Peripartum changes of the sacroiliac joints on MRI: increasing mechanical load correlating with signs of edema and inflammation kindling spondyloarthropathy in the genetically prone
- 26 May 2015
- journal article
- Published by Springer Science and Business Media LLC in Clinical Rheumatology
- Vol. 34 (8), 1419-1426
- https://doi.org/10.1007/s10067-015-2976-0
Abstract
The purpose of this study is to characterize the MRI changes of the sacroiliac joints (SIJs) during pregnancy and following labor and to correlate them with clinical symptoms. Ninety-three pelvic and hip MRIs of pregnant and ≤6 months postpartum women were retrospectively evaluated (Berlin method), for the presence of acute and structural SIJ changes. A telephone questionnaire focusing on pain characterization, co-morbidities, and clinical outcome was conducted with 52 subjects. Findings were correlated with pregnancy week/postpartum time and clinical parameters. SIJ-bone marrow edema (BME) and subchondral sclerosis were a prevalent peripartum finding (46/26 % subjects, respectively), and their frequency increased with pregnancy age. Also, BME, joint fluid, capsulitis, and enthesitis total score were correlated with pregnancy age/postpartum time (r = 0.2–0.31, P = 0.013–0.036). Significant correlation was noted between BME and subchondral sclerosis scores (r = 0.485, P < 0.0001). A sizable proportion of women showed diffuse SIJ BME (7.6 %) and this correlated with slower resolution of symptoms. Indeed, in half of the cases in which MRI was performed due to pregnancy-induced low-back pain (LBP) and diffuse BME was found—spondyloarthropathy ensued. In conclusion, pregnancy and puerperium are associated with a host of acute findings in and around the SIJ, including BME, capsulitis, and enthesitis, reflecting most probably, mechanical load and hormonal changes. While the vast majority of symptoms abate within weeks to several months postpartum, 3.8 % of women go on to develop spondyloarthropathy. Diffuse SIJ BME and the presence of risk factors for spondyloarthropathy are predictive of a chronic course.Keywords
This publication has 28 references indexed in Scilit:
- Magnetic Resonance Imaging of Sacroiliitis in Patients with Spondyloarthritis: Correlation with Anatomy and HistologyRöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2013
- Effects of etanercept versus sulfasalazine in early axial spondyloarthritis on active inflammatory lesions as detected by whole-body MRI (ESTHER): a 48-week randomised controlled trialAnnals Of The Rheumatic Diseases, 2011
- Association of familial Mediterranean fever–related MEFV variations with ankylosing spondylitisArthritis & Rheumatism, 2010
- Osteitis condensans ilii: a significant association with sacroiliac joint tenderness in womenInternational Journal of Rheumatic Diseases, 2009
- Peripartale Veränderungen des Beckenringes:Wie sinnvoll ist die Magnetresonanztomografie?RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2007
- Postpartum pelvic pain - the ‘pelvic joint syndrome’: a follow-up study with special reference to diagnostic methodsActa Obstetricia et Gynecologica Scandinavica, 2005
- Incidence of Four Syndromes of Pregnancy-Related Pelvic Joint PainSpine, 2002
- Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac jointsActa Obstetricia et Gynecologica Scandinavica, 2001
- Previous Back Pain and Risk of Developing Back Pain in a Future PregnancySpine, 1991
- The Relationship of the Effect and Pain of Pregnancy to the Anatomy of the PelvisActa Radiologica, 1952