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Objective: To compare the radiological (X-ray) and magnetic resonance imaging (MRI) fi ndings in the sacroiliac (SI) joints in patients with early spondylarthropathy (SpA). Methods: Forty consecutive HLA B27 antigen positive patients with early SpA and infl ammatory low back pain (LBP) were studied. Their SI joints were investigated by posterior anterior plain X-ray and MRI. Results: The X-ray and MRI examinations gave similar results in the SI joints in 24 patients, whereas they differed in 16, this difference being signifi cant (p = 0.007). In those 16 patients, in whom the fi ndings differed, the X-ray fi ndings were normal but MRI showed sacroiliitis which was bilateral in 13 and unilateral in 3 patients. The kappa coeffi cient between these investigations was 0.346, showing poor agreement. Conclusion: These results indicate that MRI may considerably improve the diagnosis of sacroiliitis in HLA B27 antigen positive patients with early SpA and infl ammatory LBP.
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SHORT REPORT
Radiological and Magnetic Resonance Imaging Findings
in the Sacroiliac Joints in Patients with early
Spondylarthropathy
Reijo Luukkainen1, Kimmo O.J. Virtanen2 and Pekka Luukkainen3
1Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland. 2Department of Radiology,
Satakunta Central Hospital, Pori, Finland. 3Tapiola Insurance Company, Espoo, Finland.
Abstract
Objective: To compare the radiological (X-ray) and magnetic resonance imaging (MRI) fi ndings in the sacroiliac (SI) joints
in patients with early spondylarthropathy (SpA).
Methods: Forty consecutive HLA B27 antigen positive patients with early SpA and infl ammatory low back pain (LBP)
were studied. Their SI joints were investigated by posterior anterior plain X-ray and MRI.
Results: The X-ray and MRI examinations gave similar results in the SI joints in 24 patients, whereas they differed in 16,
this difference being signifi cant (p = 0.007). In those 16 patients, in whom the fi ndings differed, the X-ray fi ndings were
normal but MRI showed sacroiliitis which was bilateral in 13 and unilateral in 3 patients. The kappa coeffi cient between
these investigations was 0.346, showing poor agreement.
Conclusion: These results indicate that MRI may considerably improve the diagnosis of sacroiliitis in HLA B27 antigen
positive patients with early SpA and infl ammatory LBP.
Keywords: early, spondylarthropathy, LBP, radiography, MRI
Introduction
The concept of spondylarthropathy (SpA) was formulated in the 1970s (1) and confi rmed by
the discovery of the association of these diseases with HLA B27 antigen (2,3). SpAs are classifi ed
into ankylosing spondylitis, reactive arthritis (ReA), psoriatic arthritis (PsA), arthritis with infl am-
matory bowel disease and undifferentiated spondylarthropathy (uSpA). One of the characteristic
features of SpAs is infl ammatory low back pain (LBP), which is often due to sacroiliitis (4). Infl am-
matory LBP is associated with stiffness which is usually worse in the morning and may awaken the
patient from sleep during the night. However, in patients with chronic infl ammatory LBP the
probability of axial SpA is only 14% (5). The European Spondylarthropathy Study Group (ESSG)
criteria are those most often used for the diagnosis of SpA (6). According to these criteria patients
are defi ned as having SpA if they have infl ammatory spinal pain or synovitis (asymmetric or
predominantly in the lower limbs), together with at least one of the following: positive family his-
tory, psoriasis, infl ammatory bowel disease, urethritis, or acute diarrhea, alternating buttock pain,
enthesopathy, or sacroiliitis as determined from X-ray of the pelvic region. The diagnosis of
sacroiliitis has traditionally been based on plain radiography (X-ray). When the patient´s anamnestic
data, clinical fi ndings and possibly also results of laboratory examinations point to sacroiliitis, an
X-ray of the SI joints has been considered indicated. However, it takes an average of 9 years before
sacroiliitis can be detected by plain X-ray, whereas magnetic resonance imaging (MRI) can detect
infl ammatory changes in SI joints in early phases of the disease (7). In the present study we com-
pared the X-ray and MRI fi ndings in SI joints of HLA B27 positive patients with early SpA and
infl ammatory LBP.
Correspondence: Reijo Luukkainen, Kreetalankatu 5C, 29200 Harjavalta, Finland.
Email: reijo.luukkainen@fi mnet.fi
Copyright in this article, its metadata, and any supplementary data is held by its author or authors. It is published under the
Creative Commons Attribution By licence. For further information go to: http://creativecommons.org/licenses/by/3.0/.

