Hi OCADers,
I have a case, together with Dr. Robinson from Australia, that might look like axial spondyloarthritis (ank spond) at first glance, but certain features do not fit.
22-year-old Caucasian male with no known history of psoriasis, experiencing stiffness of the spine and inflammatory back pain.
Please see all images here:
https://bcv.app/s227M3
I don’t believe it is a case of axSpA, as the SIJs are normal. Slight signal increases near the joints on MRI water-sensitive changes are probably due to apophyses that are still non-fused.
Psoriatic spondyloarthritis or SAPHO/CNO? I’m not sure – especially as we know little about the skin.
There is severe kyphosis and defects of the endplates that resemble Schmorl’s nodes, which are compatible with Scheuermann’s kyphosis (Edgren-Vaino configuration). But I did never see ankylosis in Scheuermanns. Also, there is significant edema in the vertebrae, a feature sometimes seen in Scheuermann’s but, of course, more frequently in axSpA.
Calling all pediatric radiologists if they have another idea?!
Thank you!
Kay.
Excellent images.
Features of axial inflammatory spondyloarthritis. Spine shows ankylosis with a mix of ankylosis, fat metaplasia and active inflammatory osteochondrosis.
SI joints show active inflammatory sacroiliitis with inflammatory signal change within the joint itself. No florid osteitis.
Joy