Background Spondylodiscitis is an important but not a well understood clinical part of ankylosing spondylitis (AS) or as a primary disease. Patients with spondylitis may attend to clinics mostly with back pain. Thoracic and lomber vertebrate involvement is prominent. There could be many other factors in etiology like brucellosis, tuberculosis, trauma, and malignities for non AS spondylitis (1). However there is a group of patients whom with inflammatory back pain but neither convenient with “Assessment of Spondyloarthritis International Society”(ASAS) classification criteria nor with magnetic resonance imaging (MRI) proven sacroiliitis.
Objectives We herein tried to compare patients with axial spondylarthritis (SpA) according to ASAS criteria and patients with signs of vertebrate involvement (spondylitis, spondylodiscitis) but without sacroiliitis.
Methods Patients with spondylitis according to ASAS/OMERACT MRI study group (2) were involved into the study. Additionally patients with inflammatory back pain and axial SpA features but without sacroiliitis both with X-ray and MRI were analyzed. We compared the demographic and clinical features, visual anologue scores (VAS) and treatments of these two groups.
Results 113 patients were (50 male/63 female) involved into the study. Patients without sacroiliitis were 39.7±10.4 and with sacroiliitis were 39.1±11.5 years old. Female predominancy in patients without sacroiliitis is significant (%69.8 and %38). Sacroiliitis were diagnosed with X-ray in 42 and MRI in 8 patients in sacroiliitis positive group. All the patients were using adequate dosage of non-steroidal anti inflammatory drugs [(NSAIDs), 150 mg/day diclofenac or 100-150mg/day indomethacin]. The VAS value was similar in both groups before treatment. However patients with sacroiliitis had prominent decrease in their VAS and erythrocyte sedimentation rate (ESR) opposite to sacroiliitis negative spondylitis patients. C-reaktive protein (CRP) value before treatment for sacroiliitis negative and positive spondylitis patients were 20.6±17.4 mg/dl and 22.1±20.2 mg/dl, and 12±10.1 mg/dl, 6.6±10.4 mg/dl after treatment respectively (table 1).
Conclusions Inflammatory back pain is the prominent symptom also in sacroiliitis negative spondylolitic patients and it is important to classify this group in the SpA disease. The NSAID response in pure spondylitic patients was interestingly poor from sacroiliitic spondylolitis patients.
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Hermann KG, Baraliakos X, van der Heijde DM, Jurik AG, Landewé R, Marzo-Ortega H, Østergaard M, Rudwaleit M, Sieper J, Braun J; Assessment in SpondyloArthritis international Society (ASAS). Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. Ann Rheum Dis. 2012 Aug;71(8):1278-88. doi: 10.1136/ard.2011.150680. Epub 2012 May 14.
Disclosure of Interest None declared