Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of acute and chronic MRI features of sacroiliitis in asymptomatic primary hyperparathyroid patients

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Asymptomatic primary hyperparathyroidism (PHPT) is characterized with autonomous overproduction of parathyroid hormone without signs or symptoms associated with hyperparathyroidism. Before symptoms become obvious, PHPT may affect structures like sacroiliac joints, which consist of bone. So, in the asymptomatic PHPT patients, structural and inflammatory changes in sacroiliac joints may lead to confusion during diagnosis workup of axial spondyloarthropathy. In this study, we evaluated active and chronic sacroiliac magnetic resonance imaging (MRI) changes relevant to sacroiliitis in the patients with asymptomatic PHPT and interpreted bone marrow edema within the scope of Assessment of SpondyloArthritis International Society–Outcome Measures in Rheumatology Clinical Trials (ASAS-OMERACT) criteria. Forty-nine patients with asymptomatic PHPT, 26 patients with newly diagnosed axial spondyloarthropathy (SpA), and 37 healthy controls were enrolled. All subjects were evaluated by sacroiliac MRI for four active (bone marrow edema, enthesitis, capsulitis, and synovitis) and four chronic (subchondral sclerosis, subchondral/periarticular erosions, periarticular fat deposition, and bony bridges/ankylosis) lesions relevant to sacroiliitis. Bone marrow edema compatible with ASAS-OMERACT active sacroiliitis criteria in sacroiliac MRI was fulfilled by 16.3 % (8/49) of the asymptomatic PHPT patients which was similar with controls but statistically lower than axial SpA. Moreover, asymptomatic PHPT patients and controls were similar for other chronic or active MRI findings. Also, we detected lower frequency of all other MRI findings, except enthesis, in asymptomatic PHPT patients according to axial SpA. Acute inflammatory including bone marrow edema fulfilling ASAS-OMERACT active sacroiliitis criteria and chronic structural sacroiliac lesions relevant to sacroiliitis in MRI were detected in asymptomatic PHPT similar frequency with controls but as expected, lower than axial SpA. But, these findings could not be attributed to excessive secretion of parathyroid hormone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Macfarlane DP, Yu N, Leese GP (2013) Subclinical and asymptomatic parathyroid disease: implications of emerging data. Lancet Diabetes Endocrinol 1(4):329–340. doi:10.1016/S2213-8587(13)70083-4

    Article  PubMed  Google Scholar 

  2. Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, Jacobs TP, Siris ES, Cafferty M, Parisien MV et al (1989) Skeletal disease in primary hyperparathyroidism. J Bone Miner Res Off J Am Soc Bone Miner Res 4(3):283–291. doi:10.1002/jbmr.5650040302

    Article  CAS  Google Scholar 

  3. Yang Q, Sun P, Li J, Yang Z, Li X, Li Z, Yan J, Li K, Wang L (2015) Skeletal lesions in primary hyperparathyroidism. Am J Med Sci 349(4):321–327. doi:10.1097/MAJ.0000000000000441

    Article  PubMed  Google Scholar 

  4. Qian ZH, Bai RJ, Yan D, Li XM, Cheng XG, Gu X, Qu H (2013) Skeletal disease in primary hyperparathyroidism: X-ray, CT and MR imaging founding. Zhonghua Yi Xue Za Zhi 93(1):30–33

    PubMed  Google Scholar 

  5. Dihlmann W (1978) X-ray diagnosis of sacroiliac joints and their close surroundings. Fortschr Geb Rontgenstrahlen Nuklearmed Erganzungsbd 97:1–160

    CAS  PubMed  Google Scholar 

  6. Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, Burgos-Vargas R, Collantes-Estevez E, Davis J, Dijkmans B, Dougados M, Emery P, van der Horst-Bruinsma IE, Inman R, Khan MA, Leirisalo-Repo M, van der Linden S, Maksymowych WP, Mielants H, Olivieri I, Sturrock R, de Vlam K, Sieper J (2009) The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis 68(6):770–776. doi:10.1136/ard.2009.108217

    Article  CAS  PubMed  Google Scholar 

  7. Fraser WD (2009) Hyperparathyroidism. Lancet 374(9684):145–158. doi:10.1016/S0140-6736(09)60507-9

    Article  CAS  PubMed  Google Scholar 

  8. Bilezikian JP, Potts JT Jr, Fuleihan Gel H, Kleerekoper M, Neer R, Peacock M, Rastad J, Silverberg SJ, Udelsman R, Wells SA (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab 87(12):5353–5361. doi:10.1210/jc.2002-021370

    Article  CAS  PubMed  Google Scholar 

  9. Sieper J, van der Heijde D, Landewe R, Brandt J, Burgos-Vagas R, Collantes-Estevez E, Dijkmans B, Dougados M, Khan MA, Leirisalo-Repo M, van der Linden S, Maksymowych WP, Mielants H, Olivieri I, Rudwaleit M (2009) New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis 68(6):784–788. doi:10.1136/ard.2008.101501

    Article  CAS  PubMed  Google Scholar 

  10. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, Jorgensen K (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18(3):233–237

