No abstract available.
Diagnosis* ; Spondylarthropathies*

OBJECTIVES: To evaluate the clinical significance of heel pain, a frequently associated enthesopathy in Behcet's disease and to evaluate the association with seronegative spondyloarthropathy. METHODS: 15 Behcet's disease patients diagnosed by International Study Group for Behcet's disease criteria with arthritis were studied prospectively in the period of 1994. 3. 1-1995. 3. 31. Modified New York criteria was adopted for the diagnosis of ankylosing spondylitis. The patients were grouped into two by the presence of heel pain which was documented as tenderness on heel. RESULTS: There were 6 patients in the heel pain group and 9 patients in the non-heel pain group. Clinical characteristics were not significantly different between the two groups. Ankylosing sponaylitis was not associated in either group. ESR was higher with the value of 41.2mm/hr in heel pain group than 25.7mm/hr in non-heel pain group but it was not significant. In heel pam group, one patient showed HLA-B27 positivity, one patient showed erosive bone cha. nge, and one patient showed sacroiliitis but non-heel pain group showed no HLA positivity or bony changes. CONCLUSIONS: We find that subset of Behcet's disease patients with heel pain showed tendency to have higher inflammatory activity, erosive bone change, sacroilitis and HLA B-27 association, thus should be classified as seronegative spondyloarthropathy but seems to be different category from ankylosing spondylitis. These observations should be conducted in a large number of patients to establish the clinical value.
Arthritis ; Diagnosis ; Heel* ; HLA-B27 Antigen ; Humans ; Prospective Studies ; Rheumatic Diseases ; Sacroiliitis ; Spondylarthropathies ; Spondylitis, Ankylosing

PURPOSE: For early diagnosis of sacroiliitis in spondyloarthropathy, the MRI findings of sacroiliitis, roles of MPGR (Multiplanar Gradient Recalled Acquisition in Steady State), and delayed post-contrast T1-weighted images were evaluated. MATERIALS AND METHODS: Twenty six patients with seronegative spondyloarthropathy (probable clinical diagnosis of ankylosing spondylitis) were grouped as either less than radiographic grade I (group A) or more than grade II (group B). The MRI findings of both sacroiliac joints were evaluated in every patient, and predominant sites were determined. The two groups were then compared. In 17 patients, the number of enhancing panni seen on early and delayed post-contrast T1-weighted images was counted and compared between the two groups. RESULTS: Panni were found in all cases, and in both groups, predominant patterns of involvement were the lower and iliac aspects of the sacroiliac joints in both groups; in group A, the synovial joints and punctate pannus were predominantly involved, and in group B, the ligamentous joints as well as the synovial joints and linear pannus. In group B, more periarticular fat accumulation than periarticular osteitis was found. For the evaluation of changes in joint space, MPGR images were superior to spin echo images. For the delineation of enhancing pannus less than radiographic grade I, delayed post-contrast images were statistically superior to those which were early post-contrast. CONCLUSION: MRI can detect early sacroiliitic change according to the predominant sites of involvement, and delayed post-contrast images play a role in the diagnosis of early sacroiliitis. MPGR imaging is good for the evaluation of joint space change.
Diagnosis ; Early Diagnosis ; Humans ; Joints ; Ligaments ; Magnetic Resonance Imaging* ; Osteitis ; Sacroiliac Joint ; Sacroiliitis* ; Spondylarthropathies ; Spondylitis ; Spondylitis, Ankylosing*

