A rare co-occurrence of anti CCP-positive rheumatoid arthritis with sacroiliitis

Abstract

Sacroiliitis is considered as the most important sign of spondyloarthropathy. Rheumatoid arthritis mainly affects peripheral joints and the involvement of sacroiliac joint is very rare. The present case study discusses the rare existence of RA and concurrent chronic bilateral sacroiliitis.

Concurrence of Rheumatoid Arthritis and Ankylosing Spondylitis: Analysis of Seven Cases and Literature Review

“…81 patients were included in the study here presented. Of these, 74 were those detected in the literature review [ 6 – 40 ] and 7 from our center. Of the total number of cases, 58 were men (71%), with a mean age of 53 years (±14.83), and a mean age of the onset of the disease was 34 years (±14.87).…”

Commentary: A rare co-occurrence of anti CCP-positive rheumatoid arthritis with sacroiliitis

“…2,3 Finally, the authors mentioned about HLA-B7 positive sacroiliitis with concurrent early anti-CCP positive RA and concluded that since the possibility for SpA had been excluded in current patient, the presence of sacroiliitis can be considered as an atypical joint involvement of RA. 1 However; in my opinion, the history of IBP, raised inflammatory markers, bilateral active sacroiliitis on MRI, and back pain not responding to RA treatment, but to NSAIDs, all these were actually fulfilling ASAS axial SpA criteria along with ACR/EULAR 2010 RA criteria. 5,6 The ASAS criteria for axial SpA are a step forward in the SpA arena and help diagnosing early non-radiographic axial SpA as well as established SpA.…”

“…As per the authors, the magnetic resonance imaging (MRI) of SIJs had confirmed chronic bilateral sacroiliitis. 1 In my opinion, especially in rheumatology field, chronicity is to be documented as per time period, since symptoms/ signs present (inflammatory back pain (IBP) in this case) and not from the radiological techniques. In case of SIJs, plain radiograph actually gives information on grading of sacroiliitis (damage due to inflammation), while MRI gives information on active inflammation/ damage due to inflammation of SIJs .2, 3 In this particular case presented, it seems to be acute LBP (6 weeks duration) rather than chronic!…”

“…Dear editor, I have read the case report titled, 'A rare co-occurrence of anti CCP-positive rheumatoid arthritis with sacroiliitis' written by Haridas et al with great interest! 1 The authors have highlighted (though rare) the need to consider the involvement of sacroiliac joints (SIJs) in patients diagnosed with rheumatoid arthritis (RA), which can be considered as an atypical joint involvement of RA from their experience with this case. However, there certain clarifications are needed for the common readers, which I would like to highlight in this commentary.…”

“…Secondly, authors also mentioned that although the patient experienced tenderness in the SIJs, ankylosing spondylitis (AS) was not suspected, as she was negative for Schober's test! 1 AS is the prototype disease of the spodyloarthritis (SpA) group. It is characterized by the presence of axial symptoms resulting in both spinal mobility limitation and radiological sacroiliitis.…”