Akademik Veri Yönetim Sistemi
28th European Paediatric Rheumatology Congress, Praha, Çek Cumhuriyeti, 20 - 23 Eylül 2022, cilt.20, sa.2, ss.71-72
Poster session: Spondyloarthritis (SpA)
and enthesitis related arthritis (ERA)
P102.
Childhood-onset sacroiliitis: rheumatic causes and the correlation
between clinical findings and magnetic resonance imaging
P. O. Avar-Aydin1 , Z. B. Ozcakar1 , S. Kaynak-Sahap2 , F. Aydin1 , C.
Arslanoglu 1
, N. Cakar1 , O. S. Fitoz2 , F. Yalcinkaya 1
1
Department of Pediatric Rheumatology, 2 Department of Pediatric
Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
Correspondence: P. O. Avar-Aydin
Pediatric Rheumatology 2022, 20(Suppl 2):P102.
Introduction: Childhood-onset sacroiliitis is a challenging condition
that requires to consider several causes in the differential diagnosis
including infections, malignancies, medications, and rheumatic
diseases.
Objectives: To evaluate the etiology and the features of MRI-proven
sacroiliitis in pediatric patients with rheumatic diseases in a referral
center from an Eastern Mediterranean country.
Methods: Demographic and clinical data were extracted from the
electronic medical records of the patients with sacroiliitis followed in
the last 5 years. Active inflammatory changes of the sacroiliac joint
(SIJ) were scored by the inflammation score according to the degree,
intensity, and depth of the bone marrow edema (BME) and the
presence of enthesitis, capsulitis, and structural damage lesions was
evaluated by the modified SPARCC scoring system.
Results: A total of 46 patients were found to have MRI-proven sacroi-
liitis with a mean follow-up of 3.13±2.15 years. There were three
groups of patients diagnosed with sacroiliitis when classified accord-
ing to etiology: JIA (n:17), FMF (n:14), and CNO (n:8). Seven patients,
FMF and JIA (n:6) and FMF and CNO (n:1) had a co-diagnosis that
might cause sacroiliitis and they were excluded from the group ana-
lyses. Thirty patients (65.2%) were male. The mean age at disease on-
set was 10.97±3.93 years and six patients diagnosed with FMF or
CNO were younger than 6 years. The prevalence of sacroiliitis in the
relevant cohorts was 11.9% for JIA, 3.8% for FMF, and 34.6% for CNO
groups. On the MRI of the SIJ, capsulitis was present in 17 patients
(37.0%) and enthesitis in 14 patients (30.4%) in addition to BME with
a mean total inflammation score of 22.50±13.80. Besides, structural
damage lesions were present in 73.9% of the patients at the onset of
sacroiliitis. Nonsteroidal anti-inflammatory drugs were used in all pa-
tients as the first-line treatment. Disease-modifying anti-inflammatory
drugs were given to 67.4% and TNFi to 54.3% of the patients.
In the comparative analyses of three groups of patients, the weight
and height percentiles were significantly lower in FMF group and
HLA-B27 was more frequent in JIA group. Other findings of demo-
graphics, family history, differential blood counts, acute phase
Pediatric Rheumatology 2022, 20(Suppl 2):75 Page 71 of 266
reactants, and the usage of TNFi were similar. BME intensity score on
MRI and the frequency of capsulitis and enthesitis were significantly
higher in CNO group. There was a significantly strong or moderate
correlation between total inflammation score and inflammatory back
pain, JSpADA score, ISSF score, clinical CNO score, and CRP; BME in-
tensity score and inflammatory back pain, JSpADA score, and CRP;
BME depth score and ISSF score, clinical CNO score, CRP, and ESR;
and the presence of sclerosis/erosion and clinical CNO score.
Conclusion: This is the first study to evaluate the etiology of
sacroiliitis in children with various pediatric rheumatic diseases and
the relationship between clinical and MRI findings of newly-
diagnosed sacroiliitis. We demonstrated that JIA, FMF, and CNO were
the causes of childhood-onset sacroiliitis in our region. Characteristic
findings on MRI might help the differential diagnosis of patients with
sacroiliitis. Moreover, inflammatory and structural damage lesions
found on MRI correlated with several clinical and laboratory features