İnflamatuvar bel ağrısı ile başvuran hastalarda sakroiliak MR görüntüleme sonuçları: tek merkez deneyimi

Öz

Amaç: Bel ağrısı, hastaların romatoloji bölümüne sıklıkla başvuru şikayetidir. Bel ağrısı ile başvuran hastalarda sakroiliit varlığı MR ile erken dönemde saptanabilmektedir. Bu nedenle inflamatuvar bel ağrısı ile başvuran hastalara sakroiliak eklem MR görüntüleme yapıldı ve tetkik sonrası almış oldukları tanılar retrospektif olarak araştırıldı. Gereç ve Yöntem: Bu çalışma Ocak 2025-Haziran 2025 tarih aralığında Romatoloji Bilim Dalında yapıldı. Çalışmaya 18 yaş üzeri ve inflamatuvar bel ağrısı yakınması ile başvurup sakroiliak MR görüntüleme yapılan 105 hasta alındı. Hastaların pelvis grafi ve sakroiliak MR sonuçları analiz edildi. Hastaların sedimantasyon, CRP değeri ve aldığı tanılar kayıt edildi. Bulgular: Çalışmaya dahil edilen 60 hasta kadın,45 hasta erkekti. Hastaların yaş ortalaması 43.7 olarak bulundu. Direkt grafide sakroiliit varlığı 42 (%40) hastada gözlendi. Sakroiliak MR’da sakroiliit çıkma sıklığı %55 olarak bulundu. Sakroiliak MRG raporları değerlendirildiğinde 44 hasta normal, 42 hastada aktif inflamasyon 16 hastada kronik değişiklikler,3 hastada dejeneratif değişiklik olarak yorumlandı. Hastaların tetkik sonuçlarına göre en sık konulan romatolojik hastalık radyografik aksiyal SpA(%40), non radyografik aksiyal SpA(%15), HLA B27 ilişkili üveit(%5), dejeneratif değişiklik (%2) olduğu görüldü. Sakroiliak MR’da inflamasyon görülme durumu açısından değerlendirildiğinde yaş, aile öykü, artrit, üveit ve sedimantasyon ile ilişki bulunmadı. Hastada eşlik eden inflamatuvar bağırsak hastalığı, entezit varlığı ve CRP yüksekliğinin MR’da inflamasyon görülmesi ile ilişkisi bulundu. Sonuç: Sakroiliak MR, inflamatuvar bel ağrısı olan hastalarda başvurulan bir görüntüleme yöntemidir. Merkezimizde MR görüntülemede sakroiliit çıkma sıklığı %55 olarak bulundu. Yaş, sedimantasyon, aile öykü, artrit, üveit ile sakroiliak MR'da sakroiliit varlığı arasında ilişki bulunmadı. Sakroiliak MR'da sakroiliit varlığı ile inflamatuvar bağırsak hastalığı, entezit varlığı ve CRP değerleri arasında istatistiksel anlamlı ilişki bulundu.

Anahtar Kelimeler

• Bel ağrısı
• sakroiliak MR
• sakroiliit

Sacroiliac MRI results in patients presenting with ınflammatory low back pain: a single-center experience

Öz

Aim: Low back pain is a common complaint among patients who present to rheumatology departments. The presence of sacroiliitis in these patients can be detected early via MRI.Therefore, this study aimed to retrospectively investigate the post-examination diagnoses of patients who presented with inflammatory low back pain and underwent sacroiliac joint MRI. Method: This study was conducted in the Department of Rheumatology between January 2025 and June 2025. A total of 105 patients aged over 18 years who presented with inflammatory low back pain and underwent sacroiliac MRI were included in the study. The patients' pelvic radiographs and sacroiliac MRI results were analyzed. The sedimentation rate, C-reactive protein (CRP) values, and established diagnoses were recorded. Results: The study included 60 female and 45 male patients. The mean age of the patients was 43.7 years. Sacroiliitis was observed on pelvic radiographs in 42 (40%) patients. The frequency of sacroiliitis on sacroiliac MRI was found to be 55%. Sacroiliac MRI reports were reported as normal in 44 patients, active inflammation in 42 patients, chronic changes in 16 patients, and degenerative changes in 3 patients. The most common diagnosed rheumatologic diseases were radiographic axial spondloarthritis SpA (40%), non-radiographic axial SpA (15%), HLA B27-associated uveitis (5%), and degenerative changes (2%). When the presence of inflammation on sacroiliac MRI was evaluated, no significant association was found with age, family history, arthritis, uveitis, or sedimentation rate. However, a significant relationship was identified between inflammation on MRI and the presence of concomitant inflammatory bowel disease, enthesitis, and elevated CRP levels. Conclusion: Sacroiliac MRI is a frequently used imaging method for patients presenting with inflammatory low back pain. The prevalence of sacroiliitis on MRI at our center was found to be 55%. There was no statistically significant between age, sedimentation rate, family history, arthritis, or uveitis and the presence of sacroiliitis on MRI. Conversely, the presence of sacroiliitis on sacroiliac MRI was significantly associated with inflammatory bowel disease, the presence of enthesitis, and CRP values.

