Lumbosacral radiographic signs in patients with previous entero- or uroarthritis

Antti Mannoja ^1*, Johanna M Pekkola ¹, Marko T Hämäläinen ¹, Marjatta Leirisalo-Repo ², Leena Laasonen ¹ and Leena Kivisaari ¹

¹ Helsinki University Central Hospital Department of Radiology FINLAND
² Helsinki University Central Hospital Department of Medicide Division of Rheumatology

^* To whom correspondence should be addressed. E-mail: antti.mannoja{at}helsinki.fi.

Accepted 9 November 2004

Abstract

OBJECTIVE: To investigate if there are differences in radiological findings in lumbosacral spine radiographs between different subgroups of patients with previous reactive arthritis.

METHODS: 95 patients with previous enteroarthritis (n=53), uroarthritis (n=37) or etiologically unknown Reiter's syndrome (n=5) were included in the study. Lumbosacral radiographs were taken 7-38 years after the initial arthritis. Three independent observers read the radiographs. Spinal changes included squaring of vertebrae, Romanus lesions, syndesmophytes and osteophytes. Sacroilitis was recorded according to the New York and Stoke methods. In addition, signs of enthesitis in the iliacal crest and disc space narrowing were recorded. Interobserver reliability and intraobserver reproducibility were determined.

RESULTS: 23 % of patients had grade 2-4 sacroilitis (New York criteria) and 14 % had syndesmophytes. In uroarthritis, as compared with enteroarthritis, there was more frequent sacroilitis (32% vs. 13%) and the number and occurrence of syndesmophytes were higher (mean 0.54 vs. 0.15 per patient, 24% vs. 6%, respectively). In other radiological features, no significant differences were present between the groups. In the whole material, patients with grade 2 or greater sacroilitis had significantly lesser number and occurrence of disc space narrowing. Inter- and intraobserver agreement calculated using Cohen's kappa method varied from 0.2 to 1.

CONCLUSION: In patients with previous uroarthritis, syndesmophytes and sacroilitis are more frequent, but radiological findings in lumbosacral spine radiographs are characteristically similar to those in patients with previous enteroarthritis.

Keywords: radiology, reactive arthritis, sacroiliac joint, spine, spondyloarthropathies

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