SPR Unknown #71 -- FINAL

Krishna Amuluru

Loyola

kamuluru008@md.northwestern.edu

Mary Wyers, M.D.

Abstract

15 y/o male with diarrhea and chronic back pain

Keywords

IBD, Inflammatory bowel disease, sacroilitis, IBD arthropathy, 1768


Publication Date: 20120504

History

15 y/o male with diarrhea and chronic back and hip pain

Findings

Radiograph of the pelvis shows no fracture or dislocation. There is subtle asymmetric increased sclerosis surrounding both SI joints.

MR shows increased T2 signal (images 2-4) within both greater trochanters, especially surrounding the insertion of the right gluteus medius musculature at the greater trochanter. There is increased T2 signal surrounding both SI joints. There is mural enhancement of the sigmoid colon on the post gad sequence (image 5).

Discussion

Inflammatory bowel disease (IBD), such as Crohn disease or Ulcerative colitis can be associated with peripheral arthritis and/or spondyloarthropathy.

Patients may present with arthritis which can be clinically indistinguishable from that of ankylosing spondylitis (AS), consisting of low back pain and stiffness. Arthritis is the most common extraintestinal abnormality in IBD. 10-15% of patients with IBD may develop arthropathy. Most cases are mild and peripheral with few osseous changes. However, 20-30% will develop spondyloarthropathy like AS. Activity of peripheral arthritis parallels gut inflammation. HLA-B27 will be positive in 50% of patients with IBD arthritis.

Imaging findings in radiographs of spondyloarthropathy are similar to that of ankylosing spondylitis and may include bilateral sacroiliitis, syndesmophytes with vertebral body fusion (bamboo spine), or peripheral arthropathy.

MR fluid-sensitive sequences may show high signal edema at sites of tendon insertions (enthesitis), at the sacroiliac joints, and arthritis related changes involving peripheral joints.

References

  1. Jose FA et al: Development of extraintestinal manifestations in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 15(1):63-8, 2009
  2. Dotson JL et al. Extraintestinal manifestations of pediatric inflammatory bowel disease and their relation to disease type and severity. J Pediatr Gastroenterol Nutr. 2010 Aug;51(2):140-5.

5 images