A 54-year-old female patient has been referred to a rheumatologist due to chronic back pain that began five years ago. The pain is characterized by slow onset, morning stiffness in the lower lumbar region lasting over 30 minutes, and improvement with movement but not rest. It also includes night pain and alternating buttock pain. The patient experiences significant pain reduction within 24-48 hours of NSAID intake.
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In brief, this is a case demonstrating changes of degenerative nature as a differential to axial spondyloarthritis.
This is a case of a 54-year-old patient presenting with inflammatory back pain for about 5 years in rheumatology. The pain responds well to NSAIDs. There were no further SpA-typical manifestations, HLA-B27 is negative, and the CRP was at the upper normal limit. The patient works partially physically, is slightly overweight with a BMI of 28 kg/m², and no other mechanical stress factors were found.
In the imaging performed beforehand, active inflammatory changes (bone marrow edema) were found in the facet joints at the lumbosacral junction. Changes were also detectable on follow-up two years later, although less intense. In the imaging of the sacroiliac joints, bone marrow edema is also seen mainly in the ventral area, which is most likely compatible with the mechanical genesis of changes. The erosions are only conditionally assessable due to the absence of an erosion-sensitive sequence, e.g. VIBE.
In summary, in this case, there is a high probability of mechanical, degenerative changes in the LWS and sacroiliac joints. In a similar constellation in a patient with SpA-typical manifestations, an erosion-sensitive MRI sequence or a low-dose CT of the sacroiliac joints would be indicated.
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#spondyloarthritis #elearning #sacroiliacjoint #reactivearthritis
11 сен 2024