Clinical Medicine: Arthritis and Musculoskeletal Disorders 2008:1 59–62
59

Luukkainen et al
Patients and Methods
or sacroiliitis (grade I to IV) using the modifi ed
Forty consecutive patients fulfi lling the ESSG New York criteria (8). Correspondingly, the MRI
criteria for SpA were included in the study. Other images of the SI joints were evaluated on the scale:
criteria for inclusion were: age 20–50 years, dura-
normal or sacroiliitis, which included one or more
tion of disease not more than 6 years, HLA B27 of the following: subchondral bone marrow edema,
antigen positivity, inflammatory LBP, and no synovitis, capsulitis, irregularity and narrowing of
sacroiliitis in possible earlier X-ray or MRI inves-
joint space or erosion. Figure 1 shows normal X-ray
tigations. The mean age of the 40 patients, of whom fi nding of a patient and Figure 2 bilateral sacroiliitis
25 were women, was 34.1 (range 20–50) years, in MRI of the same patient. The X-ray fi lms and
mean duration of SpA 2.8 (range 0.1–6.0) years, MRI images were mixed, patients`names and birth-
mean erythrocyte sedimentation rate 13.8 (range days being concealed when they were interpreted
1–88) mm/h and mean blood hemoglobin 137 by one of the authors (KV).
(range 110–169) g/l. The diagnoses were the fol-
Differences between fi ndings in X-ray and and
lowing: 23 uSpA, 14 ReA and 3 PsA. The protocol MRI investigations of the SI joints were determined
of the study was approved by the ethical commit-
using chi-square test and the level of agreement
tee of Satakunta Central Hospital. The objectives between these investigations was evaluated by kappa
were explained to all patients prior to enrolment coeffi cient (9). Kappa values range from −1 to +1,
in the trial and their oral consent was obtained.
the value 1.0 representing perfect agreement.
Altogether 80 SI joints of 40 patients were
investigated by posterior anterior plain X-ray and Results
by MRI using 0.5 Tesla magnet (Gyrosan, Philips). The X-ray and MRI examinations gave similar
Three different semicoronal sequences were exam-
results on the SI joints in 24 patients, whereas they
ined: T1 weighted TR 500 with TE 30; T1 SPIR differed in 16 cases, the difference being signifi cant
TR 110 with TE 20 and the same sequence with (p = 0.007). Of the patients with similar results in
intravenous bolus administration of 15 mL of con-
the X-ray and MRI, 14 yielded normal fi ndings,
trast agent Magnevist (469 mg/mL, Schering AG); 9 had bilateral sacroiliitis and one had unilateral
and SPIR/TSE TR 1400 with TE 140. In plain X-ray sacroiliitis. Of the remaining 16 patients the X-ray
the SI joints were evaluated on the scale: normal fi ndings in the SI joints where normal but MRI
Figure 1. Normal X-ray fi ndings of the Si joints.
60
Clinical Medicine: Arthritis and Musculoskeletal Disorders 2008:1

