抄録
We clinically studied the sacroiliac changes in patients with rheumatoid arthritis (RA) from various angles to attempt to obtain a deeper understanding of such changes. It is of atmost importance yet very difficult to evaluate the radiographic changes that provide the basis for the diagnosis; one often finds it impossible to differentiate whether the changes in question are due to inflammation or due to degeneration.
Pathological changes of sacroiliac joints in patients with RA usually progress latently, but if they are monitored them carefully, it may be able to demonstrate their association with clinical symptoms in a considerably large percentage of the patients. And it has been found that inflammatory changes of the sacroiliac joints are more common among patients with RA with a longer duration and in an advanced stage; they have an especially closer correlation with RA of a severe stage with that has badly affected the cervical spine and the hip joint.
Pathohistological studies generally fail to demonstrate any evidence of severe synovitis as may be usually observed with other joints, but they reveal a lot of pannus formation. In addition, subchondral bone tissues present evidence of rather mild destruction, with a tendency towards fibrosis being noted in an early stage.
We succeeded in demonstrating the following points by this study:
1) Radiological sacroilitis in patients with RA is not as rare as it is usually estimated to be.
2) Tomography is the most useful for evaluation of radiological inflammatory changes (erosin) at the sacroiliac joints.
3) Associated clinical symptoms run parallel with radiographic grades to some extent.
4) The extent of radiographic sacroiliac inflammation is correlated with the severity of RA.
5) Patients present only mild synovitis but there is evidence of chronic inflammation accompanied by pannus formation, with pathological changes strongly appearing at the chondral bone of the sacral side.
