脊柱关节病骶髂关节的病理表现

目的 了解不同阶段骶髂关节（SIJ）炎的病理变化,提高脊柱关节病（SpA)的早期诊断水平。方法 8例强直性脊柱炎（AS）及5例未分化脊柱关节病（uSpA)患者行CT导引下SIJ关节内激素治疗前,先取SIJ组织。所得标本行HE染色,普通光学显微镜观察。结果 CT0－I级SIJ炎的uSpA病人,SIJ可见滑膜炎症（包括衬里层细胞肥大增生、疏松结缔组织炎症细胞浸润）,局灶性软骨基质减少、变性、纤维化,软骨下骨板炎症细胞浸润。CTⅡ-Ⅲ级SIJ炎病理变化主要为软骨严重变性、破坏,血管翳形成,大量炎症细胞浸润,软骨下骨板破坏;CTⅣ级SIJ炎的病理改变则以软骨下骨板破坏,大量死骨形成,钙盐沉着为主要特点。3份标本的滑膜和软骨下骨板可见嗜酸性粒细胞（EO）比例增高。结论 滑膜衬里细胞肥大增生、疏松结缔组织炎症细胞浸润等滑膜炎表现,局灶性软骨基质减少、变性、纤维化和软骨下骨板炎症细胞浸润、破坏,是早期SIJ炎的病理特点;在CT未出现改变以前,病理学检查有助于早期诊断。     

骶髂关节炎磁共振检查意义初探

目的：探讨骶髂关节（SIJ）炎磁共振（MRI）检查的意义。方法：强直性脊柱炎（AS）12例，未分化脊柱关节病（uSpA)7例，作X线平片、CT和MRI检查。其中14例作动态MRI增强，11例作CT导引经皮穿刺活检。8例正常志愿者作MRI平扫和动态MRI增强。结果：CT和MRI对Ⅲ、Ⅳ级SIJ炎的判断基本一致，对0－Ⅱ级的判断二者相差较大。SIJ关节区的强化与组织炎症细胞的检出相关。关节旁骨髓水肿仅见于SIJ炎，也与SIJ的强化及组织炎症相关。结论：MRI通过增强（动态）、关节旁水肿等表现，推断Ⅱ、Ⅲ级SIJ的炎性活动程度，明确0级、I级SIJ炎的诊断，了解IV级SIJ是否存在炎症活动，对SIJ炎的早期诊断和病情活动性判定有重要意义。     

脊柱关节病患者骶髂关节细针活检的病理表现及其临床意义

目的了解骶髂关节(SIJ)炎的病理表现,提高强直性脊柱炎(AS)的早期诊断水平。方法对96例脊柱关节病(SpA)患者的SIJ进行CT导引下的细针活检,3例非SpA死亡病例为对照组。记录临床资料进行分析。结果76例SpA的SIJ存在炎症表现,包括骨髓炎、血管翳形成和炎性细胞浸润,软骨下骨板破坏,软骨变性、破坏,滑膜炎,附着点炎等。其中45例0～Ⅰ级CT下SIJ炎均存在骨髓炎、软骨下骨板炎、软骨变性等改变;0级CT下SIJ炎的滑膜无病理改变,而部分Ⅰ级和所有≥Ⅱ级SIJ炎滑膜可见炎症;软骨破坏和骨化发生率以0～Ⅰ级最低,且仅见于软骨下骨板侧,关节面侧未见破坏;骨质硬化也是0～Ⅰ级最少见;附着点炎仅见于部分≥Ⅱ级SIJ炎;炎性细胞浸润程度Ⅳ级最低。45例0～Ⅰ级CT下SIJ炎的SpA经病理检查诊断为AS;其平均病程显著短于≥Ⅱ级者。结论0级CT下SIJ炎时SIJ已可有炎症存在。SIJ炎可能自骨髓开始,继而血管翳形成,软骨下骨板破坏,软骨变性、破坏,最后纤维化、骨化而导致关节融合。滑膜炎和附着点炎不是SIJ炎的最早改变。病理检查有利于AS的早期诊断和鉴别诊断。     

