• A 59 years old lady
  • Presented with left lumbar pain
  • No history of trauma
  • Clinically: no neurological deficit
  • Per abdomen: no mass palpable

Radiographic findings:

  • KUB radiograph performed to look for urolithiasis
  • Sclerotic changes at both sacroiliac joints margin (yellow arrows)
  • Bilateral but asymmetrical; worse on the right side
  • Narrowing of joint spaces
  • No fusion of the joint is seen
  • No obvious soft tissue mass density seen
  • No periosteal reaction

Diagnosis: Bilateral sacroiliatis

Causes of bilateral sacroiliatis (asymmetrical):

  • Gout
  • Psoriathic arthritis
  • Reactive arthritis (Reiter syndrome)
  • Osteoarthritis
  • Relapsing polychondritis
  • Behcet disease
  • Sacroiliitis circumscripta

Causes of bilateral sacroiliatis (symmetrical):

  • Enteropathic arthritis
  • Crohn disease
  • Ulcerative colitis
  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Hyperparathyroidism (pseudo sacroiliitis
  • Osteitis condensans ilii
  • Multicentric reticulohistiocytosis
  • Whipple disease

Grading of sacroiliatis:

  • Grade 0: normal
  • Grade 1: some blurring of the joints margin; suspicious
  • Grade II: minimal sclerosis with some erosion
  • Grade III:
    • Definite sclerosis on both sides
    • Severe erosions with widening of joint spaces with or without anklylosis
  • Grade IV: complete ankylosis



Author: radhianahassan