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Introduction
  •  Epidemiology
    • commonly part of ankylosing spodyliitis or Reiter's syndrome
    • most commonly presents in teen to middle aged individuals
      • males > females
  • Pathophysiology
    • can stem from traumatic event or infection
    • pregnancy may lead to increased incidence in some females
    • often stems from chronic inflammation of SI joints
    • can lead to fibrosis and ossification within SI joint
  • Associated conditions
    • ankylosing spodyliitis 
      • associated with HLA-B27
      • 1-2% of all individuals will have HLA-B27
    • Reiter's syndrome 
      • oligoarticular arthritis, conjunctivitis and urethritis
    • joint arthritis
  • Prognosis
    • depends on cause but most patients will eventually resolve the episode and continue without issues
Presentation
  • Symptoms
    • pain with prolonged standing
    • difficulty climbing stairs
    • generalized low back pain
    • weakness from hip musculature on affected side
    • morning stiffness
  • Physical exam
    • FABER test
      • pain with flexion, abduction, and external rotation of hip
    • ankylosing spondylitis associated with
      • spinal flexion deformities
      • starting in T and L spines
Imaging
  • Radiographs
    • may show some erosive changes in the bone, but it’s not specific
    • may show calcifications or sclerosis within SI joint
  • MRI is study of choice
    • use gadolinium
    • T2’s show fluid/inflammation at the SI joint and maybe an abscess
Studies
  • Labs
    • WBC
      • usually normal
      • can be elevated with infection
    • ESR/CRP
      • usually elevated
    • blood cultures
      • are positive in 50%
    • HLA-B27
      • check for rheumatoid factor (should be negative for true Ankylosing spondylitis)
Treatment
  • Depends on cause
    • infection
      • IV antibiotics
        • until symptoms and the CRP resolve
        • then put on orals antibiotic
      • surgery
        • may be necessary if this fails or if there is a large abscess
    • trauma or overuse
      • rest, activity modification, NSAIDS, corticosteroid injections
        • indications
          • most resolve with soft tissue rest and activity modification
    • pregnancy
      • observation
        • typically resolves after childbirth
    • part of larger spondylopathy
      • aggressive PT, NSAIDs, TNF inhibitors
        • severe symptoms may require TNF inhibitors or other similar medications
 

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