OBJECTIVES:To investigate the clinical features of undifferentiated spondyloarthropathy among the HLA-B27 positive arthralgic patients and to compare with those of ankylosing spondylitis. METHODS: Two hundred and three HLA-B27 positive subjects among patients with arthralgia in various joints were classified according to the standard diagnostic criteria. The onset age, disease duration, numbers of involved joint, X-ray and bone scan findings were compared between patients with undifferentiated spondyloarthropathy(uSpA) and ankylosing spondylitis(AS). RESULTS: 1) The patients diseases were classified as ankylosing spondylitis(46%), undifferentiated spondyloarthropathy(29%), juvenile spondyloarthropathy(4%), reactive arthritis(3%), psoriatic spondyloarthropathy(1%) and unclassified(17%). 2) In undifferentiated spondyloarthropathy, the durations of the symptoms were shorter than ankylosing spondylitis and the male predominance is less prominent(5: 1 as compared to 17:1 in ankylosing spondylitis). 3) The numbers of involved peripheral joints and the frequency of peripheral joint inflammation were more frequent in undifferentiated spondyloarthropathy while the spinal joint symptoms including sacroiliac joint and the radiological severity grade of sacroiliitis were higher in ankylosing spondylitis. 4) There were no significant differences in bone scan uptake and ESR between undifferentiated spondyloarthropathy and ankylosing spondylitis. CONCLUSION: The prevalence of undifferentiated spondyloarthropathy was notable high in HLA-B27 posicive arthralgic patients when a new classification criteria was applied, Attention should be paid on the diagnosis and progression of this elusive and challenging clinical entity.
Age of Onset ; Arthralgia ; Classification ; Diagnosis ; HLA-B27 Antigen ; Humans ; Inflammation ; Joints ; Male ; Prevalence ; Sacroiliac Joint ; Sacroiliitis ; Spondylarthropathies* ; Spondylitis, Ankylosing*

Reiter's syndrome belongs to the family of spondyloarthropathies that usually present with a triad of arthritis, urethritis, and uveitis. The diagnostic criteria include clinical, radiological, and genetic findings, and the response to treatment. Nervous system involvement in Reiter's syndrome is extremely rare. We report here on a 36-year-old man who initially presented with progressive cervical myelopathy and was diagnosed as Reiter's syndrome 2 years later. The myelopathy was stable after treatment with methotrexate and sulfasalazine. This case suggests that Reiter's syndrome can present as progressive myelopathy and should be considered in the differential diagnosis of treatable myelopathies.
Adult ; Arthritis ; Arthritis, Reactive ; Diagnosis, Differential ; HLA-B27 Antigen ; Humans ; Methotrexate ; Nervous System ; Spinal Cord Diseases* ; Spondylarthropathies ; Sulfasalazine ; Urethritis ; Uveitis

A 55-year-old-male patient had acute lower back pain and radiculopathy with high spiking fever, which indicated pyogenic discitis. Intravenous antibiotics were administered but a high spiking fever and elevated laboratory findings indicated an infection. Therefore, surgery was performed. However, histological diagnosis revealed tophaceous gout. A diagnosis of spinal gout should be considered when there are clinical presentations of acute back pain and fever, especially in patients with acute back pain and a prior history of hyperuricemia or gout.
Anti-Bacterial Agents ; Back Pain ; Diagnosis ; Discitis* ; Fever ; Gout ; Humans ; Hyperuricemia ; Low Back Pain ; Radiculopathy ; Spine* ; Spondylarthropathies*

OBJECTIVE: To investigate the diagnostic value of magnetic resonance imaging (MRI) in early detection of sacroiliitis, to identify risk factors of early sacroiliitis, and to propose a diagnostic algorithm for early ankylosing spondylitis (AS). METHOD: Twenty-nine consecutive patients with inflammatory back pain (IBP) and unclear sacroiliitis (unilateral grade 2> or=sacroiliitis in plain radiography (PR) based on modified New York criteria) were studied. Clinical features of spondyloarthropathy, HLA B27 positivity, and MR image set of the sacroiliac (SI) joints were obtained. Two radiologists interpreted MR images independently to diagnose definite sacroiliitis. An association between sacroiliitis in MRI and each clinical and laboratory feature was assessed with linear logistic regression analysis. Post-test probability was determined with sensitivity/specificity of clinical and laboratory features. RESULTS: MRI showed definite sacroiliitis in sixteen patients. The most frequently noted finding was erosion and high signal intensity lesion within the joint cavity in gadolinium enhanced T1-weighted images. Unilateral grade 2> or =sacroiliitis in PR was the only significant risk factor of definite sacroiliitis in MRI. When unclear sacroiliitis in PR, more than one clinical feature of spondyloarthropathy, and HLA B27 were found, probability of AS was 83% in a proposed diagnostic algorithm. CONCLUSION: MRI of the SI joints can detect sacroiliitis in more than half of patients with IBP and unclear sacroiliitis in PR. Unilateral grade 2> or =sacroiliitis in PR was a risk factor of definite sacroiliitis in MRI. A diagnostic algorithm for early detection of AS is proposed.
Back Pain ; Early Diagnosis* ; Gadolinium ; Humans ; Joints ; Logistic Models ; Magnetic Resonance Imaging* ; Radiography ; Risk Factors ; Sacroiliitis* ; Spondylarthropathies ; Spondylitis, Ankylosing

