[1: Clinical aspects, laboratory diagnosis and therapy. Low backache--when is sacroiliitis the cause?].
Despite the availability of modern imaging modalities, early diagnosis of sacroiliitis remains a challenge. The patient's history and the results of the clinical examination form the basis for establishing a working diagnosis, which then needs to be confirmed by laboratory tests and diagnostic imaging. Common causes of sacroiliitis are inflammatory diseases of the spine, in particular seronegative spondyloarthropathies; infectious sacroiliitis is much less common. Besides serological testing (HLA-B27), imaging techniques are essential for diagnosing early forms of sacroiliitis. The treatment of the condition initially involves the use of non-steroidal anti-inflammatory drugs (NSAIDs). In patients with infectious sacroiliitis, antibiotics are the treatment of choice. Local application of steroids, or physiotherapy, can be helpful. The value of disease-modifying drugs (DMARDs) (sulfasalazine, methotrexate) has not been verified, and is questionable. New approaches such as anti-tumor necrosis factor alpha (anti-TNF alpha) need to be tested in controlled studies.
Kellner
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Rheumaeinheit der Universität, Med. Poliklinik, Klinikum Innenstadt der LMU München. Kellner@medpoli.med.uni-muenchen.de
Kellner
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D001168:Arthritis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D001416:Back Pain / Q000209:etiology* / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans; D012446:Sacroiliac Joint