CT引导下骶髂关节注射治疗强直性脊柱炎

目的　研究骶髂关节注射治疗强直性脊柱炎 (AS)的方法和疗效。方法　在CT引导下 ,患者取俯卧位 ,将腰穿针插入骶髂关节注入得宝松 (1ml) /醋酸强的松龙 (5 0mg) +2 %普鲁卡因 2ml。结果　 12例AS ,经骶髂关节注射后 ,10例有效 (显效 7例 ,有效 3例 ) ,2例无效 ,总有效率 83% ,下背痛程度越重、本次发作时间越长及对NSAIDs反应越差 ,疗效越好。结论　骶髂关节注射治疗AS是一种有效的方法 ,近期 (3～ 6个月 )疗效肯定 ,选择合适的患者疗效将更好。     

骶髂关节穿刺的断层解剖研究

目的 探讨经臀骶髂关节（sacroiliac joint,SIJ)穿刺的最佳途径和穿刺的安全性。方法 防腐盆部标本SIJ CT扫描,于低温冷冻下参照CT扫描基线行水平断层或冠状断层。观察SIJ在不同层面的表现,并与CT图像对照分析。结果 断层标本显示SIJ包括滑膜部和韧带部,CT显示的骶髂骨间不全是滑膜部。SIJ下1／3,则全为滑膜部占据,且其后面无骨质覆盖,但其下半部为SIJ边缘且骨盆壁较薄。从臂部至SIJ后缘路径无重要神经、血管,虽然SIJ盆面有腰骶干及髂血管等经过,但远离穿刺部位,不失为最佳穿刺途径。结论 经臀SIJ最佳穿刺部位为SIJ下1／3的上半部。经该途径穿刺安全,但不宜过深,以免穿透盆壁,误伤盆内结构。     

127例未分化脊柱关节病五年随访

目的了解未分化脊柱关节病（undifferentiated spondyloarthropathies,uSpA）的临床特点及发展规律。方法分析127例uSpA患者临床特点及5年随访结果。结果127例uSpA患者：（1）男女比例为1．8：1,女性患者起病晚,病情轻,预后较好;（2）病程中腰背部疼痛（93．7％）和外周关节肿痛者（96．0％）最多见;（3）女性腰背部疼痛的首发率明显高于男性（P〈0．05）,男性髋关节、臀区或足跟及其他附着点部位疼痛起病的首发率均高于女性（P〈0．05）;（4）7例以手关节受累为首发症状者均为女性;（5）家族史阳性率42．5％,HLA．B27阳性率52．8％,两性间差异无统计学意义（P〉0．05）;（6）首诊影像学特点,CT对诊断uSpA较X线敏感,两者骶髂关节炎阳性率分别为75．0％（78／104）和60．0％（51／85）。两者诊断骶髂关节炎分级符合率45．6％（31／68）。男性骶髂关节破坏的阳性率高于女性（P〈0．05）;（7）5年随访,18例发展为强直性脊柱炎（ankylosing spondylitis,AS）,1例为炎性肠病关节炎,1例为银屑病关节炎（psoriatic arthritis,PsA）,20例仍为uSpA,16例症状消失。18例确诊AS的患者中男性13例,占72．2％。5年内骶髂关节CT示Ⅱ级以上骶髂关节破坏进展明显,初诊和5年后阳性率分别为3．6％和48．2％。结论uSpA是一组常见的临床症状多样的脊柱关节病,有遗传倾向;男性骶髂关节受累较女性严重;部分患者可进展为AS、PsA及炎性肠病关节炎等其他脊柱关节病。对uSpA患者应密切随访,定期行骶髂关节CT检查有助于早期诊断。     

