Bone edema of the whole vertebral body: an unusual case of spondyloarthritis.
Spondyloarthritis (SpA) is usually characterized by early inflammatory involvement of the sacroiliac joints (SI), which constitutes one of the most important classification criteria according to the SpondyloArthritis International Society (ASAS). These criteria do not include inflammatory spine lesions which can be detected on MRI, although spine involvement is very common in axial SpA. This is because spine MRI lesion often retrieved in SpA are not very specific, and can be found in many other diseases such as malignancy and osteoarthritis. Here we present the case of a 33-year old woman who presented a worsening low back pain, with a thoracic spine MRI showing bone marrow edema (BME) of the whole T8 vertebral body. Owing to this peculiar presentation, together with the unresponsiveness of the pain to nonsteroidal anti inflammatory drugs (NSAIDs) and a slight increase of the biomarker CA19-9, a malignancy was suspected. Therefore, the patient underwent bone scintigraphy, Single positron emission computed tomography (SPET/TC), positron emission tomography and repeated MRI without reaching a diagnosis. Finally, when SI joints MRI was performed, BME of the SI joints emerged: this was fundamental to formulate the diagnosis of axSpA.
Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Augusta
A
Ortolan
Rheumatology Unit, Immacolata Concezione Hospital, Piove di Sacco, Italy.
Paolo
P
Lazzarin
Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
Mariagrazia
M
Lorenzin
Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
Lucia
L
Rampin
Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy. roberta.ramonda@unipd.it.
Roberta
R
Ramonda
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001842:Bone and Bones / Q000473:pathology*; D004487:Edema / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation; D017116:Low Back Pain / Q000473:pathology; D008279:Magnetic Resonance Imaging; D012216:Rheumatic Diseases / Q000473:pathology*; D012446:Sacroiliac Joint / Q000473:pathology; D058566:Sacroiliitis / Q000175:diagnosis; D025241:Spondylarthritis / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000473:pathology*; D015899:Tomography, Emission-Computed, Single-Photon
D000894:Anti-Inflammatory Agents, Non-Steroidal
Imaging; Imaging—MRI; Rheumatic diseases; Specialty fields; Spondyloarthritis
Rheumatology (Oxford). 2010 Apr;49(4):749-55
20083538
Ann Rheum Dis. 2009 Jun;68(6):777-83
19297344
Neuroradiology. 2005 May;47(5):316-21
15891876
BMC Musculoskelet Disord. 2015 Feb 04;16:9
25649319
J Rheumatol. 2015 Jul;42(7):1186-93
25934824
Nuklearmedizin. 1982 Dec;21(6):258-61
6984755
Ann Rheum Dis. 2008 Nov;67(11):1535-40
18230629
Ann Rheum Dis. 2016 Jul;75(7):1308-14
26286018
Ann Rheum Dis. 2008 Sep;67(9):1276-81
18006539
Ann Rheum Dis. 2016 Nov;75(11):1958-1963
26768408
Arthritis Rheum. 1977 Jun;20(5):1058-64
141287
Ann Rheum Dis. 2011 Mar;70 Suppl 1:i97-103
21339229
Clin Rheumatol. 1983 Dec;2(4):407-14
6235086
Scand J Rheumatol. 2016 Nov;45(6):491-498
27098409
Arthritis Rheumatol. 2014 Mar;66(3):667-73
24574227
Curr Opin Rheumatol. 2010 Jul;22(4):381-7
20386452
AJNR Am J Neuroradiol. 2002 Jun-Jul;23(6):906-12
12063214
Clin Rheumatol. 2000;19(1):51-7
10752500
Int J Rheum Dis. 2015 Jun;18(5):553-9
25528889
Clin Rheumatol. 2009 Sep;28(9):1007-19
19526194
Arthritis Rheum. 2009 May;60(5):1331-41
19404934
Ann Rheum Dis. 2009 Oct;68(10):1520-7
19454404
J Rheumatol. 2015 Feb;42(2):258-63
25512483
Clin Rheumatol. 2016 Jun;35(6):1447-55
27094946
Arthritis Rheum. 2010 Oct;62(10):3048-58
20496416
Arthritis Care Res (Hoboken). 2016 Nov;68(11):1726-1730
26990879