    Article  CAS  PubMed  Google Scholar 

  11. RG L, SJ P, WP M, P C-k, M. O (209) Active inflammatory lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis—definitions, assessment system, and reference image set. J Rheumatol 84:1–2

  12. M O, WP M, SJ P, P C-s, RG L (2009) Structural lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis: definitions, assessment system, and reference image set. J Rheumatol 84:18–34

  13. Rudwaleit M, Jurik AG, Hermann KG, Landewe R, van der Heijde D, Baraliakos X, Marzo-Ortega H, Ostergaard M, Braun J, Sieper J (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68(10):1520–1527. doi:10.1136/ard.2009.110767

    Article  CAS  PubMed  Google Scholar 

  14. Baraliakos X, Braun J (2015) Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences? RMD Open 1(Suppl 1), e000053. doi:10.1136/rmdopen-2015-000053

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Marcocci C, Cetani F (2011) Clinical practice. Primary hyperparathyroidism. N Engl J Med 365(25):2389–2397. doi:10.1056/NEJMcp1106636

    Article  CAS  PubMed  Google Scholar 

  16. Tuite MJ (2008) Sacroiliac joint imaging. Semin Musculoskelet Radiol 12(1):72–82. doi:10.1055/s-2008-1067939

    Article  PubMed  Google Scholar 

  17. Lim YZ, Wang Y, Wluka AE, Davies-Tuck ML, Hanna F, Urquhart DM, Cicuttini FM (2014) Association of obesity and systemic factors with bone marrow lesions at the knee: a systematic review. Semin Arthritis Rheum 43(5):600–612. doi:10.1016/j.semarthrit.2013.10.006

    Article  PubMed  Google Scholar 

  18. Hartz AJ, Fischer ME, Bril G, Kelber S, Rupley D Jr, Oken B, Rimm AA (1986) The association of obesity with joint pain and osteoarthritis in the HANES data. J Chronic Dis 39(4):311–319

    Article  CAS  PubMed  Google Scholar 

  19. Madsen KB, Jurik AG (2010) Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint. Arthritis Care Res (Hoboken) 62(1):11–18. doi:10.1002/acr.20008

    Article  Google Scholar 

  20. Weber U, Lambert RG, Ostergaard M, Hodler J, Pedersen SJ, Maksymowych WP (2010) The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum 62(10):3048–3058. doi:10.1002/art.27571

    Article  PubMed  Google Scholar 

  21. de Hooge M, van den Berg R, Navarro-Compan V, van Gaalen F, van der Heijde D, Huizinga T, Reijnierse M (2013) Magnetic resonance imaging of the sacroiliac joints in the early detection of spondyloarthritis: no added value of gadolinium compared with short tau inversion recovery sequence. Rheumatology (Oxford) 52(7):1220–1224. doi:10.1093/rheumatology/ket012

    Article  Google Scholar 

  22. Jans L, van Langenhove C, Van Praet L, Carron P, Elewaut D, Van Den Bosch F, Lambrecht V, Jaremko JL, Verstraete K (2014) Diagnostic value of pelvic enthesitis on MRI of the sacroiliac joints in spondyloarthritis. Eur Radiol 24(4):866–871. doi:10.1007/s00330-013-3074-9

    Article  CAS  PubMed  Google Scholar 

  23. Chen F, Li S, Zhang X, Chen Y, Hu S, Zhao Y (2014) Magnetic resonance imaging for pelvic bone marrow fat deposition in patients with ankylosing spondylitis. Nan Fang Yi Ke Da Xue Xue Bao J South Med Univ 34(2):256–259

    Google Scholar 

  24. Aydingoz U, Yildiz AE, Ozdemir ZM, Yildirim SA, Erkus F, Ergen FB (2012) A critical overview of the imaging arm of the ASAS criteria for diagnosing axial spondyloarthritis: what the radiologist should know. Diagn Interv Radiol 18(6):555–565

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, 34890, Istanbul, Turkey

    Mehmet Engin Tezcan

  2. Department of Endocrinology and Metabolism, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey

    Sule Temizkan, Kadriye Aydin & Aysenur Ozderya

  3. Department of Radiology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey

    Safiye Tokgoz Ozal

  4. Department of Family Medicine and Diabetes, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey

    Deniz Gul & Mehmet Sargin

Authors
  1. Mehmet Engin Tezcan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sule Temizkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Safiye Tokgoz Ozal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deniz Gul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kadriye Aydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aysenur Ozderya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mehmet Sargin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Engin Tezcan.

Ethics declarations

This study was approved by the Local Research Ethics Committee and carried out in compliance with the Helsinki Declaration. Both of the patient groups and the healthy participants gave written informed consent.

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tezcan, M.E., Temizkan, S., Ozal, S.T. et al. Evaluation of acute and chronic MRI features of sacroiliitis in asymptomatic primary hyperparathyroid patients. Clin Rheumatol 35, 2777–2782 (2016). https://doi.org/10.1007/s10067-016-3172-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-016-3172-6

Keywords

Search

Navigation