骶髂关节局部治疗强直性脊柱炎的追踪研究

强直性脊柱炎 (ankylosingspondylitis ,AS)是一种以骶髂关节 (SIJ)炎为标志的慢性免疫介导的关节炎。目前主要以影像学作为诊断的金标准。现今对AS的治疗多采用口服非甾体消炎止痛药 (NSAIDs) ,慢作用药 (SAARDs)和激素。由于SAARDs应用的确切疗效尚存在争议 ,另外有很大一部分患者仅以骶髂关节炎为突出表现 ,而无中轴关节以外的症状 ,此时全身用药的“风险 /效益比值”就远比局部用药大。2 0世纪 90年代初开始应用骶髂关节局部注射技术治疗控制AS的疼痛症状 ,并得到了较好的临床验证[1 3 ] 。不足的是这些报道都是方法介绍或短…     

依那西普联合甲氨蝶呤对强直性脊柱炎髋关节病变的诱导与维持治疗初步探讨

目的 初步探讨肿瘤坏死因子(TSF)-a拮抗剂对强直性脊柱炎(AS)髋关节损害的疗效,以及探讨其疗程和维持治疗的方法.方法 研究对象为AS合并髋关节损害的患者86例.治疗方案:①依那西普在开始6个月的用法为:25mg皮下注射,每周2次,持续2个月;以后每周1次再持续2个月;然后每2周1次再持续2个月.②甲氨蝶呤(MTX)15mg,口服或静脉注射,每周1次.③非甾体抗炎药(NSAIDs)和小剂量激素在控制症状后停用.结果 28例(33%)在2周内症状控制良好而停用NSAIDs;在8周内,有43例(50%)停用NSAIDs,其中36例(42%)NSAIDs和小剂量激素均已停用;在第9-16周,每周1次使用依那西普,在第16周的评价中,49例(60%)已经完全停用激素和NSAIDs;在第17-24周,每2周1次使用依那西普,有38例(44%)完全停用激素和NSAIDs,病情保持稳定.治疗后2、4、6个月髋关节功能评分均比治疗前明显提高(P<0.05);BASDAI、BASFI均下降,与治疗前对比差异均有统计学意义(P<0.05).治疗前后髋关节病变的放射学变化:治疗3个月后,19例磁共振成像(MRI)显示髋关节滑膜炎伴积液,而骨盆平片未见髋关节明显损害者中,11例滑膜炎消失,4例显著好转;骨盆平片显示有Ⅱ级或Ⅲ级损害的84个髋关节中,有13个髋关节出现放射学一个级别的改善,16个关节有改善,但未达到一个级别,49个关节没有放射学的改变.结论 依那西普与MTX联合治疗AS的髋关节损害有效,并且病情控制后,可以逐渐减低依那西普的剂量密度.     

未分化脊柱关节病83例临床分析

目的　了解未分化脊柱关节病 (uSpA)的发病情况及临床特点。方法　收集半年内就诊于门诊的 10 2例血清阴性脊柱关节病患者 ,其中 83例属uSpA ,均不符合国际上通用的强直性脊柱炎 (AS)或其他肯定的血清阴性脊柱关节病 (如银屑病性关节炎、瑞特综合征、肠病性关节炎等 )的诊断标准 (如修订的纽约标准、美国风湿病学学会分类标准 ) ,对此 83例进行了临床分析。结果　uS pA患者男女比例为 1 6∶1,女性比例较AS组明显高 ,平均年龄 2 8 8岁 ,平均病程 3 1年。临床症状较AS轻 ,均无腰椎活动受限 ;uSpA组患者HLA B2 7阳性率低于AS组 ;有 4例晚起病的 (5 0岁以后 )AS患者 ;不一定有骶髂关节炎 ;普通X线及CT诊断骶髂关节炎者分别占 34 %和 73%。 89 1%符合Amor标准 ,85 6 %符合欧洲脊柱关节病研究组 (ESSG)标准。结论　uSpA在血清阴性脊柱关节病中占很大比重 ,临床工作中应给予足够的重视。推荐用Amor和ESSG标准进行诊断。该病的治疗和转归还有待于长期的随诊观察。     

