Female ; Humans ; Hyperostosis ; diagnosis ; Middle Aged ; Sacroiliitis ; diagnosis ; Spondylitis ; diagnosis ; Spondylitis, Ankylosing ; diagnosis

PURPOSE: We wanted to evaluate the diagnostic value of the various findings on sacroiliac CT for detecting the early changes of ankylosing spondylitis (AS). MATERIALS AND METHODS: Between April 2005 and March 2006, 51 sacroiliac CT images with the clinical suspicion of AS, but no definite evidence of AS on the plain radiograph only, were retrospectively reviewed. Finally, 36 patients (mean age: 28.6 years; 34 males and 2 females), who were clinically diagnosed as AS (AS group, n=26) or they had no evidence of AS (non-AS group, n=10), were evaluated. Two musculoskeletal radiologists analyzed the presence of marginal irregularity, bony erosion and subchondral sclerosis. A statistical analysis was performed to evaluate the incidence, sensitivity and specificity of each finding. RESULTS: Marginal irregularity was seen in 21 of 26 AS subjects, and in 8 of 10 non-AS subjects. Bony erosion was only seen in 13 of 26 AS subjects. Subchondral sclerosis was observed in 19 of 26 AS subjects and in 8 of 10 non-AS subjects. The sensitivity/specificity for each findings were 72.4%/28.6%, 100%/43.5% and 70.4%/22.2%, respectively. Except for bony erosions, these results showed no statistical significance (p=.006). CONCLUSION: Bony erosion on CT is a very sensitive finding for the early changes of AS, whereas marginal irregularity or subchondral sclerosis is not so helpful in differentiating AS from non-AS. Attention to these results may further enhance the accurate diagnosis of the early changes in AS.
Arthritis ; Diagnosis ; Humans ; Incidence ; Joints ; Male ; Retrospective Studies ; Sclerosis ; Sensitivity and Specificity ; Spondylitis ; Spondylitis, Ankylosing*

STUDY DESIGN: A case report is presented of destructive lesion involuting intervertebral disc space and adjoing vertebral bodies in association with ankylosing spondylitis. OBJECTIVE: To report unusual clinical and radiological presentation of spondylodiscitis and its treatment wi th anterior interbody fusion. SUMMARY OF BACKGROUND DATA: Althought there is some mention in the literature of pathogenesis, diagnosis and treatment of spondylodiscitis in ankylosing spondylitis, we think that its occurrence is frequent enough to warrant this condition and we should differentiate it from other infectious or tumorous condition. RESULTS: Anterior debridement and anterior interbody fusion with structural bone graft were performed. The microscopic study showed nonspecific chronic inflammation and extensive necrosis. CONCLUSION: It was suggested that primary spondylodiscitis or pseudoarthrosis resulted from mechanical trauma be related to this condition rather than infectious spondylitis.
Debridement ; Diagnosis ; Discitis ; Inflammation ; Intervertebral Disc ; Necrosis ; Pseudarthrosis ; Spondylitis ; Spondylitis, Ankylosing* ; Transplants

Reiter's syndrome is associated with a classic triad of arthritis, conjunctivitis, urethritis, and is the most common type of reactive arthritis. This syndrome is a one type of seronegative arthropathy, requiring differential diagnosis with psoriatic arthritis and ankylosing spondylitis, since it is associated with psoriasis-like skin lesion, sacroilitis, spondylitis. The arthritis of Reiter's syndrome is known to be acute, short-lived, and transient, but with subsequent attacks, it is more likely that it will lead to permanent joint damage or disability. We recently have experienced one case of Reiter's syndrome with severe joint destruction and significant functional disability, so here we report one case with review of literature.
Arthritis ; Arthritis, Psoriatic ; Arthritis, Reactive ; Conjunctivitis ; Diagnosis, Differential ; Joints* ; Skin ; Spondylitis ; Spondylitis, Ankylosing ; Urethritis

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*

Humans ; Spondylitis, Ankylosing/diagnosis* ; Delayed Diagnosis ; East Asian People ; Asian People

The spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases in association with HLA-B27. They share the clinical features including sacroiliitis, spondylitis, oligoarthritis, enthesitis and extra-articular involvement. Recently ASAS proposed new classification criteria sets of axial and peripheral SpA. They were designed to include non-radiographic SpA, thus can guide the early diagnosis of disease before the structural damage occurs. SpA has a strong genetic predisposition. Non-MHC genes, such as IL23R and ERAP1, as well as HLA-B27 were confirmed as susceptibility genes through several GWAS. Major pathology in SpA is entheseal inflammation and new bone formation. Intrinsic ability of HLA-B27 to trigger innate immune response and several proinflammtory cytokines may contribute to the inflammation in SpA. New bone formation could be explained by a mechanism, partly or completely independent of the inflammatory process.
Cytokines ; Early Diagnosis ; Genetic Predisposition to Disease ; HLA-B27 Antigen ; Immunity, Innate ; Inflammation ; Osteogenesis ; Rheumatic Diseases ; Sacroiliitis ; Spondylitis ; Spondylitis, Ankylosing

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

The characteristic pathological lesions in ankylosing spondylitis are vertebral body osteoporosis, ankylosis of the apophyseal joints, intervertebral disc calcification, and ligamentous ossification. Calcification of the annulus fibrosis reduces the movement and elasticity of the intervertebral disc, causing this point to be the site of least resistance when the spine is subjected to trauma. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. The ligamentous fragility and multiple fused vertebral segments cause the fractured ankylosing spondylitic spine to resemble a long-bone fracture. In ankylosing spondylitis patient who have sustained minor trauma, a complete radiological study of the entire spine and not just the symptomatic region must be performed for an accurate diagnosis, so that any fracture possible along the spine can be detected and thus prevent any medicolegal problems. The authors report 4 cases of ankylosing spondylitis including 2 cases with severe neurological abnormalities that had occurred after minor trauma.
Ankylosis ; Diagnosis ; Elasticity ; Fibrosis ; Humans ; Intervertebral Disc ; Joints ; Ligaments ; Osteoporosis ; Spinal Fractures ; Spine ; Spondylitis, Ankylosing*

Infliximab is a chimeric monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha) that is used to treat chronic inflammatory diseases such as ankylosing spondylitis (AS). Side effects include greater susceptibility to severe infections, such as tuberculosis. Positive diagnosis of tuberculous infections, such as tuberculous peritonitis, are often difficult due to the nonspecific nature of symptoms and the rarity of the infection, with definitive diagnoses requiring either a positive culture or histological biopsy. Here, we describe a case of tuberculous peritonitis during infliximab therapy in a 71-year-old man with AS; the disease was confirmed via histopathological examination.
Aged ; Biopsy ; Diagnosis ; Humans ; Peritonitis ; Peritonitis, Tuberculous* ; Spondylitis, Ankylosing* ; Tuberculosis ; Tumor Necrosis Factor-alpha ; Infliximab