What is your approach to a patient with incidental radiographic findings of sacroiliitis without clinical inflammatory back pain?
I agree. As mentioned, often, the radiology report going back to orthopedics, for example, may say "spondyloarthropathy" whereas, in fact, the radiologist is just describing osteoarthritis and/or spondylosis (the combination of OA and degenerative disc disease). Then, a rheumatology referral is initiated. Many radiologists use the terms spondyloarthropathy and degenerative spondylosis interchangeably, which is not correct. In unilateral sacro-iliitis, with pain and especially fever, for example, an infection must be ruled out. The finding of bone marrow edema by an MRI is actually non-specific, and it requires follow-up. Finally, in my opinion, the new entity of non-radiographic axial spondyloarthropathy is confusing to many practicing phys...
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This is a frequent situation and a very challenging one. My approach is to ensure that the clinical scenario is actually true that the patient does have true sacroiliitis that meets the Assessment of Spondyloarthritis International Society (ASAS) criteria (Please see at the end).
In my opinion, the most common scenario here is an over-read or mis-read from radiology where incidental or non-specific finding has been actually read as sacroiliitis on an MRI when the findings do not actually represent the inflammatory process. Nothing further is needed in these cases.
In case that the MRI actually does have the presence of sacroiliitis by ASAS criteria but the patient is asymptomatic, taking a detailed and focused history and physical exam wo...
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