转化生长因子-β_1/Smad信号转导在强直性脊柱炎骶髂关节中表达的研究

目的 了解强直性脊柱炎(AS)骶髂关节中转化生长因子(TGF)-β_1/Smad信号转导通路中主要分子的表达情况,探讨TGF-β_1/Smad信号转导在AS发病机制中的作用.方法 53例AS患者均检测血清TGF-β_1.及红细胞沉降率(ESR)、C反应蛋白(CRP)水平.其中30例行CT导引下穿刺活检取得骶髂关节组织,通过免疫组织化学方法,检测TGF-β_1、p-Smad3、Smad7的表达.采用多个样本均数的单因素方差分析、两样本均数的t检验以及Kolmogorov-Smimov检验进行统计学处理.结果 AS患者中ESR/CRP升高组血清TGF-β_1(15.9±5.6)ng/ml,较健康对照组、ESR/CRP健康组[(5.4±5.8)ng/ml和(4.1±3.6)ng/ml]均明显升高.与健康对照组相比,AS骶髂关节组织可见TGF-β_1高表达,主要在血管翳中炎症细胞的胞质中表达;Smad7明显低表达;p-smad3则主要表达于骨髓及血管翳中炎症细胞的细胞核中,提示smad3已被激活.结论 AS中存在TGF-β_1的过高表达,Smad信号通路的激活,Samd7的低表达,可能与AS骶髂关节炎症活动、软骨的纤维化变性有关.     

Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy

OBJECTIVE: To evaluate the efficacy of periarticular corticosteroid injection of the sacroiliac joint (SIJ) in patients with seronegative spondylarthropathy in a double blind, controlled study. METHODS: 20 patients with seronegative spondylarthropathy and clinical sacroiliitis entered the study. In 10 patients one affected SIJ was treated with periarticular injection of 1.5 ml (40 mg/ml) methylprednisoloneacetate and 1.5 ml (20 mg/ml) lignocaine (MP group), whereas 10 patients received 1.5 ml isotonic sodium chloride and 1.5 ml (20 mg/ml) lignocaine (non-MP group). Clinical assessment at the onset of the study and after two months follow-up included the patients' estimation of pain in the SIJ by the visual analogue scale (VAS) and by a pain index which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the two months follow-up examination the VAS (p = 0.02) and the pain index (p = 0.01) had improved significantly in the MP group compared with the non-MP group. CONCLUSION: The results of our study indicate that the periarticular injection of methylprednisolone may be effective in the treatment of clinical sacroiliitis in patients with seronegative spondylarthropathy.     

骶髂关节病变病理学与影像学诊断的相关性

目的通过了解骶髂关节炎病理特点,并以病理结果为标准,探讨病理表现与放射性核素单光子发射计算机断层成像术(single-photon emission computed tomography,SPECT)、磁共振显像(magnetic resonance imaging,MRI)、计算机断层扫描(computed tomography,CT)、X线等影像学检查的关系。方法对中轴型脊柱关节炎患者进行CT引导下骶髂关节(sacroiliac joint,SIJ)穿刺,所得组织进行病理检查,并同时行SIJ的SPECT、MRI、CT和X线检查,按组织病理结果分为SIJ炎组和无炎性反应组。结果 36例患者获得组织有软骨、软骨下骨板、关节滑膜、骨髓、肌腱或韧带附着点等。获得率以软骨为最高,继以软骨下骨板、关节滑膜、骨髓和韧带附着点,各占92%、83%、75%、72%、22%;其中28例(2836,78%)患者SIJ炎病理变化包括软骨(93%)和软骨下骨板改变(75%)、滑膜炎(64%)、骨髓炎(46%)、附着点炎(32%),8例(22%)未发现有SIJ炎改变。MRI示29例(81%)患者共56个SIJ可见不同程度的异常信号改变,软骨线改变、软骨下骨板改变、骨髓水肿、脂肪沉积、骨质硬化分别为82%、71%、65%、59%、76%;SPECT示29例(81%)共52个SIJ可见骶髂关节感兴趣区的放射性比值有不同程度的升高,23例(64%)CT阳性,19例(53%)X线阳性。以病理结果为标准,SPECT、MRI、CT、X线的阳性预测值分别为89.6%、93.1%、95.6%、94.7%,敏感性分别为92.8%、96.4%、73.3%、64.2%,特异性分别62.5%、75.0%、87.5%、87.5%。4种诊断方法的受试者工作特征曲线下面积分别为0.79、0.84、0.83、0.76。结论病理检查是诊断Sl J炎和活动性炎性反应的主要方法。MRI和SPECT的相互补充,能提高骶髂关节活动性炎症的敏感性和特异性。MRI和SPECT的诊断价值与CT和X线相当,并可通过对炎症的活动度进行量化,有利于随访和疗效的评价,是诊断SIJ炎重要的辅助手段。     

