Clinical Application Of CT Guided Sacroiliac Joint Puncture And The Observation Of The Pathological Manifestation Of Sacroiliitis

Objective To evaluate the clinical value of CT guided sacroiliac joint biopsy and intraarticular corticosteroid injection for sacroiliitis in patients with spondyloarthropathy (SPA). To Study the pathological feature of sacroiliitis to improve the threshold of early diagnosis of ankylosing spondylitis (AS). Methods 3 adult specimens and 43 patients suffering from refractory back pain, including 23 cases with AS, 17 cases with undifferentiated spondyloarthropathy (uSpA) and 3 cases with osteitis condensana ilii (OCI) were studied. The patient/specimen was placed in a prone position. Guided by CT, the biopsy needle tip was posited in the synovium compartment of sacroiliac join (SIJ). After the tissue sample was taken out, 15mg triamcinolone acetonide was injected into each joint (the specimen was injected in blue ink). All patients underwent continuous clinical follow-up at 4 to 12 week intervals after the intervention, while specimens were performed section anatomy. The pathological feature and the clinical data were recorded and analyzed. Result 1. The section anatomy of specimens revealing the blue ink was inside the sacroiliac joint and diffused to paraarticular. 2. After intervention, 35 of the 40 cases (88%) showed a statistically significant abatement of subjective complaints. The case number of night pain, morning stiff, pain in SIJ, "4" sign and the dose of the nonsteroidal anti-inflammation drugs were demonstrated a statistically significant reduce. 3. Synovitis, including lining cell hyperplasiaand inflammatory cell infiltration in loose connective tissue, local cartilage degeneration and destruction, pannus formation, inflammatory cells infiltration and destruction subchondral bony plate, enthesitis, as well as hematopoietic cells within the subchondral bone marrow were largely replaced by inflammation cells, were found in all SIJ samples of patients with AS (21/21,100%). The same pathological manifestations except enthesitis were discovered in 12 (12/15,80%) cases with uSpA. Of 3 cases with OCI, 2 cases were found the inflammation evidences in their SIJ samples, whereas the remainder was showed no inflammatory manifestation. Conclusion 1. CT guided SIJ biopsy could detect sacroiliitis in early stage, improve the threshold of early diagnosis and differentiated diagnosis in AS. Meanwhile, intraarticular corticosteroid injection was an effective and safe local treatment for sacroiliitis. 2. Synovitis, including lining cell hyperplasia and inflammatory cell infiltration in loose connective tissue, local cartilage degeneration and destruction, pannus formation, inflammatory cells infiltration and destruction subchondral bony plate, enthesitis, as well as hematopoietic cells within the subchondral bone marrow were largely replaced by inflammation cells, were the pathological manifestation of sacroiliitis in patients with SPA. The pathological change of sacroiliitis might initiate in the subchondral bony plate, rather than synovium or enthesis.