1/42. Polyarthritis following intravesical BCG immunotherapy. Report of a case and review of 26 cases in the literature.OBJECTIVE: To delineate the characteristics of aseptic arthritis induced by intravesical BCG immunotherapy. methods: review of a personal case and 26 cases from the literature. RESULTS: Mean number of intravesical BCG instillations at arthritis onset was five. arthritis onset was within two weeks of the last instillation in 90% of cases. Half the patients had fever and half had conjunctivitis or uveitis. Symmetric polyarthritis was the most common pattern (n = 19), followed by oligoarthritis (n = 7). One patient had monoarthritis. The main targets were the knees (81%), ankles (48%), and wrists (40%). Twenty-six percent of patients reported back pain and 11% had sacroiliitis manifesting as pain or radiological changes. Mean erythrocyte sedimentation rate was 89 mm/h and mean c-reactive protein was greater than 70 mg/l. HLA B27 was positive in 56% of cases. Joint fluid usually exhibited inflammatory properties with polymorphonuclear neutrophils as the predominant cell type. synovial membrane biopsy showed nonspecific synovitis in the six patients who had this investigation. Nonsteroidal antiinflammatory therapy was effective in 75% of cases. Three of the six patients given isoniazid and/or rifampin responded to this treatment. CONCLUSION: Although arthritis induced by intravesical BCG immunotherapy is more often polyarticular than oligoarticular, it shares many features with reactive arthritis.- - - - - - - - - - ranking = 1keywords = sacroiliitis (Clic here for more details about this article) |
2/42. Systemic amyloidosis and sacroiliitis in a patient with systemic lupus erythematosus.We report a case of a 25-year-old female with juvenile onset systemic lupus erythematosus who developed systemic secondary amyloidosis with renal and gastrointestinal involvement. She has also had radiological signs of bilateral asymptomatic sacroiliitis without lower back pain or hla-b27 antigen.- - - - - - - - - - ranking = 5keywords = sacroiliitis (Clic here for more details about this article) |
3/42. "Ankylosing spondylitis" without sacroiliitis in a woman without the HLA B27 antigen.An elderly woman with otherwise typical ankylosing spondylitis for 45 years lacked radiologic evidence of sacroiliitis and the HLA B27 antigen. The illness was complicated by renal tuberculosis requiring a left nephrectomy 23 years after the onset of low back pain, and 20 years after an episode of severe iritis. After the eradication of the tuberculosis by surgery and chemotherapy, she has continued to have symptomatic spondylitis. The case seems to be an exception to the rule that sacroiliitis is a sine qua non for ankylosing spondylitis. women with ankylosing spondylitis tend to have milder disease with an apparently lower frequency of roentgenographic changes in sacroiliac joints.- - - - - - - - - - ranking = 6keywords = sacroiliitis (Clic here for more details about this article) |
4/42. sacroiliitis in familial mediterranean fever: an unusual presentation in childhood.familial mediterranean fever (FMF) is an autosomal recessively transmitted disease characterized by attacks of fever and serositis. The course of arthritis, which is a common manifestation of FMF, is generally benign. sacroiliitis due to FMF has been reported by several authors, but all the patients described so far had roentgenographic abnormalities, and most of them were adult cases. Here we report the youngest FMF patient with sacroiliitis without any abnormality on sacroiliac x-ray. She is also the first FMF patient in whom sacroiliac involvement was diagnosed by computed tomography (CT) in childhood. It is concluded that CT is a useful technique for the early diagnosis of destructive arthritis in FMF patients even in early childhood.- - - - - - - - - - ranking = 1keywords = sacroiliitis (Clic here for more details about this article) |
5/42. Axial osteomalacia with sacroiliitis and moderate phosphate diabetes: report of a case.We report a new case of axial osteomalacia diagnosed in a 51-year-old white Caucasian male, made particular by its association with sacroiliitis, positive hla-b27 antigen, and also moderate phosphate diabetes responsible for a decreased appendicular bone mass. The diagnosis was suspected when X-ray evaluation showed increased density and coarse trabeculation mainly involving the pelvis and spine. Dual energy X-ray absorptiometry confirmed the elevated bone density at the lumbar spine (T score: 1.92) contrasting with a decreased bone mass at the femoral neck (T score: -2.33). The diagnosis was confirmed by histomorphometry of the iliac crest showing marked thickening of the cortices (2190 microns /- 0.574, N = 780 /- 40) and an increased trabecular bone volume (33.24%, N = 14 /- 3). Osteoid parameters were also markedly increased with an osteoid volume of 2.1% (N = 1.2 /- 0.5) and a mean osteoid thickness of 28.7 microns (N = 13 /- 2.5), with a normal bone fluoride content (0.082%, N < 0.10). bone resorption as assessed on bone biopsy and by the measurement of markers of bone remodeling (serum procollagen type I C-terminal telopeptide and 24 hr urinary cross-laps to creatinine ratio) was increased. This latter finding was not necessarily due to axial osteomalacia and could be the consequence of moderate phosphate diabetes. The patient was treated with calcitriol which was promptly discontinued due to gastrointestinal symptoms and replaced by calcidiol without any significant effect on the low back pain.- - - - - - - - - - ranking = 5keywords = sacroiliitis (Clic here for more details about this article) |