Incidental computed tomography sacroiliitis: clinical significance and inappropriateness of the New York radiological grading criteria for the diagnosis

The clinical implications of computed tomography (CT) detected sacroiliac joint (SIJ) changes compatible with sacroiliitis has been rarely discussed in the literature. The aim of the present study was to describe prevalence and clinical correlations of sacroiliitis, noted incidentally by abdominal CT in patients referred for non-musculoskeletal complaints, utilizing the New York radiological grading criteria for reference. Five hundred ninety-eight CT scans of the abdomen of patients 18–55 years old, performed at a community medical center, were prospectively examined for the presence of imaging changes consistent with sacroiliitis. Patients with the evidence of bilateral sacroiliitis of grade ≥2 were interviewed and underwent a rheumatologic examination. Twenty-two patients (13 females) were enrolled. Only eight patients (six males) had a history and clinical picture compatible with previously undiagnosed axial spondyloarthritis (SpA). Only the presence of erosions/joint space irregularity and/or inhomogeneous osseous sclerosis around SIJs on CT correlated with the clinical diagnosis of axial SpA. Dense homogenous osseous sclerosis was unrelated to axial SpA and was seen almost exclusively in females. The prevalence of incidental CT sacroiliitis is low, while the New York radiological grading criteria for diagnosing sacroiliitis may be inappropriate for CT imaging. CT noted erosions of the SIJ appear to be a reliable diagnostic sign of sacroiliitis, while the significance of the osseous sclerosis, seen on CT adjacent to SIJs requires better understanding.     

结缔组织生长因子及I型和Ⅲ型胶原在脊柱关节病骶髂关节组织中的表达

目的 了解脊柱关节病(SpA)患者骶髂关节中结缔组织生长因子(CTGF)、I型胶原、Ⅲ型胶原的表达情况,探讨CTGF在spA关节软骨纤维化、骨化、关节强直中的作用.方法 30例spA患者(17例双侧影像学骶髂关节炎≥Ⅱ级,13例影像学骶髂关节炎Ⅰ级)均接受CT引导下骶髂关节穿刺活检术,取得骶髂关节组织.组织标本均行苏木素一伊红(HE)染色确认存在骶髂关节炎后,通过免疫组织化学染色方法,标记CTGF、Ⅰ型胶原及Ⅲ型胶原的表达情况.统计学方法采用单因素方差分析和t检验.结果 30例SpA患者骶髂关节组织中CTGF主要在血管翳炎症细胞及骨髓细胞的胞质中高度表达,阳性细胞数明显多于正常组织对照组[(57.9±42.4)腐倍视野和(2.7±2.5),高倍视野);Ⅰ型胶原及Ⅲ型胶原明显沉积于骨、部分软骨及韧带,平均吸光度均明显高于对照组(分别为0.298±0.080和0.044±0.024;28.254±41.165和0.105±0.054).结论 SpA骶髂关节中存在CTGF的高表达,Ⅰ型胶原及Ⅲ型胶原的沉积增多,提示CTGF参与了SpA骶髂关节局部胶原沉积、软骨纤维化变性过程,可能在SpA关节软骨纤维化、关节强直中起重要的作用.

