Reactive Arthritis

Chapter 34 discusses reactive arthritis (ReA), which is a seronegative spondyloarthropathy (SpA) usually of younger patients. ReA is a postinfectious SpA. ReA is a SpA suspected in younger patients, especially those 25-30 years old, with inflammatory back pain, oligoarthritis, and extraarticular symptoms following infection, usually gastrointestinal or genitourinary. It more commonly involves the peripheral than the axial skeleton, especially the lower extremity. Sacroiliac joint involvement is also common. The Assessment of SpA International Society (ASAS) classification criteria are useful in diagnosing ReA and distinguishing it from other SpA. Peripheral disease is first evaluated by radiography, but MRI is the gold standard for identifying active disease.

Can imaging modalities be used as follow-up criteria after brucellar sacroiliitis treatment?

Introduction: This study aimed to identify a follow-up modality that can be used to evaluate therapeutic responses in patients receiving treatment for brucellar sacroillitis and to determine whether antibiotherapy can be stopped. Methodology: A total of 32 patients with sacroiliac joint involvement demonstrated via magnetic resonance imaging or bone scintigraphy were followed up and treated. Patients received 200 mg/day of doxycycline and 600–900 mg/day of rifampicin for 3–21 months, and 1 g/day of streptomycin for 21 days. Results: The mean age of the 32 patients involved was 21.81 ± 4.09. In total, 10/32 patients did not complete therapy, and the remaining 22 patients received combination antibiotic treatment for a mean of 8.95 ± 4.34 months. Of the 22 patients, 15 underwent MRI, and 7 of them did not consent to MRI. Similarly, 17 patients were followed up by bone scintigraphy, and 5 patients did not have scintigraphy results. In 9/17 patients followed up with bone scintigraphy, sacroiliitis findings were found to reduce after a mean of 7.44 ± 3.71 months, whereas in 12/15 patients on whom MRI was performed, there were no active sacroiliitis findings for a mean of 6.95 ± 2.83 months. Conclusions: While active involvement findings in bone scintigraphy were observed for a longer period in scintigraphy images, active sacroiliitis findings disappeared in a relatively shorter period of time with MRI. Therefore, we have demonstrated that high-resolution MRI is a very sensitive technique compared to scintigraphy.

Ollier’s Disease of the Iliac Bone with Sacroiliac Joint Involvement in an Adolescent Patient

Ollier’s disease of the hip bone involving the sacroiliac joint has not yet been reported in the English-language literature in both the mature and immature skeletons. The authors present such a unique case in an adolescent girl that posed a significant diagnostic challenge secondary to the rarity of the lesion and atypical clinical picture.