We describe two cases of SAPHO syndrome with history of palmoplantar pustulosis and pain on the anterior chest wall and lower back area. The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome includes a group of disorders characterized by bony lesions commonly involving the anterior chest wall and associated with skin manifestations. The skeletal manifestation is characterized by the association of inflammation and hyperostotic change, in the form of sternocostoclavicular hyperostosis, spondyloarthropathy and chronic recurrent multifocal osteomyelitis. Common cutaneous lesions include palmoplantar pustulosis, pustulotic psoriasis, and severe forms of acne. The pathogenesis remains elusive, but a link with seronegative spondyloarthropathy is probable. To date, the treatment is empirical. Nonsteroidal anti-inflammatory drugs are the first choice, and other drugs including corticosteroid, disease modifying antirheumatic drugs, pamidronate, and infliximab have been tried with some therapeutic benefit. SAPHO syndrome is a condition in the differential diagnosis of infectious or tumorous conditions of the bone. Early and proper diagnosis is important to avoid unnecessary investigations or treatments.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Antirheumatic Agents ; Diagnosis ; Diagnosis, Differential ; Hyperostosis ; Hyperostosis, Sternocostoclavicular ; Inflammation ; Osteomyelitis ; Psoriasis ; Skin Manifestations ; Spine ; Spondylarthropathies ; Thoracic Wall ; Infliximab

We describe two cases of SAPHO syndrome with history of palmoplantar pustulosis and pain on the anterior chest wall and lower back area. The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome includes a group of disorders characterized by bony lesions commonly involving the anterior chest wall and associated with skin manifestations. The skeletal manifestation is characterized by the association of inflammation and hyperostotic change, in the form of sternocostoclavicular hyperostosis, spondyloarthropathy and chronic recurrent multifocal osteomyelitis. Common cutaneous lesions include palmoplantar pustulosis, pustulotic psoriasis, and severe forms of acne. The pathogenesis remains elusive, but a link with seronegative spondyloarthropathy is probable. To date, the treatment is empirical. Nonsteroidal anti-inflammatory drugs are the first choice, and other drugs including corticosteroid, disease modifying antirheumatic drugs, pamidronate, and infliximab have been tried with some therapeutic benefit. SAPHO syndrome is a condition in the differential diagnosis of infectious or tumorous conditions of the bone. Early and proper diagnosis is important to avoid unnecessary investigations or treatments.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Antirheumatic Agents ; Diagnosis ; Diagnosis, Differential ; Hyperostosis ; Hyperostosis, Sternocostoclavicular ; Inflammation ; Osteomyelitis ; Psoriasis ; Skin Manifestations ; Spine ; Spondylarthropathies ; Thoracic Wall ; Infliximab

SAPHO syndrome, characterized by synovitis, acne, pustulosis, hyperostosis, and osteitis is rare compared to other spondyloarthropathies. It is also difficult to diagnose, and treatment methods have not yet been fully identified. Approximately 72% of patients are diagnosed with at least one other disease before a final diagnosis of SAPHO syndrome. In addition, SAPHO syndrome is subject to a delayed diagnosis period of 4.5 to 9.1 years. Medications such as non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and tumor necrosis factor inhibitors are used in treatment of SAPHO syndrome. Bisphosphonate is also used for refractory SAPHO syndrome; however, most reports on this relate to intravenous injection of medication. The authors experienced and subsequently reported on a case involving a patient with SAPHO syndrome accompanied by fracture and infection of the left second finger who was treated with the oral biphosphonate, alendronate.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Alendronate* ; Antirheumatic Agents ; Delayed Diagnosis ; Diagnosis ; Fingers ; Humans ; Hyperostosis ; Injections, Intravenous ; Osteitis ; Spondylarthropathies ; Synovitis ; Tumor Necrosis Factor-alpha