20 yo female just gave birth to first child and developed low back pain. MRI showed some L5/S1 disc space disease but to my surprise XR showed sacroilitis in the joint. Rhem panel negative. Has anyone seen this? I was planning on sending to rheum but the negative panel surprised me too. Normal BMI and no IVDU
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Sacroilitis
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Is it triangular? It may also be osteitis condensans illi.
Can you see the SI joint on the MR? Given recent baby, I’d bet it’s benign sclerosis and unrelated. There should be marrow edema for true sacroiliitis.
Can you see the SI joint on the MR? Given recent baby, I’d bet it’s benign sclerosis and unrelated. There should be marrow edema for true sacroiliitis.
Rheum panel include HLA-B27?
H/o psoriasis? It likes the SIJ. Sacroiliac joint pain as an important element of psoriatic arthritis diagnosis
Still more likely related to relaxin hormone and pushing out a baby. How far out from childbirth? C-section or vag delivery?
She just gave birth people. All her ligaments and tendons are loosey goosey from her progesterone and relaxin then she forced a watermelon through a lemon sized hole. Pelvic/back pain is completely normal.
What was the physical exam like? Treat patients not pictures.
If she's in a ton of pain, I'd be willing to treat her SI joints, facets, disc, whatever. But honestly this will improve over the next 3 months or so on it's own.
What was the physical exam like? Treat patients not pictures.
If she's in a ton of pain, I'd be willing to treat her SI joints, facets, disc, whatever. But honestly this will improve over the next 3 months or so on it's own.
Thanks for the thoughts. To answer some questions - She is approximately 9 + months out from childbirth vag delivery. No hx of rheum disease. Did PT x2 without benefit. Panel I ran included ANA, RF, HLA-B27, ESR, CRP - all normal. MRI was for lumbar spine as her pain localizes to lumbosacral junction. I read about how the first rheumatic flare for many patients occurs during and after childbirth but I have never seen it. Radiologist read XR as sacroilitis. Exam is pretty benign other then pain around the lumbosacral junction - pain to palpation of the SI joints but provocative testing is not positive.
Have to admit I've never heard of this. I'll double check the imaging on Monday.
9 mo later……
Do SIJ and triple cream + sij stretches.
If MRI Lspine normal and rheum workup neg, then nothing else to do. Would not offer MBB without correlation with hx and if disc pain and normL mri there is nothing else to do.
Do SIJ and triple cream + sij stretches.
If MRI Lspine normal and rheum workup neg, then nothing else to do. Would not offer MBB without correlation with hx and if disc pain and normL mri there is nothing else to do.
I think you meant to say, "FABER and Gaenslen positive. Sacral compression positive. Fortin finger positive. Tender to palpation at the SIJ."
Right?
Isn't that what you meant to say?
what is the third thing in your cream? I do a reasonable number of ketoprofen/lidocaine topical creams
I wouldn't. Likely self resolving process unless clinically you think she has an inflammatory Spondyloarthropathy or infection. MRI only helpful if it affects your management.
Resolving process this many months after delivery? No.
MRI to assess for disease process and possible need for Rheum to Rx Plaquenil.
Inject it.
Why wait for the mri? Is it gonna chance ur management?
If inflammation on mri would send to rheum. So yes.
Yes it would. MRI is the gold standard in diagnosing true sacroilitis
Maybe. Maybe not. Clearing out this lady but I’ve had a lady in the past with cancer on the SIJ. CT scan is posted in the picture forum somewhere
Probably gonna poke it even if it doesn’t light up on the mri
Wouldn’t poke it if it lights up. True sacroilitis on mri will show inflammation/edema throughout periarticular bone. I don’t think a local injection will help much
I find SI injections very effective in MRI-positive spondyloarthropathies. Not super durable but usually high percent relief.
I have seen 2 in last 16 years. I work with 2 Rheumatologists. How many you seeing?
Not a ton, 1-2/year. I think my demographic skews younger than yours since I do minimal Medicare.
