Spondyloarthropathies

Objective: Seronegative spondyloarthritis (SpA) is characterized by chronic inflammation affecting the axial skeleton, entheses and occasionally peripheral joints. The involvement of the sacroiliac joints, sacroiliitis, is considered as a pathognomonic radiographic finding. Magnetic resonance imaging (MRI) is the method of choice for its early detection. Bone scintigraphy (BS) is characterized by high sensitivity in the diagnosis of bone and articular diseases. Limited value of BS in the diagnosis of sacroiliitis may be attributed to the use of planar imaging. In the present study, we aimed to investigate the role of SPECT in SpA, compared to MRI. Methods: Forty-three patients suffering from inflammatory back pain underwent MRI evaluation of the sacroiliac joints and BS, combined with SPECT in the same region, for the assessment of sacroiliitis. Results: Bone SPECT revealed no findings of sacroiliitis in 11 patients, with total agreement with MRI. Findings of chronic lesions were demonstrated from both modalities in 2 patients. Bone SPECT and MRI findings were in concordance regarding the investigation of active sacroiliitis, with the exception of one patient with mild SPECT findings and negative MRI examination; the diagnosis of AS however, was established one year later, after a positive follow-up MRI. The evaluation of the planar imaging of the whole skeleton and SPECT imaging, revealed additional lesions. Conclusions: Bone SPECT is a reliable imaging method in the diagnosis of active sacroiliitis. Its application on planar BS, an economic and widely available diagnostic technique, appears to be a valuable aid for the clinician. Öz Amaç: Seronegatif spondiloartrir (SpA) aksiyal iskelet, entezler ve nadiren perifer eklemlerin kronik enflamasyonu ile karakterizedir. Sakroiliak eklem tutulumu, sakroiliit, patognomonik bir radyografik bulgu olarak kabul edilir. Manyetik rezonans görüntüleme (MRG) erken tanı için tercih edilen yöntemdir. Kemik sintigrafisi (KS) kemik ve eklem hastalığının tanısında yüksek duyarlılığa sahiptir. KS'nin sakroiliit tanısındaki kısıtlı değeri planar görüntüleme kullanılmasına bağlı olabilir. Bu çalışmada SpA'da SPECT'in rolünün MRG ile karşılaştırılması amaçlandı.

Introduction
Spondyloarthritis (SpA) are a group of inflammatory rheumatic diseases that share some common clinical and genetic features such as inflammatory back pain, peripheral arthritis, enthesitis, anterior uveitis, sacroiliitis, and HLA-B27 positivity. The aim of the present study was to describe the clinical, radiologic, and genetic features of patients with undifferentiated spondyloarthritis (uSpA) and ankylosing spondylitis (AS).
Patients and methods
This study included 225 SpA patients (134 uSpA and 91 AS) attending our Rheumatology Outpatient Clinic consecutively. Patients underwent peripheral and axial joint and enthesitis assessment, erythrocyte sedimentation rate or C-reactive protein determination, HLA-B27 tissue typing, radiographic evaluation, and sacroiliac MRI.
Results
In total, 26 of 91 AS patients and 115 of 134 uSpA patients were women (28.6 vs. 85.8%) and 65 of AS and 19 of uSpA were men (71.4 vs. 14.2%). The time for diagnosis was 15.82 ± 20.7 months for AS patients and 5.91 ± 3.63 months for uSpA patients. Diagnostic delay was 102.46 ± 88.99 (median 83, range 8–377) months for AS and 74.23 ± 60.7 (median 55.5, range 0–238) months for uSpA patients. HLA-B27 positivity was present in 51.6% of AS and 14.9% of uSpA patients. The mean BASDAI level of patients with AS was 6.4 ± 1.1 and that of uSpA patients was 4.8 ± 2.1.
Conclusion
SpA are frequent diseases and physicians other than rheumatologists should also be aware of them. uSpA is more frequent in women than men. Early diagnosis of SpA is important because early treatment with new biological therapies may lead to much better results than applying them in the advanced stages.

Ankylosing spondylitis (AS) is a chronic, inflammatory, and progressive rheumatic disease that is a member of a family of disease referred to as spondyloarthritis. Although the prevalence estimates of AS vary from 0.25% up to 4.5% in living human populations , the frequency of the disease in the past has not yet been determined. Some suspected AS cases have been reported only based on the vertebral ankyloses or fusions of sacroiliac joints dating from the Neolithic period to the Middle Ages among ancient Anatolian populations, but the AS diagnosis has not been definitively revealed in these cases. In this study, we aimed to identify an AS case that has AS-originated pathological changes on a relatively well-preserved middle-aged male skeleton, recovered from the archaeological excavation of Kılıçlı Church, Sinope, Northern Turkey and dated to the 18-9th centuries. In addition, we made a differential diagnosis with other pathologies such as diffuse idiopathic skeletal hyperostosis, reactive arthritis, and psoriatic arthritis. In the specimen, there are four macroscopic features that are diagnostic of AS: (a) both sacroiliac joints were symmetrically obliterated, (b) spinal fusion was observed without skipping any vertebrae, (c) the spine has "bamboo spine" appearance, and (d) the vertebral syndesmophytes caused squaring of the vertebral bodies. We conclude that the Kılıçlı skeleton, one of the few archaeological specimens showing all symptoms of AS disease, is the first convincing case in Anatolia.

Spondyloarthropathies (SpA) encompass a group of common inflammatory rheumatic conditions. These disorders share common genetic predisposing factors and clinical features,
including inflammatory arthritis, enthesitis, and potential extra-articular manifestations. Up to now, the diagnosis of SpA in palaeopathology is based on a set of major lesions: sacroiliitis,
vertebral syndesmophytes and peripheral arthritis. Development of additional criteria for the diagnosis of SpA may  contribute to a better evaluation of their prevalence into osteological samples and give increased knowledge of the incidence of these diseases in past populations. By comparing biomedical data with data from the palaeopathological literature, we point out musculoskeletal changes rarely, if ever, used for SpA identification on osteological material. In order to evaluate the relevance of these “minor” changes in palaeopathology, we carried out a comparative study of three skeletal samples: 6 probable cases of SpA, 32 possible cases, and 53 “healthy” individuals from the same post-medieval cemetery. The results indicate that some of these features (e.g. osteolytic lesions at the temporomandibular joint, association of peripheral calcification and erosion of  vertebral end plates)  are characteristic of affected individuals. These results also allow us to recognise “minor” lesion patterns that seem specific to this group of conditions. Thanks to this type of study, origins and causes of SpA could be discussed. Combined with information about funerary treatment or organisation of burial area, these palaeopathological data  can  also  contribute to  reveal behavioural aspects of  past populations, especially care for disabled people.
spondyloarthropathies, palaeopathology, diagnosis, criteria, enthesis.