Subclinical sacroiliitis in brucellosis. Clinical presentation and MRI findings

PURPOSE

The aim of this work was to detect subclinical sacroiliac joint involvement in patients with brucellosis and study their clinical and laboratory features.

PATIENTS AND METHODS

The study included 100 brucellosis patients being followed-up in the Gastroenterology and Hepatology Unit, Theodor Bilharz Research Institute and Cairo University outpatient clinics. A thorough history, physical examination, routine laboratory tests, and abdominal ultrasound were obtained for all patients. Extended rheumatological examination was performed including clinical testing for sacroiliitis and enthesitis. None of the patients reported a history of back pain or any symptoms suggestive of sacroiliitis during the course of the infection. Plain x-ray and MRI scan of the sacroiliac joints were performed for all patients.

RESULTS

Asymptomatic sacroiliitis was present in 24 % of the brucellosis patients; none of the patients had tenderness over their spine with preserved lumbar spine mobility. Sacroiliitis was mainly unilateral being bilateral in 20.83 %. There was an obvious relationship with animal contact and occupation of the patients. Osteoarticular involvement was common (67 %) including arthralgias, arthritis, myalgias, spondylitis, enthesitis and bursitis, being clearly higher in those with sacroiliitis. The MRI scan showed blurring of the margins in 66.67 %, widening in 25 %, narrowing in 54.17 %, erosions in 20.83 %, and sclerosis in 12.5 %.

CONCLUSION

Osteoarticular manifestations of brucellosis are prevalent and subclinical sacroiliitis is evident, a finding that may classify these patients as having brucellar spondyloarthropathy (BSA). Referring brucellosis patients for rheumatological assessment has the advantage of early assessment of asymptomatic cases with sacroiliitis which is commonly overlooked.

Clinical significance of soluble-endoglin levels in systemic lupus erythematosus: possible association with anti-phospholipid syndrome

AIM

The pathogenic role of soluble endoglin (s-Eng), as an antiangiogenic protein, has largely been demonstrated in various vascular disorders. Our aim was to assess, in a cross-sectional study, plasma levels of s-Eng in systemic lupus erythematosus (SLE) patients and its relation with the disease characteristics.

PATIENTS AND METHODS

Plasma from 86 patients with SLE and 36 normal healthy subjects was assayed for s-Eng levels by enzyme-linked immunosorbent assay. Demographic, clinical, autoantibodies and serological data were prospectively assessed. Disease activity was assessed by total SLE disease activity index score.

RESULTS

In our SLE patients, the levels of s-Eng were comparable between SLE patients and the control group. However, these levels were significantly associated with antiphospholipid syndrome (APS). In addition, s-Eng levels were significantly associated with antiphospholipid antibodies in our studied population. On the other hand, we did not find significant differences in mean plasma s-Eng levels in relation to disease activity, other organ system involvement or the presence of anti-dsDNA.

CONCLUSION

Our preliminary data indicated the importance of s-Eng in a special subgroup of SLE patients associated with secondary APS. An additional prospective, large-scale, longitudinal study should be carried out to support these findings.