Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group minimal sclerosis - grade II sacroiliitis

My recent SI xrays showed "minimal sclerosis". It was a typical NHS report, confined to two sentences, that really didn't say an awful lot. I've gone and googled the criteria for diagnosis for AS and it says that Grade II bilateral is enough, and grade II sacroiliitis = minimal sclerosis.

So, is "minimal sclerosis" always Grade II sacroiliitis, or could it be something completely different? And if it is Grade II sacroiliitis (bilateral) and I have the other clinical criteria (definitely started well before age 30, and rib cage expansion of only about 1 inch, responds to NSAIDS, etc) can it be anything other than AS?

Well clinically speaking, it takes a grade of 3-4 to be definite symptom of AS.

BUT, the thing is that if you wait for 2 to become 3-4 then you have lost out in time to treat yourself and have caused a lot of unnecessary pain and suffering. This is the dilemma that faces rheumies today. That is why TASC is trying to develop better testing methods by identifying gene markers to AS.

If I had a chance to go back in time twenty years, I would have not listened to the first doctor and went and got a second opinion and possibly get treated earlier. Then I wouldn't have people coming up to me to ask how did I hurt my back.

Hmmm... sounds fishy. I wonder if we end up diagnosing ourselves better than the doctors. My 2nd sister finally saw a rheumy yesterday, who diagnosed her with fibromyalgia and osteoarthritis, but not spondylitis ~~~ even though she's had joint fusing in her fingers & wrists, chronic sacrum pain, and is HLAB25+. Weird these docs.

Hi Erica

Your poor sis....I had a dx of fibromyalgia, osteoarthritis and sero-negative rheumatoid from one rheumy even though my daughter has AS and both of us are HLAB27+. I saw another rheumy who did bones scans and wow what do you know I too have AS.
Tell your sis to hang in there and find another rheumy!!!

Noelene

people will say "lots of things" can cause SI dysfunction, but really i think if you add everything up, there really isn't a lot that causes SI inflammation, spinal and other joint degeneration at a relatively young age, rib involvement, enthesitis, (with eye, skin, GI involvement) than the spondys. none of 4 rheumies in the last 4 years were able to come up with anything else, except for the first rheumy who was wrong about fibro (ruled out by dozens of other doctors over the years).

dozens (at least 24!) that would be in fact a lot of doctors to rule out fibro!

No. "Minimal sclerosis" does not necessarily mean Grade II sacroiliitis. Sclerosis is a fairly vague term that simply means "a thickening or hardening of a body part" in this case, bone or tissue. As a general term, it is also used to describe osteoarthritic changes.

Sclerosis is a part of the clinical definition of Grade II Sacroiliitis, but it is not the only component to the diagnosis. Evidence of erosions or loss of definition of the joint margins (sometimes referred to as fuzzy joint space margins) is also required. One of the best definitions I have found of sacroiliitis classification can be found here: http://www.sma.org.sg/smj/4302/4302me1.pdf

"Sacroiliitis is usually graded according to the New York criteria.
* Grade 0 indicates normal SI joints within thin sharp cortical margins and normal cartilage space.
* Grade I refers to non-specific “suspicious” findings.
* Grade II changes are due to minimal sacroiliitis and consist of loss of definition of the SI joint margins. There may be minimal sclerosis and erosions. There may or may not be joint space narrowing.
* Grade III or moderate sacroiliitis manifests as definite sclerosis on both sides of the joint, erosions, and loss of joint space.
* Grade IV changes consist of complete bony ankylosis of the SI joints.
Changes are seen initially in the lower and middle thirds of the SI joint, with periarticular osteoporosis. Erosions and subchondral sclerosis progress to bony ankylosis. There is an eventual return to normal bone density."

This document lists other causes of sacroiliitis as well:
"Although the radiographical appearances of sacroiliitis may appear similar, differences in symmetry and distribution, as well as other clinical manifestations, provide clues to the correct diagnosis(2). The causes of sacroiliitis and mimicking conditions are summarised in the Table" below. http://www.sma.org.sg/smj/4302/4302me1.pdf

Table I. Patterns of disorders causing or mimicking sacroiliitis.
A. Bilateral and symmetrical
• Ankylosing spondylitis • Enteropathic arthropathies e.g. ulcerative colitis, Crohn’s disease, Whipple’s disease • Psoriatic arthropathy • Osteitis condensans ilii* • Hyperparathyroidism*
B. Bilateral and asymmetrical
• Psoriatic arthropathy • Reiter’s disease • Rheumatoid arthritis • Depositional arthropathies e.g. gout, CPPD, ochronosis • Osteoarthritis
C. Unilateral
• Infection
Key: * indicates conditions which may mimic sacroiliitis.

Sacroiliitis and Sacroiliac Joint Dysfunction are not interchangeable terms.

Sacroiliac Joint Dysfunction is a condition that causes pain in the SI joints from a variety of causes. SI Joint Dysfunction includes many different sacroiliac joint problems, including SI joint dysfunction, SI joint syndrome, SI joint strain, and SI joint inflammation.

Sacroiliitis refers to inflammation, and the damage caused by inflammation, of the sacroiliac joint. Sacroiliitis could be called a form of SI Joint Dysfunction.

***edited to add***
Can your doctor review the films directly or ask the Radiologist to re-review them??

thanks stormy,

that was really good to read.

yep!

once again sat down and started making a list, quit at 34....
wow! i was even surprised it was that many, and they're the ones i remember.
between living in two different states and having to start over again with finding doctors once i moved here, having various doctors retire, or my insurance change so old doctors were no longer in network, or orthopedists or physiatrists firing me and sending me off to rheumies, all of those things together, it really added up. maybe a few disciplines not as qualified to make the judgement, but a lot of those work very closely with fibro patients so some very qualified: the physiatrists and rheumies especially, 4 of each of those alone.

i know the quick first tests for fibro and EDS (rare collagen disorder) so well now:

fibro: press on triggerpoints, make decisions based on how hard one must press to elicit a response. answer questions about fatigue and sleep and all over body aches and pains.

EDS: hypermobile?

Thanks stormy. That was absolutely excellent information. It really just proves to me that the rather cursory interpretations and reports done by NHS of xrays are not enough, and they do need to be examined much more closely. We have two GPs here - one who seems to understand the spondy disorders (I wonder if he has something like that himself) and one who definitely doesn't. I'm having to wait now until the good one comes back on duty in the new year. I don't know if he will be able to read the xray any better, but at least I think I will get a better written referral from him to a rheumie. At this stage even though I think AS fits really well with both my personal and family history, I do need to keep in mind that it could be something else completely. Whatever it is, at the least I am reassured that SOMETHING showed up on the xray rather than all the other completely negative investigations I have had over the years.