Brucellar arthritis and sacroiliitis: an eight-year retrospective comparative analysis of demographic, clinical and paracilinical features

Abstract

Background Brucellosis is a common global zoonotic disease with a wide range of complex and non-specific clinical manifestations that may lead to misdiagnosis and delayed treatment. Osteoarticular involvement is the most common complaint in brucellosis. Methods This retrospective descriptive study was performed on patients presenting to a teaching hospital in Kermanshah, Iran with a diagnosis of brucellosis during 2011–2019. The demographic and clinical characteristics, complications, laboratory findings and treatment were recorded during the study period. Then, the difference in the collected data was investigated between brucellosis patients with and without arthritis or sacroiliitis. Results Of 425 patients, 130 (30.58%) had osteoarticular involvement. Sacroiliitis (13.6%) followed by spondylitis (12.9%) and peripheral arthritis (9.6%) was the most common type of complication. 15% of patients with Sacroillitis had spondylitis, concomitantly. There were no significant demographic differences between patients with and without brucellar arthritis or sacroiliitis. The patients with brucellar arthritis had a significantly higher frequency of arthralgia. Arthralgia, neck pain, back pain, positive Faber test, radiculopathy and vertebral tenderness were significantly more frequent in patients with Sacroiliitis; while fever and headache were significantly more common in patients without sacroiliitis. The median wright and 2ME titers were higher in brucellosis patients with arthritis or sacroiliitis versus patients without arthritis or sacroiliitis, but the difference was not significant. Synovial fluid was analyzed in 20 cases. The mean white cell count, glucose and protein level were 3461 ± 2.70, 58.54 ± 31.43 mg/dLit and 8.6 ± 11.85 g/dLit, respectively. Neutrophil cells were predominant in 80% of samples. patients with arthritis had a higher median platelet count and patients with sacroiliitis had higher median levels of AST and ALP significantly. Conclusions Arthritis and sacroiliitis had a frequency of 9.64% and 13.6%, respectively. Any complaints of low back pain and radiculopathy as well as the presence of spondylitis in patients should raise suspicion of sacroiliitis. High levels of ALP and a high platelet count may be associated with brucellar sacroiliitis and arthritis, respectively. The use of paraclinical methods such as MRI and bone scan seems necessary for diagnosis of sacroiliitis.