Wang Yanyan, Geng Shaohui, Lin Zhimin, Jiang Haixu, Yang Chunhua, Zhang Yamei, Huang Feng
Department of Rheumatology, Beijing Electric Power Hospital, Beijing, 100073, China.
School of Life Sciences, Beijing University of Chinese Medicine, Beijing, 102488, China.
Clin Rheumatol. 2025 Mar;44(3):1337-1344. doi: 10.1007/s10067-024-07278-8. Epub 2025 Jan 25.
To study the clinical, imaging, and computed tomography (CT)-guided biopsy pathology of patients with infectious sacroiliitis (ISI). We retrospectively analysed 135 patients diagnosed with ISI between 2008 and 2020, comprehensively evaluating clinical characteristics, laboratory test outcomes, pathological examination results, and magnetic resonance images (MRI). Among the 135 patients with ISI, 90 (66.7%) were diagnosed with pyogenic sacroiliitis (PSI), 28 (20.7%) with tuberculous sacroiliitis (TSI), and 17 (12.6%) with brucella infectious sacroiliitis (BSI); 69 (51.1%) met the 2009 ASAS criteria for axial spondyloarthritis. The rate of back pain is lower in the PSI group (18.9%) than in the TSI (39.2%) and BSI (64.7%) groups. The Berlin MRI scoring in the sacroiliac joint showed erosion and bone marrow oedema in the PSI (3.11 ± 2.33, 8.55 ± 2.66) and TSI (3.14 ± 2.08, 7.88 ± 3.90) groups, with higher values than in the BSI group (1.62 ± 1.54, 5.23 ± 3.05). The erythrocyte sedimentation rate (ESR) was higher in the PSI (52.71 ± 29.63 mm/h) and TSI (56.22 ± 19.39 mm/h) groups than in the BSI group (33.29 ± 25.12 mm/h). Our study is crucial because all patients underwent CT-guided sacroiliac joint biopsy; 130 patients (86.7%) had positive results through tissue culture and pathological examination, and one (0.8%) had a confirmed Malassezia fungal infection by tissue next generation sequencing. Two patients (1.5%) were diagnosed through blood culture, and another (0.8%) was diagnosed through the brucellosis agglutination test. ISI is diagnostically challenging as it can mimic spondyloarthritis, particularly when relying exclusively on imaging and clinical parameters. CT-guided sacroiliac joint biopsy is indispensable as a diagnostic intervention for precisely differentiating infectious sacroiliitis and identifying the specific pathogens involved, especially in female patients who exhibit negative HLA-B27 status and manifest systemic symptoms such as fever, elevated ESR, and unilateral lesions on imaging. Key Points • To the best of our knowledge, this is the largest single-centre cohort study on infectious sacroiliitis in China. • CT-guided biopsy of the sacroiliac joint is necessary for identifying infectious sacroiliitis and pathogens. • This study provides insights into the clinical and imaging features of infectious sacroiliitis based on a large number of cases.
研究感染性骶髂关节炎（ISI）患者的临床、影像学及计算机断层扫描（CT）引导下活检病理情况。我们回顾性分析了2008年至2020年间诊断为ISI的135例患者，全面评估其临床特征、实验室检查结果、病理检查结果及磁共振成像（MRI）。在135例ISI患者中，90例（66.7%）诊断为化脓性骶髂关节炎（PSI），28例（20.7%）为结核性骶髂关节炎（TSI），17例（12.6%）为布鲁氏菌感染性骶髂关节炎（BSI）；69例（51.1%）符合2009年ASAS轴性脊柱关节炎标准。PSI组背痛发生率（18.9%）低于TSI组（39.2%）和BSI组（64.7%）。骶髂关节的柏林MRI评分显示，PSI组（3.11±2.33，8.55±2.66）和TSI组（3.14±2.08，7.88±3.90）存在侵蚀和骨髓水肿，评分高于BSI组（1.62±1.54，5.23±3.05）。PSI组（52.71±29.63mm/h）和TSI组（56.22±19.39mm/h）的红细胞沉降率（ESR）高于BSI组（33.29±25.12mm/h）。我们的研究至关重要，因为所有患者均接受了CT引导下骶髂关节活检；130例患者（86.7%）组织培养和病理检查结果呈阳性，1例（0.8%）通过组织下一代测序确诊为马拉色菌真菌感染。2例患者（1.5%）通过血培养确诊，另1例（0.8%）通过布鲁氏菌凝集试验确诊。ISI的诊断具有挑战性，因为它可模仿脊柱关节炎，尤其是仅依靠影像学和临床参数时。CT引导下骶髂关节活检作为一种诊断干预措施不可或缺，可精确区分感染性骶髂关节炎并识别所涉及的特定病原体，特别是对于HLA - B27状态为阴性且影像学表现为单侧病变并伴有发热、ESR升高和全身症状的女性患者。要点 • 据我们所知，这是中国最大的关于感染性骶髂关节炎的单中心队列研究。 • CT引导下骶髂关节活检对于识别感染性骶髂关节炎和病原体是必要的。 • 本研究基于大量病例深入探讨了感染性骶髂关节炎的临床和影像学特征。
