|IMAGES IN RHEUMATOLOGY
|Year : 2022 | Volume
| Issue : 3 | Page : 320-321
Accessory sacroiliac joints: A commonly misinterpreted mimic of spondyloarthropathy
Shivraj Padiyar1, Prathyusha Manikuppam1, Madhavi Kandagaddala2, Rosh V Georgy1, John Mathew1
1 Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
|Date of Submission||06-Mar-2022|
|Date of Acceptance||29-May-2022|
|Date of Web Publication||18-Aug-2022|
Dr. John Mathew
Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Keywords: Accessory sacroiliac joint, spondyloarthropathy mimic, sacroilitis
|How to cite this article:|
Padiyar S, Manikuppam P, Kandagaddala M, Georgy RV, Mathew J. Accessory sacroiliac joints: A commonly misinterpreted mimic of spondyloarthropathy. Indian J Rheumatol 2022;17:320-1
|How to cite this URL:|
Padiyar S, Manikuppam P, Kandagaddala M, Georgy RV, Mathew J. Accessory sacroiliac joints: A commonly misinterpreted mimic of spondyloarthropathy. Indian J Rheumatol [serial online] 2022 [cited 2022 Oct 2];17:320-1. Available from: https://www.indianjrheumatol.com/text.asp?2022/17/3/320/353993
A 30-year-old housewife, presented with chronic noninflammatory low back pain for 1 year, who on evaluation was found to have bilateral sacroiliitis in the plain pelvic radiographs with a negative HLA-B27. She was started on biologicals for the same with which she had only minimal response. On evaluation in our institute, she was found to have normal inflammatory markers (C-reactive protein-6 mg/L). Imaging of the sacroiliac (SI) joints showed bilateral accessory sacroiliac joints (ASIJs) with juxta-articular edema and degenerative arthritic changes with a normal SI joint [Figure 1]a, [Figure 1]b and [Figure 2]a, [Figure 2]b, which was contributing to the pain. In view of minimal response to analgesics, she was given a computerized tomography-guided intra-articular steroid injection to ASIJ with which she had a very good response with a reduction in pain by 75% by the 1st week, which was sustained during the follow-up visit 1 month later. However, subsequently, after 3 months she had a recurrence of back pain with lesser intensity, which was managed by pain-relieving physiotherapy. The ASIJ, a common variant of SI joints is situated between the medial aspect of the posterior superior iliac spine and a rudimentary transverse tuberosity just lateral to the second sacral foramen. It can be either present at birth or can be acquired as a fibrocartilaginous joint as a result of childbirth, in elderly and obese people, with a prevalence of 19%. Due to the imperfect angulation of the two bony surfaces, these joints are more prone to degenerative changes being symptomatic in approximately half of the cases. Treatment is mainly rest, nonsteroidal anti-inflammatory drugs, and intra-articular steroids. This case highlights the importance of knowing the anatomical variants of SI joint in a case of chronic back pain and preventing the misdiagnosis with spondyloarthropathy and its treatment, especially when progressive arthritic changes are observed.
|Figure 1: (a and b): The oblique coronal CT sections (a) of the sacroiliac joints show accessory right sacroiliac joint with degenerative changes (thin white arrow) and the accessory left sacroiliac joint (b) with bony ankylosis (thick white arrow). CT: Computerized tomography|
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|Figure 2: (a and b): The STIR oblique coronal images of the bilateral sacroiliac joints demonstrates accessory right sacroiliac joint (a) with degenerative changes (thin white arrow) and the accessory left sacroiliac joint (b) (thick white arrow). STIR: Short Tau Inversion Recovery|
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ehara S, El-Khoury GY, Bergman RA. The accessory sacroiliac joint: A common anatomic variant. AJR Am J Roentgenol 1988;150:857-9.
Prassopoulos PK, Faflia CP, Voloudaki AE, Gourtsoyiannis NC. Sacroiliac joints: Anatomical variants on CT. J Comput Assist Tomogr 1999;23:323-7.
[Figure 1], [Figure 2]