by the SI joint is more common than many people even healthcare professionals think. Several published clinical papers noted that 15-30% of people who complained of lower back pain actually had problems in their sacroiliac (SI) joint. […] Studies show the SI joint is a source of pain in about 15%-30% of patients with chronic low back pain. […] It’s important to be proactive in researching the prevalence of SI joint pain so you can be informed when you talk to your doctor about your concerns.
#45 Sacroiliitis – early diagnosis is key | JIR
https://www.dovepress.com/sacroiliitis-early-diagnosis-is-key-peer-reviewed-fulltext-article-JIR
It should be remembered that many patients with AxSpA, particularly at early stages of the disease, can present with atypical acute, intermittent or unilateral pain originating from the SIJ, which may be misinterpreted as secondary to a mechanical cause. […] MRI of the SIJs and of the spine has revolutionized diagnosis of early SpA. […] MRI was rapidly embraced as a dominant diagnostic tool and at the same time included into the classification criteria for AxSpA, becoming the cornerstone of SpA diagnosis. […] The presence of characteristic structural lesions on MRI improves diagnostic accuracy and was therefore advocated as a consideration in the ASAS classification criteria update. […] The report of negative imaging should not replace clinical considerations and a reasoned approach to the diagnosis. […] Accordingly, the 2009 ASAS classification criteria allow classification of patients with AxSpA without any imaging evidence of sacroiliitis.
#46 The Prevalence of MRI-Defined Sacroiliitis and Classification of Spondyloarthritis in Patients with Acute Anterior Uveitis: A Longitudinal Single-Centre Cohort Study
https://www.mdpi.com/2075-4418/12/1/161
MRI-defined sacroiliitis (highly suggestive BME) was found in 36% of AAU patients. […] Follow-up examination after two years in 55 initially MRI-negative patients revealed two patients who developed axSpA with active sacroiliitis. These findings raise the question of whether all patients with AAU should undergo a targeted rheumatological examination to rule out SpA. […] AAU patients with sacroiliitis were significantly more often HLA-B27-positive and had worse disease activity measures compared to those without sacroiliitis, which is congruent with previous findings comparing axSpA and non-axSpA subsets. […] Therefore, according to our results, even the absence of chronic back pain does not guarantee the absence of sacroiliitis; thus, it is important to search for additional SpA features and to follow up with these patients.
#47
https://link.springer.com/article/10.1007/s10067-022-06143-w
Patients with Crohn’s disease (CD) usually undergo magnetic resonance enterography (MRE) for evaluating small bowel involvement. Musculoskeletal symptoms are the most frequent extraintestinal manifestation in inflammatory bowel diseases, especially in CD, with sacroiliitis at imaging occurring in about 646% of patients and possibly correlating with axial spondyloarthritis. The primary study aim was to assess the prevalence of sacroiliitis in adult and pediatric patients with CD performing an MRE. […] The prevalence of sacroiliitis at MRE was 20% in adults and 6.7% in pediatric patients. […] Sacroiliitis is a frequent and reliable abnormality at MRE in adult patients with CD, associated with the age of the patients50 years and CD duration. […] Sacroiliitis incidentally detected at magnetic resonance enterography performed for Crohn’s disease is a frequent and reliable finding in adult patients, rarer in the pediatric population. […] Clinicians may rely on magnetic resonance enterography to properly evaluate and manage patients for sacroiliitis.
#48 Sacroiliitis and endocarditis in the absence of fever: an unusual clinical presentation following diarrhea in a young patient | The Egyptian Journal of Internal Medicine | Full Text
https://ejim.springeropen.com/articles/10.1186/s43162-025-00405-0
Further research is needed to elucidate the pathophysiological mechanisms underlying afebrile presentations of serious infections and to identify risk factors for atypical clinical manifestations. […] The absence of fever in this patient, despite the presence of two significant sites of infection, is an atypical presentation that may have delayed the recognition of the underlying infectious processes. […] This case highlights the importance of maintaining a high index of suspicion for infectious etiologies in patients presenting with musculoskeletal complaints, even in the absence of fever. […] Further research is needed to elucidate the pathophysiological mechanisms underlying afebrile presentations of serious infections and to identify risk factors that may predispose certain individuals to atypical clinical manifestations.
#49 Sacroiliitis – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK448141/
Reports on the prevalence of sacroiliac pain vary widely. Some studies report the prevalence as 10% to 25% of those with lower back pain. In those with a confirmed diagnosis, the presentation of pain was ipsilateral buttock (94% cases) and midline lower lumbar area (74%). As mentioned previously the presentation can vary. Up to 50% of cases have radiation to the lower extremity: 6% to the upper lumbar area, 4% percent to the groin, and 2% percent to the lower abdomen. […] Sacroiliitis is best managed by an interprofessional team that consists of a physical therapist, physician rheumatologist, and dietitian. Patient education is the key to good outcomes. All patients should be informed that the condition is benign and will improve with conservative measures. The patient should be encouraged to participate in a regular exercise program, lose weight and eat healthily. Home exercises can help prevent deconditioning. The patient should also be asked to quit smoking and abstain from alcohol. There is ample evidence indicating that patients who remain physically active have an excellent quality of life. […] The majority of patients with sacroiliitis have an excellent outcome. However, the recovery may take 2-4 weeks. Recurrences are common if patients do not change their lifestyle. Some series report a recurrence rate of over 30%.
#50 Sacroiliitis – early diagnosis is key | JIR
https://www.dovepress.com/sacroiliitis-early-diagnosis-is-key-peer-reviewed-fulltext-article-JIR
Sacroiliitis, inflammation of the sacroiliac joint (SIJ), may be associated with many rheumatic and nonrheumatic disorders. […] The diagnosis of sacroiliitis may be difficult in many patients, and awareness of its typical manifestations along with recognition of its diverse presentations and cognizance of the limitations of todays imaging modalities are critical to good clinical practice. […] This review provides a didactic approach to the early diagnosis of sacroiliitis in patients with suspected AxSpA, discussing differential interpretation of data acquired from patients histories, physical examination, and imaging. […] The various imaging modalities, however, also have their limitations in both sensitivity and specificity, leading to inconclusive descriptions and reports in some patients.