1/8. Septic sacroiliitis during the postpartal period. Diagnostic contribution of magnetic resonance imaging.Septic sacroiliitis is an uncommon condition that is often diagnosed late. Two cases in the immediate postpartal period are reported. magnetic resonance imaging contributed decisively to the early diagnosis.- - - - - - - - - - ranking = 1keywords = sacroiliitis (Clic here for more details about this article) |
2/8. Investigation of sacroiliac disease: Comparative evaluation of radiological and radionuclide techniques.An attempt has been made to improve diagnostic precision in a group of diseases associated with inflammation of the sacroiliac joints, by using a 99mTechnetium stannous pyrophosphate bone scan. inflammation of these joints is associated with osteoblastic activity and is reflected by an increase in the uptake of radionuclide, which can be precisely quantitated. The uptake was markedly above the range of normal in patients with active ankylosing spondylitis (AS), and also in a number of patients with possible AS, psoriasis, and Reiter's syndrome. However, patients with Grade 4 radiological changes of the sacroiliac joints frequently had normal scans. This technique may be useful in the early diagnosis of sacroiliitis, and the nosological implications of the changes in patients with Reiter's syndrome and psoriasis are of interest.- - - - - - - - - - ranking = 0.2keywords = sacroiliitis (Clic here for more details about this article) |
3/8. Whipple's disease with axial and peripheral joint destruction.A seropositive white man had follow-up for 16 years with a diagnosis of palindromic rheumatism. Treatment had included parenteral gold, methotrexate, prednisone, hydroxychloroquine sulfate, and penicillamine before diarrhea led to a biopsy-proven diagnosis of Whipple's disease. Clinical and radiographic criteria for ankylosing spondylitis were met. In addition to classic Whipple's arthropathy, he had the combined but singular findings of pancarpal destruction and cervical apophyseal fusion. HLA typing revealed the B7 antigen. This case illustrates the pitfalls in diagnosis of a chronic polyarthritis that has, as a typical feature, a long latency before manifesting its more specific signs and symptoms (ie, diarrhea, malabsorption, and hyperpigmentation). Care should be taken during evaluation of any disease with atypical and nonspecific features (eg, positive rheumatoid factor in a patient with polyarthritis) and one should continue to reevaluate the original impression while confirmatory evidence is lacking. Moreover, the roentgenographic findings of pancarpal narrowing, apophyseal fusion, and advanced iliofemoral joint disease, in addition to sacroiliitis and syndesmophyte formation, challenge the generally held notion that Whipple's arthropathy is a nondestructive joint disease.- - - - - - - - - - ranking = 0.2keywords = sacroiliitis (Clic here for more details about this article) |
4/8. psoriasis, sacroiliitis, and aortitis: an echocardiographic mimic of aortic root dissection.A patient with psoriasis, HLA-B27-positive sacroiliitis, and aortitis presented with clinical features suggesting acute aortic dissecting aneurysm. Although M-mode and two dimensional echocardiography supported the diagnosis, dissection was excluded by angiography and by direct observation at surgery. Asymmetric thickening of the right coronary cusp secondary to psoriatic aortitis was found to be etiologic of both the regurgitation and the false-positive echo for dissection. It is emphasized that in the setting of any fibrocalcific or inflammatory disease of the aorta, the echo diagnosis of dissection is fraught with hazard.- - - - - - - - - - ranking = 1keywords = sacroiliitis (Clic here for more details about this article) |
5/8. osteomalacia, pseudosacroiliitis and necrosis of the femoral heads in fanconi syndrome in an adult.The symptom of bone pain led to the discovery of fanconi syndrome in a 20-yr-old patient. The presenting osteomalacia was associated with an early deterioration of the sacroiliac joint and osteonecrosis of both femoral heads. The coexistence of these 2 unusual disorders was not coincidental. A diagnosis of osteomalacia was considered because of impaired mineralization predominantly affecting the median part of the sacroiliac joints. The bone necroses, of probable microfracture origin, were probably directly related to the osteomalacia.- - - - - - - - - - ranking = 0.8keywords = sacroiliitis (Clic here for more details about this article) |
6/8. Comparison of bone scan, computed tomography, and magnetic resonance imaging in the diagnosis of active sacroiliitis.Quantitative bone scan (QBS), computed tomography (CT), and magnetic resonance imaging (MRI) have each been used to confirm the diagnosis of active sacroiliitis (SI) in patients with low back pain (LBP). The authors prospectively evaluated 19 patients referred for symptoms of possible inflammatory LBP (group I), 26 seronegative spondyloarthropathy (SNSP) patients with LBP (group II, inflammatory or mechanical), and 5 SNSP patients without LBP (group III) to determine which radiological scan alone or in combination with other serological tests (Westergren erythrocyte sedimentation rate, c-reactive protein, HLA-B27, immunoglobulin a) was most useful in confirming a clinical diagnosis of active inflammatory SI. All patients were followed up for a minimum of 1 year to confirm the clinical diagnosis and evaluate response to therapy. Eight of 19 group I patients had active SI clinically or on plain radiographs on follow-up evaluation. Of these patients, 5 had abnormal QBS (71%), 3 had abnormal CT scans (38%), and 8 had abnormal MRI scans (100%, type I lesions). These type I MRI lesions were indicative of active inflammation manifested as subcortical bone marrow edema. The remaining 11 group I patients had negative scans for SI. Ten of 26 group II patients with LBP had SI diagnosed clinically and confirmed with positive QBS (60%), CT (100%), and MRI (100%, type I lesions). The remaining 16 group II patients had mechanical LBP without active SI clinically and had negative QBS (88%), CT (19%), and MRI (100%, normal or type II lesions). These type II MRI lesions represented old postinflammatory lesions with either fibrosis or fat replacement. All 5 group III patients had negative scans for active SI. Three patients (2 group I and group II) with inflammatory SI treated with sulfasalazine showed marked improvement on serial MRI scans. Westergren erythrocyte sedimentation rate, c-reactive protein, immunoglobulin a, and CT scan alone or in combination with other tests were not reliable predictors of active SI. Positive QBS and HLA-B27 tests were the best combination of screening tests with 82% predictability of inflammatory SI in whites, and QBS alone had an 80% predictability in black patients. However, MRI, which had 100% predictability, was the best single test for confirming active inflammatory SI.- - - - - - - - - - ranking = 1keywords = sacroiliitis (Clic here for more details about this article) |
7/8. Seronegative spondylarthropathy without spine involvement in Behcet's syndrome.The case of a 49-year-old man affected by Behcet's syndrome (BS) without any clinical or radiological evidence of ankylosing spondylitis, exhibiting a peripheral enthesitis typical of seronegative spondyloarthropathy (SpA) is reported. The diagnosis of SpA is supported by computed tomographic evidence of sacroiliitis. This case confirms our hypothesis that patients with BS may have other forms of SpA than AS.- - - - - - - - - - ranking = 0.2keywords = sacroiliitis (Clic here for more details about this article) |
8/8. sarcoidosis accompanied by pulmonary tuberculosis and complicated by sacroiliitis.We report the unique occurrence of a unilateral sacroiliitis in a patient with active sarcoidosis accompanied by pulmonary tuberculosis. Convincing (clinical) evidence of sarcoidosis as the extremely rare cause of this articular involvement is presented. Discussion is focused on comparison of sarcoidosis and tuberculosis, particularly with respect to their articular involvement, and the literature of previously reported cases of sarcoid sacroiliitis is briefly reviewed.- - - - - - - - - - ranking = 1.2keywords = sacroiliitis (Clic here for more details about this article) |