Bone Marrow Edema in Sacroiliac Joints Common Among Young Athletes

This article is part of Rheumatology Advisor’s 2017 in-depth coverage of ACR, which took place in San Diego, CA. Our staff will be reporting on the latest treatment advancements and research initiatives for spondyloarthritis. Click here to read more of Rheumatology Advisor‘s conference coverage.

SAN DIEGO — Low-grade bone marrow edema is common among young athletes, and the damage is most frequent in the posterior lower ilium, according to a study presented at the 2017 American College of Rheumatology/Association of Rheumatology Health Professionals annual meeting.

Ulrich Weber, MD, from the King Christian 10th Hospital for Rheumatic Diseases in Gråsten, Denmark, presented the findings during the meeting. In 2 cohorts of healthy hobby runners (n=20) and professional ice hockey players (n=22), Dr Weber and colleagues sought to determine the frequency of bone marrow edema and the anatomic distribution in 8 sacroiliac joint regions.

Dr Weber noted that the objective of the study was to learn more about the “background noise” of magnetic resonance imaging (MRI) features in the sacroiliac joints of young athletes to determine the difference between normal variation and disease. According to Dr Weber, establishing the frequency and anatomic clustering of sacroiliac joint bone marrow edema in young athletes can help discriminate from the lesion spectrum seen on sacroiliac joint MRIs in patients with early axial spondyloarthritis (SpA).

The hobby runners had MRI scans taken of their sacroiliac joints before a 6.2-km competitive run and 24 hours after the run. The ice hockey players had an MRI scan taken at the end of their competitive season. The scans were assessed for bone marrow edema by 3 blinded readers. The researchers conducted an analysis that included the mean frequency of sacroiliac joint quadrants with bone marrow edema and their distribution in 8 regions: upper ilium, lower ilium, upper sacrum, lower sacrum, with each of these subdivided into anterior and posterior.

In the cohort of healthy runners, the investigators found that the average number of sacroiliac joint quadrants showing bone marrow edema was 3.1 before and after the run. In addition, the average number of quadrants showing bone marrow edema in ice hockey players was 3.6. Dr Weber added that the posterior lower ilium was the region that was most affected in these athletes, followed by the anterior upper sanctum. Overall, bone marrow edema was identified in 3 to 4 quadrants on average for both groups of athletes.

“The presence of solely low-grade [bone marrow edema], especially clustered in the posterior lower ilium or anterior upper sacrum, may not be sufficient to confirm axial SpA in these patients,” he stated. “This study’s results may enhance management of SpA patients by allocating treatment resources more specifically, especially if a rheumatologist is considering effective, but expensive, biological therapy.”

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Reference

Weber U, Jurik AG, Zejden A, et al. Bone marrow edema in sacroiliac joints of young athletes is common and shows most frequently in the posterior lower ilium. Presented at: 2017 ACR/ARHP Annual Meeting; November 3-8, 2017; San Diego, CA. Abstract 1830.