Abstract：

Objective To investigate the expression of connective tissue growth factor(CTGF),coll agen I and collagen Ⅲ in sacroiliac joint(SIJ)of patients with spondyloarthropathy(SpA).Methods Thirty patients with SpA,including 17 patients with grade Ⅱ saeroiliitis and 13 patients with grade Ⅰ sacroiliitis,were performed on CT guided needie biopsy of SIJ.After sacroiliitis were confirmed by staining with hematoxylin and eosin in sacroiliac joint tissue sample,immunohistochemical assay was performed to determine the expression of CTGF,collagen Ⅰ and collagen Ⅲ in sacroiliac ioint tissue.Univariate Chi-square test was used for data comparison between multiple groups and t-test was used for two group data comparison.Results Contrast to healthy controls,CTGF were found upexpressed on the cytoplasm of inflammatory cells in pannus and bone marrow of sacroiliac tissue samples of patients with SpA,while collagen I and collagen Ⅲ were found up-expressed in bone,cartilage and ligament tissue[(57.9±42.4)/HP vs(2.7±2.5)/HP P<0.05,0.298±0.080 vs 0.044±0.024 and 28.254±41.165 vs 0.105±0.054.P<0.05 respectively].Conclusion CTGF,collagen Ⅰ and collagen Ⅲ are up-expressed in SIJ of SpA patients.CTGF may play an important role in articular cartilage fibrosis and ossification of SpA.     

Baseline sacroiliac joint magnetic resonance imaging abnormalities and male sex predict the development of radiographic sacroiliitis

We evaluated the relationship between the baseline sacroiliac joint (SIJ) magnetic resonance imaging (MRI) findings and the development of radiographic sacroiliitis and tested their prognostic significance in cases of ankylosing spondylitis. Patients who had undergone an SIJ MRI at the rheumatology department were identified. Individuals for whom pelvic X-rays were available after at least 1 year of MRI were included in the analysis. All radiographs and MRI examinations were scored by two independent readers. Medical records of the patients were reviewed to obtain potentially relevant demographic and clinical data. We identified 1,069 SIJ MRIs, and 328 fulfilled our inclusion criteria. Reliability analysis revealed moderate to good inter- and intra-observer agreement. On presentation data, 14 cases were excluded because they had unequivocal radiographic sacroiliitis at baseline. After a mean of 34.8 months of follow-up, 24 patients developed radiographic sacroiliitis. The presence of active sacroiliitis (odds ratio (OR) 15.1) and structural lesions on MRI (OR 8.3), male sex (OR 4.7), fulfillment of Calin’s inflammatory back pain criteria (P?=?0.001), and total MRI activity score (P?<?0.001) were found to be related to the development of radiographic sacroiliitis. By regression modeling, the presence of both active inflammatory and structural damage lesions on MRI and male sex were found to be predictive factors for the development of radiographic sacroiliitis. Our present results suggest that the occurrence of both active inflammatory and structural lesions in SIJs revealed by MRI is a significant risk factor for radiographic sacroiliitis, especially in male patients with early inflammatory back pain.     