Anahtar Kelimeler

• Low back pain
• sacroiliac joint MRI
• sacroiliitis

Kaynakça

1. Dunn, K. M., and P. R. Croft. "Epidemiology and natural history of low back pain." European Journal of Physical and Rehabilitation Medicine 40.1 (2004): 9
2. Khan MA. Update on spondyloarthropathies. Ann Intern Med 2002;136:896–907.
3. Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998;41:58–67.
4. Saraux A, Guedes C, Allain J, Devauchelle V, Valls I, Lamour A, et al. Prevalence of rheumatoid arthritis and spondyloarthropathy in Brittany, France. Societe de Rhumatologie de l’Ouest. J Rheumatol 1999;26:2622–7.
5. Gran JT, Husby G, Hordvik M. Prevalence of ankylosing spondylitis in males and females in a young middle-aged population in Tromso, northern Norway. Ann Rheum Dis 1985;44:359–67.
6. Calin A, KayeB, Sternberg M, Antell B, Chan M. The prevalence and nature of back pain in an industrial complex. A questionnaire and radiographic and HLA analysis. Spine 1980;5:201–5.
7. Underwood MR, Dawes P. Inflammatory back pain in primary care. Br J Rheumatol 1995;34:1074-1077.
8. Khan MA. Ankylosing spondylitis: introductory comments on its diagnosis and treatment. Ann Rheum Dis 2002;61(suppl III):iii3–7.

9. Mau W, Zeidler H, Mau R, Majewski A, Freyschmidt J, Stangel W, et al. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol 1988;15:1109–14.
10. Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 2003;23:61–6.
11. Rudwaleit, M., et al. "How to diagnose axial spondyloarthritis early." Annals of the rheumatic diseases 63.5 (2004): 535-543.
12. Sudoł-Szopinska I, Urbanik A. Diagnostic imaging of sacroiliac joints and the spine in the course of spondyloarthropathies. Pol J Radiol 2013;78:43-9.
13. İnci, M. F., & İnci, R. (2013). Psöriazisli hastalarda sakroileitin manyetik rezonans görüntüleme bulguları. Journal of Clinical and Experimental Investigations, 4(2), 199-203.
14. Sieper J, van der Heijde D, Landewe R, Brandt J, Burgos-Vagas R, Collantes-Estevez E, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis. 2009;68(6):784-8.
15. Simpson, A. K., Cholewicki, J., & Grauer, J. (2006). Chronic low back pain. Current pain and headache reports, 10(6), 431-436.
16. Guzmán J, Esmail R, Karjalainen K, et al. Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ 2001;322:1511–1516.
17. Rudwaleit, M., Metter, A., Listing, J., Sieper, J., & Braun, J. (2006). Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 54(2), 569-578.
18. Dean LE, Jones GT, MacDonald AG, et al. Global prevalence of ankylosing spondylitis. Rheumatology 2013;1–8.
19. Stolwijk C, Onna MV, Boonen A, et al. Global prevalence of spondyloarthritis: a systematic review and meta-regression analysis. Arthritis Care Res 2016;68(9):1320–1331
20. Onen, F., Akar, S., Birlik, M., Sari, I., Khan, M. A., Gurler, O., ... & Akkoc, N. (2008). Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey. The Journal of rheumatology, 35(2), 305-309.
21. Kumar, A., Girishekar, B., Rao, V. K., & Kishen, T. J. (2023). Incidence of Sacroiliitis among Patients Presenting with Chronic Low Back Pain to a Tertiary Care Spine Center. Journal of Orthopedics and Joint Surgery, 5(2), 56-58.
22. Brown MA, Laval SH, Brophy S, Calin A. Recurrence risk modelling of the genetic susceptibility to ankylosing spondylitis. Ann Rheum Dis 2000; 59:883.
23. López-Medina C, Molto A, Sieper J, et al. Prevalence and distribution of peripheral musculoskeletal manifestations in spondyloarthritis including psoriatic arthritis: results of the worldwide, cross-sectional ASAS-PerSpA study. RMD Open 2021; 7.
24. de Winter JJ, van Mens LJ, van der Heijde D, et al. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther 2016; 18:196.
25. Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis 2008; 67:955.
26. Sreedhar C, Sree Ram M, Alam A, et al. Sacroiliitis in routine MRI for low back ache. Indian J Radiol Imaging 2006;16(4):643. DOI: 10.4103/0971- 3026.32288
27. Rizvi A, Kazmi S, Rafi M, et al. Incidence of sacroiliitis in females presenting with low back pain. Eur Int J Sci Technol 2015;4(8):40–46.
28. Çebiçci, M. A. Psöriasisli Hastalarda Sakroiliit Sıklığı. Türk Tıp Dergisi, 8(2), 57-60.
29. Poddubnyy D, Sieper J. Similarities and differences between nonradiographic and radiographic axial spondyloarthritis: a clinical, epidemiological and therapeutic assessment. Curr Opin Rheumatol 2014; 26:377.