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vol. 56

What’s in a name? That which we call sacroiliitis by any other name would look the same…

Alfredo Tarantino
Justyna Paulina Jablonska
Paola D’Aprile

Reumatologia 2018; 56, 3: 129-130
Online publish date: 2018/06/30
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“What’s in a name? That which we call a rose
By any other name would smell as sweet.”
Romeo and Juliet (II, 2, 1–2)

Since the appearance of magnetic resonance imaging (MRI), the diagnostic rates of sacroiliac joint (SIJ) changes have increased rapidly.
The term sacroiliitis is generally used to indicate oedema of the SIJ of rheumatic origin, but similar oedematous lesions may be of non-rheumatic origin, even more frequently, in patients with chronic low back pain. Distinguishing rheumatic from non-rheumatic sacroiliitis is very important in terms of therapeutic choice. In particular, overdiagnosis of rheumatic sacroiliitis may result in the prescription of expensive and inappropriate treatments. Therefore, the term “sacroiliitis” may possibly be unsuitable in the near future.
Let us start by asking “what is inflammation?” Inflammation is, generally speaking, the body’s immune system’s response to a stimulus. Inflammation happens when the immune system fights against something that may turn out to be harmful. Inflammatory conditions always have a name ending with “-itis”, as in this case: sacroiliitis. We can divide them into rheumatic and non-rheumatic, such as mechanical and infective.
Diagnostics of rheumatic sacroiliitis, which is the primary feature and a hallmark of axial spondyloarthritis, is primarily based on clinical examination and laboratory testing. The clinical criterion used by rheumatologists when referring patients for accessory examinations (laboratory or radiological), is chronic back pain [1].
According to the Assessment of Spondyloarthritis International Society (ASAS) criteria, four types of inflammatory lesions in sacroiliitis associated with spondyloarthritis (SpA) can be identified: bone marrow oedema and osteitis, synovitis, enthesitis and capsulitis. Bone oedema and osteitis are indispensible to diagnose active sacroiliitis only [2].
Bone marrow oedema is detected as areas of increased signal intensity in T2-weighted images with fat saturation or short  inversion recovery sequences (STIR), and is interpreted as an acute inflammatory lesion. It is usually hypointense in T1-weighted sequences. In T1-weighted sequences with fat suppression after the i.v. injection of paramagnetic contrast it shows an enhacement due to inereased of vascularization and reactive perfusion to inflammation and it is categorized as osteitis [3].
To diagnose sacroiliitis it was...

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