Radiological and magnetic resonance imaging fi ndings in the sacroiliac joints in patients with early spondylarthropathy
Figure 2. Bilateral sacroiliitis in MRI of the same patient.
showed sacroiliitis which was bilateral in 13 and both acute and chronic infl ammatory changes in
unilateral in 3 patients. There were no signifi cant the SI joints (7,13).
differences in the X-ray and MRI fi ndings between
The disadvantage of MRI is its relatively high
the patients with uSpA, Rea and PsA. The grade cost. Since LBP is a particularly common symp-
of X-ray and MRI examinations did not correlate. tom, the SI joints of all such patients cannot be
The kappa coeffi cient for X-ray and MRI investi-
investigated by MRI. To be cost-effective, selection
gations was 0.346.
of patients is therefore essential. Patients with
spondylarthropathy belong to the group in which
Discussion
MRI has to be considered.
LBP is a very common symptom attributable to
In this study X-ray and MRI gave similar results
many etiological factors, one of which is sacroili-
in only 24 out of the 40 HLA B27 antigen positive
itis. In most cases, however, the cause of pain patients with early spondylarthropathy and infl am-
remains unknown (10). It is important to diagnose matory low back pain, whereas they differed in the
sacroiliitis in such patients as early as possible, remaining16 patients, in whom MRI showed either
since its treatment differs from that of LBP with bilateral or unilateral sacroiliitis.
other etiologies (11). Infl ammatory involvement
In conclusion, the results of this study thus sug-
of one or both SI joints causing chronic LBP is a gest that MRI may considerably improve the
characteristic feature of SpAs (12). Conventional diagnosis of sacroiliitis in HLA B27 antigen posi-
plain X-ray and also computed tomography are tive patients with spondylarthropathy and infl am-
insuffi cient in the diagnosis of sacroiliitis in the matory low back pain.
early stages of the disease, since they can detect
only abnormalities of cancellous or cortical bones. Disclosure
X-ray cannot detect infl ammation or bone marrow The authors report no confl icts of interest.
edema in the absence of bone changes. Erosion of
the SI joint has often to be fairly severe before
being visualized by X-ray, which is the case in References
SpAs of even up to 9 years of duration of the dis-
[1]
Wright, V. and Moll, J.M. 1976. (eds): The seronegative spondylar-
ease (7). In contrast, MRI is able to detect soft
thritides a new concept. In Seronegative Polyarthritis. Amsterdam,
tissue components such as bone marrow, cartilage,
North Holland, 29–80.
[2] Brewerton, D.A., Hart, F.D., Nicholls, A. et al. 1973. Ankylosing
synovium and joint capsule, and can thus detect
spondylitis and HL-A 27. Lancet, 1:904–7.
Clinical Medicine: Arthritis and Musculoskeletal Disorders 2008:1
61

Luukkainen et al
[3]
Brewerton, D.A., Caffrey, M., Nicholls, A. et al. 1973. Reiter’s disease
[9]
Liebertau, A.M. 1983. Measures of association. Sage Publications,
and HL-A 27. Lancet, 2:996–8.
London.
[4] Mielants, H., Veys, E.M., Goemare, S. et al. 1993. A prospective
[10] Lipson, S.J. 1997. Low back pain. In: Kelley, W.N., Harris, A.D. and
study of patients with spondylarthropathy with special reference to
Ruddy, S. (eds): Textbook of Rheumatology. Philadelphia, WB.
HLA-B27 and to gut histology. J. Rheumatol., 20:1353–8.
Saunders Company. pp. 439–56.
[5]
Rudwalait, M., van der Heijde, D., Khan, M.A. et al. 2004. How to
[11] Khan, M.A. and Skosey, J.L. 1988. Ankylosing spondylitis and related
diagnose axial spodylarthritis early. Ann. Rheum. Dis., 63:535–43.
spondylarthropathies. In: Samter, M. (Ed): Immunological Diseases.
[6] Dougados,
M.,
van der Linden, S., Juhlin, R. et al. 1991. The European
Boston, Little, Brown and Co. pp. 1509–38.
Spondylarthropathy Study Group preliminary criteria for the
[12] van der Linden, S. 1997. Ankylosing spondylitis. In: Kelley, W.N.,
classifi cation of spondylarthropathy. Arthritis. Rheum., 34:1218–27.
Harris, A.D. and Ruddy S. (eds): Textbook of Rheumatology.
[7]
Braun, J., Sieper, J. and Bollow, M. 2000. Imaging of sacroiliitis.
Philadelhia, WB. Saunders Company. pp. 969–82.
Clin. Rheumatol., 19:51–7.
[13] Oostveen, J.C. and van de Laar, M.A. 2000. Magnetic resonance
[8]
van der Linden, S., Valkenburg, H. and Cats, A. 1984. Evaluation of
imaging in rheumatic disorders of the spine and sacroiliac joints.
diagnostic criteria for ankylosing spondylitis. Arthritis. Rheum.,
Semin. Arthritis. Rheum., 30:52–69.
27:361–8.
62
Clinical Medicine: Arthritis and Musculoskeletal Disorders 2008:1

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