Simultaneous sacroiliitis and symphysitis pubis

Abstract

This is the description of a rare, documented association of sacroiliitis with symphysitis
pubis.
A 37-year-old woman experienced low back pain since 2009 with inflammatory characteristics
(worse at rest, improvement during movement) associated with morning stiffness
of 2 hours. Her X-ray demonstrated sacroiliitis. A magnetic resonance image (MRI)
showed bilateral bone edema of the sacroiliac joints with enhancement after gadolinium
injection (Fig. 1). At the same time, a magnetic resonance image revealed edema on
her symphysitis pubis better showed after contrast infusion and reduction of joint space
(Fig. 2). HLA-B27 was positive. C-reactive protein and erythrocyte sedimentation rate
were within normal range, 0.44 mg/l and 11 mm/1st hour, respectively. Rheumatoid factor
and antinuclear antibodies were negative. A diagnosis of spondyloarthritis was made
and she was treated with non-steroidal antiinflammatory drugs. She experienced slight
improvement of her symptoms and she is waiting for anti-TNF therapy.
Spondyloarthritis patients may have involvement of their symphysitis pubis. In
fact, Helliwell et al. [1] have radiologically evaluated 91 subjects with spondyloarthritis
and revealed that 31 % of ankylosing spondylitis patients, 30 % of enteropathic spondyloarthritis,
25 % of psoriatic arthritis and 14 % of reactive arthritis have symphisitis.
The authors performed single radiographies in that study. We were not able to find any
study that evaluated the frequency of symphisitis pubis in spondyloarthritis patients using
modern techniques such as MRI. Recently, we described a case of symphisitis pubis
after pregnancy [2].