title: Subclinical sacroiliitis in brucellosis. Clinical presentation and MRI findings.
abstract: OBJECTIVE
  The aim of this work was to detect subclinical sacroiliac joint involvement in patients with brucellosis and study their clinical and laboratory features.
  
  
  METHODS
  The study included 100 brucellosis patients being followed-up in the Gastroenterology and Hepatology Unit, Theodor Bilharz Research Institute and Cairo University outpatient clinics. A thorough history, physical examination, routine laboratory tests, and abdominal ultrasound were obtained for all patients. Extended rheumatological examination was performed including clinical testing for sacroiliitis and enthesitis. None of the patients reported a history of back pain or any symptoms suggestive of sacroiliitis during the course of the infection. Plain x-ray and MRI scan of the sacroiliac joints were performed for all patients.
  
  
  RESULTS
  Asymptomatic sacroiliitis was present in 24 % of the brucellosis patients; none of the patients had tenderness over their spine with preserved lumbar spine mobility. Sacroiliitis was mainly unilateral being bilateral in 20.83 %. There was an obvious relationship with animal contact and occupation of the patients. Osteoarticular involvement was common (67 %) including arthralgias, arthritis, myalgias, spondylitis, enthesitis and bursitis, being clearly higher in those with sacroiliitis. The MRI scan showed blurring of the margins in 66.67 %, widening in 25 %, narrowing in 54.17 %, erosions in 20.83 %, and sclerosis in 12.5 %.
  
  
  CONCLUSIONS
  Osteoarticular manifestations of brucellosis are prevalent and subclinical sacroiliitis is evident, a finding that may classify these patients as having brucellar spondyloarthropathy (BSA). Referring brucellosis patients for rheumatological assessment has the advantage of early assessment of asymptomatic cases with sacroiliitis which is commonly overlooked.
authors.affiliation: Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt, gheitamer@hotmail.com.
authors.forename: T A
authors.initials: TA
authors.lastname: Gheita
authors.forename: S
authors.initials: S
authors.lastname: Sayed
authors.forename: G S
authors.initials: GS
authors.lastname: Azkalany
authors.forename: H S
authors.initials: HS
authors.lastname: El Fishawy
authors.forename: M A
authors.initials: MA
authors.lastname: Aboul-Ezz
authors.forename: M H
authors.initials: MH
authors.lastname: Shaaban
authors.forename: R H
authors.initials: RH
authors.lastname: Bassyouni
mesh_terms: D000328:Adult; D058345:Asymptomatic Infections; D002006:Brucellosis / Q000150:complications* / Q000175:diagnosis*; D019411:Clinical Laboratory Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010808:Physical Examination / Q000379:methods; D015203:Reproducibility of Results; D058566:Sacroiliitis / Q000175:diagnosis* / Q000209:etiology*; D012680:Sensitivity and Specificity
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