6/42. Late-onset spondyloarthropathy mimicking reflex sympathetic dystrophy syndrome.Atypical presentations are common when spondyloarthropathy develops in older patients. We report two cases initially mistaken for reflex sympathetic dystrophy syndrome (RSDS). Both the patients were men, aged 62 and 75 years, respectively, with marked painful edema of a foot. One patient reported a moderate-energy trauma as the triggering event. Severe diffuse demineralization was noted on radiographs and diffuse hyperactivity on bone scans starting at the early vascular phase. These findings suggestive of RSDS led to treatment with calcitonin, griseofulvin, and pamidronate, all of which were ineffective. Laboratory tests showed severe inflammation, promoting investigations for other conditions. Spondyloarthropathy was diagnosed based on oligoarthritis with sacroiliitis, presence of HLA B27, and a favorable response to non-steroidal antiinflammatory therapy. In older patients, edema of the foot with severe demineralization and the laboratory evidence of inflammation should suggest a spondyloarthropathy.- - - - - - - - - - ranking = 1keywords = sacroiliitis (Clic here for more details about this article) |
7/42. Ulcerative colitis complicating seronegative HLA-A2-B27 rheumatoid arthritis with sacroiliitis.The case is reported of a 50 year old man with longstanding seronegative rheumatoid arthritis who developed ulcerative colitis. The patient also had sacroiliitis and his tissue was typed as HLA-A2-B27 several years before the bowel disease began. A possible overlap between primary inflammatory bowel disease, complications to the treatment of rheumatoid arthritis with drugs, and gastrointestinal rheumatoid vasculitis is discussed.- - - - - - - - - - ranking = 5keywords = sacroiliitis (Clic here for more details about this article) |
8/42. osteomyelitis and pyogenic sacroiliitis: A difficult diagnosis.Pyogenic sacroiliitis is an uncommon infection often diagnosed late because of poor localization of symptoms and inadequate physical examination. We describe a 12-year-old girl whose osteomyelitis and pyogenic sacroiliitis was initially misdiagnosed and discuss examination, investigation and management of the condition. This case highlights the importance of thorough physical examination and the consideration of septic arthritis in an unusual joint.- - - - - - - - - - ranking = 6keywords = sacroiliitis (Clic here for more details about this article) |
9/42. myocarditis and sacroiliitis: 2 previously unrecognized manifestations of tumor necrosis factor receptor associated periodic syndrome.Tumor necrosis factor receptor associated periodic syndrome (TRAPS) is an autosomic-dominant periodic syndrome associated with mutations in the extracellular domain of the 55 kDa TNF receptor. Clinically, episodes of severe myalgia, arthralgia/arthritis, sterile peritonitis, scrotal inflammation, serositis, migratory rash, conjunctivitis, and recurrent fever are characteristic. We describe a 9-year-old African American boy with the P46L mutation of the TNF receptor who presented with 2 previously unrecognized manifestations: sacroiliitis and myocardiopathy, both showing a reversible course.- - - - - - - - - - ranking = 5keywords = sacroiliitis (Clic here for more details about this article) |
10/42. sacroiliitis in familial mediterranean fever and seronegative spondyloarthropathy: importance of differential diagnosis.familial mediterranean fever (FMF) is a multisystemic autosomal recessive disease, occasionally accompanied by sacroiliitis. Transient and non-erosive arthritis of the large joints is the most frequent articular involvement. amyloidosis is also the most significant complication of FMF, leading to end stage renal disease. Here we present three cases of FMF with sacroiliitis and review the literature for spinal arthritic involvement of FMF. All cases were referred to our clinic with a diagnosis of seronegative spondyloarthropathy and with low back pain sourced by sacroiliitis. They also had homozygous M694V gene mutations and negative HLA B27 antigens. Molecular analysis of the gene mutation is recommended during the evaluation of uncertain cases in order to clarify diagnostic discrimination. We suggest that FMF with sacroiliitis, which is rare in rheumatological practice, should be considered in the differential diagnosis of seronegative spondyloarthropathy or other rheumatologic diseases causing spinal involvement.- - - - - - - - - - ranking = 4keywords = sacroiliitis (Clic here for more details about this article) |
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