CT引导下骶髂关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗强直性脊柱炎的研究

目的 通过对骶髂关节局部注射重组人Ⅱ型肿瘤坏死因子(TNF)受体-抗体融合蛋白(rhTNFR:Fc)的病理及影像研究,初步评价局部生物制剂治疗的临床疗效和安全性.方法 16例强直性脊柱炎(AS)患者采用单侧骶髂关节腔内注射rhTNFR:Fc的局部治疗方法(每月1次,25 mg/次,共3次,总疗程8周),对比20例全身皮下注射用药组(每周2次,25 mg/次,共16次,总疗程8周),分析其疗效、安全性、耐受性.同时观察注药前后骶髂活检组织细胞因子TNF-α、转化生长因子(TGF)-β、白细胞介素(IL)-6 mRNA的表达和光镜、免疫组织化学的变化,以及单光子发射计算机断层(SPECT)和磁共振成像(MRI)在代谢和宏观形态学上的改变.采用t检验或t'检验及χ2 Fisher's 精确检验或秩和检验.结果 rhTNFR:Fc局部注射显示:①治疗组在12周后Bath强直性脊柱炎疾病活动指数(BASDAI)评分(32±13)mm、疲乏(40±16)mm、晨僵(35±16)min、骶髂关节局部压痛(34±22)mm、患者总体评价VAS评分(40±17)mm上有明显改善(P<0.01),不良反应减少,并能节省医疗费用.②治疗后活检组织TNF-α、TGF-βmRNA相对表达量(0.891±0.06,0.84±0.05)较治疗前(1.08±0.19,1.13±0.33)明显下降(P<0.05),IL-6 mRNA相对表达量无明显改变(P>0.05).光镜下表现的滑膜炎、附着点炎、软骨变性、软骨下骨板破坏、骨髓炎的阳性率有所下降,而炎症细胞指数明显下降(z=-2.71,P<0.05).③治疗后骶髂关节放射学核素(ROI)的平均值(1.38±0.16)较治疗前(1.45±0.14)明显减少(P<0.05),MRI上的骨髓水肿、脂肪沉积等改变明显减轻(P<0.05).结论 骶髂关节腔注射rhTNFR:Fc,具有良好的疗效、安全性、耐受性及疗效经济学价值,特别有益于病变早期或局限于骶髂关节病变、不能耐受全身使用生物制剂的AS患者,临床推广应用前景.     

Sacroiliac joints: osteoarthritis or arthritis

One of the most challenging aspects of treating the sacroiliac joint (SIJ) pain is the complexity of diagnosis. Imaging methods have gained importance for the diagnosis of SIJ diseases. CT and MR exams had equal efficacy superior to radiography in staging structural changes in the SIJ due to osteoarthritis or sacroiliitis. The diagnosis of spondyloarthropaty can be delayed for several years using certain radiography studies. MR imaging reveal early cartilage changes and active inflammatory changes in the subchondral bone and surrounding ligaments in spondyloarthropaties, as well as subperiosteal and transcapsular yuxtaarticular infiltrations characteristic of septic sacroiliitis, which could not be found by either CT of radiography. T1-WI with fat suppression (FS) and STIR images improve the demonstration of erosions and inflammatory changes respectively, on MR studies. Additional T1-FS after i.v. contrast has proven valuable in demonstrating the extension of inflammatory changes and abscesses in septic sacroiliitis, and in spondyloartropaties may be useful although this is debatable. Scintigraphy gives high sensibility only in early inflammatory changes and low specificity for the diagnosis of sacroiliitis due to high bone turnover in the SIJ, although specific radioprobes are useful in confirming the septic etiology and evaluating additional foci. This complex joint of very limited mobility shows a lot of structural variations and some anatomical degenerative changes due to age, which are necessary to know to an adequate image interpretation and diagnosis of disease.     

Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint

OBJECTIVE: To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ in a double blind, controlled study. METHODS: Twenty-four consecutive non-spondylarthropathic patients with chronic pain in the region of the SIJ entered the study. Thirteen patients were treated with a periarticular injection of methylprednisoloneacetate and lidocaine (MP group) of the SIJ, whereas 11 patients received isotonic sodium chloride and lidocaine. Clinical assessment at the onset of the study and after one month included the patient's estimation of pain in the region of the SIJ by the visual analogue scale (VAS) and by a pain index, which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the one month's follow-up examination both the VAS (p = 0.047) and the pain index (0.017) had improved significantly in the MP group compared with the non-MP group. CONCLUSION: These results suggest that periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ in non-spondylarthropathic patients.     

Clinical sequelae and sacroiliac joint changes by computed tomography after recovery from septic sacroiliitis

Summary Nine cases of septic sacroiliitis were re-examined clinically and by CT after a follow-up period of 1.5–7 years. At the final ckeck-up, six of the patients were asymptomatic, while pain could be provoked by palpation or compression in three cases. The sacroiliac joint CT findings were considered normal in two cases. Joint space narrowing, subchondral sclerosis, cysts, erosions, ankylosis and/or osteophytes were detected in seven cases. We conclude that recovery from septic sacroiliitis is good although destructive and degenerative changes often develop as sequelae of an osteolytic involvement.