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Subclinical sacroiliitis in brucellosis

Clinical presentation and MRI findings

Subklinische Sakroiliitis bei Brucellose

Klinisches Bild und MRT-Befunde

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Abstract

Purpose

The aim of this work was to detect subclinical sacroiliac joint involvement in patients with brucellosis and study their clinical and laboratory features.

Patients and methods

The study included 100 brucellosis patients being followed-up in the Gastroenterology and Hepatology Unit, Theodor Bilharz Research Institute and Cairo University outpatient clinics. A thorough history, physical examination, routine laboratory tests, and abdominal ultrasound were obtained for all patients. Extended rheumatological examination was performed including clinical testing for sacroiliitis and enthesitis. None of the patients reported a history of back pain or any symptoms suggestive of sacroiliitis during the course of the infection. Plain x-ray and MRI scan of the sacroiliac joints were performed for all patients.

Results

Asymptomatic sacroiliitis was present in 24 % of the brucellosis patients; none of the patients had tenderness over their spine with preserved lumbar spine mobility. Sacroiliitis was mainly unilateral being bilateral in 20.83 %. There was an obvious relationship with animal contact and occupation of the patients. Osteoarticular involvement was common (67 %) including arthralgias, arthritis, myalgias, spondylitis, enthesitis and bursitis, being clearly higher in those with sacroiliitis. The MRI scan showed blurring of the margins in 66.67 %, widening in 25 %, narrowing in 54.17 %, erosions in 20.83 %, and sclerosis in 12.5 %.

Conclusion

Osteoarticular manifestations of brucellosis are prevalent and subclinical sacroiliitis is evident, a finding that may classify these patients as having brucellar spondyloarthropathy (BSA). Referring brucellosis patients for rheumatological assessment has the advantage of early assessment of asymptomatic cases with sacroiliitis which is commonly overlooked.

Zusammenfassung

Ziel

Ziel dieser Arbeit war die Aufdeckung einer subklinischen Beteiligung des Sakroiliakalgelenks bei Brucellosepatienten und die Untersuchung klinischer wie laborchemischer Charakteristika.

Patienten und Methoden

In die Studie eingeschlossen wurden 100 Brucellosepatienten, das Follow-up lag bei der Gastroenterology and Hepatology Unit am Theodor Bilharz Research Institute und Ambulanzen der Universität Kairo. Eine gründliche Anamnese, körperliche Untersuchung, Routinelabordiagnostik und eine abdominale Sonographie wurden für alle Patienten durchgeführt, außerdem eine ausführliche rheumatologische Untersuchung einschließlich klinischer Tests hinsichtlich Sakroiliitis und Enthesitis. Keiner der Patienten gab Rückenschmerzen an oder andere Symptome, die auf eine Sakroiliitis im Verlauf der Infektion hingewiesen hätten. Native Röntgenaufnahmen und Magnetresonanztomographien wurden für alle Patienten angefertigt.

Ergebnisse

Eine asymptomatische Sakroiliitis bestand bei 24% der Brucellosepatienten; keiner hatte eine Schmerzempfindlichkeit im Bereich der Wirbelsäule und bei allen war die LWS(Lendenwirbelsäule)-Mobilität erhalten. Die Sakroiliitis war im Wesentlichen unilateral, in 20,83 % bilateral. Ein offensichtlicher Zusammenhang bestand zu Tierkontakt und Beruf der Patienten. Eine osteoartikuläre Beteiligung war verbreitet (67 %), einschließlich Arthralgien, Arthritis, Myalgien, Spondylitis, Enthesitis und Bursitis, deutlich häufiger bei den Patienten mit Sakroiliitis. Die MRT zeigte verwaschene Grenzen in 66,67 %, Erweiterungen in 25 %, Verschmälerungen in 54,17 %, Erosionen in 20,83 % und Sklerosierungen in 12,5 %.

Fazit

Osteoartikuläre Manifestationen einer Brucellose sind prävalent, eine subklinische Sakroiliitis evident; diesem Befund zufolge lassen sich diese Patienten als Patienten mit Brucellose-assoziierter Spondylarthropathie (BSA) klassifizieren. Patienten mit Brucellose zu einem rheumatologischen Assessment zu überweisen hat den Vorteil einer frühen Evaluierung von asymptomatischen Sakroiliitiden, die in der Regel übersehen wird.

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Compliance with ethical guidelines

Conflict of interest. TA Gheita, S Sayed, GS Azkalany, HS El Fishawy, MA Aboul-Ezz, MH Shaaban, and RH Bassyouni state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    T.A. Gheita MD, S. Sayed & G.S. Azkalany

  2. Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    H.S. El Fishawy

  3. Gastroenterology and Hepatology unit, Theodor Bilharz Research Institute, Cairo, Egypt

    M.A. Aboul-Ezz

  4. Radiodiagnosis Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    M.H. Shaaban

  5. Medical Microbiology and Immunology Department, Faculty of Medicine, El-Fayoum University, Fayoum, Egypt

    R.H. Bassyouni

Authors
  1. T.A. Gheita MD
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  2. S. Sayed
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  3. G.S. Azkalany
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  4. H.S. El Fishawy
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  5. M.A. Aboul-Ezz
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  6. M.H. Shaaban
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Correspondence to T.A. Gheita MD.

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Gheita, T., Sayed, S., Azkalany, G. et al. Subclinical sacroiliitis in brucellosis. Z. Rheumatol. 74, 240–245 (2015). https://doi.org/10.1007/s00393-014-1465-1

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  • DOI: https://doi.org/10.1007/s00393-014-1465-1

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