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Inflammatory sacroiliitis in childhood
A Gedalia1, N Watemberg, M Rotschild
1Department of Pediatrics, Ben Gurion University of the Negev, Beer Sheva, Israel.
Insights
Inflammatory sacroiliitis is a rare, transient condition in young children presenting with refusal to walk. This benign condition, often misdiagnosed, resolves without lasting effects.
Area of Science:
- Pediatric Rheumatology
- Pediatric Orthopedics
- Pediatric Infectious Diseases
Background:
- Unilateral inflammatory sacroiliitis is uncommon in pediatric patients.
- Early diagnosis is crucial to differentiate from septic arthritis and other rheumatic conditions.
Observation:
- Two young children, a 27-month-old boy and a 10-month-old girl, presented with refusal to walk due to unilateral inflammatory sacroiliitis.
- Both exhibited elevated erythrocyte sedimentation rates with negative HLA-B27, and normal initial radiographic findings of sacroiliac (SI) joints, lumbosacral spines, and hip joints.
- Joint/bone scans showed increased radionuclide uptake in affected SI joints, with computerized tomography revealing abnormalities in one case.
Findings:
- The pediatric patients diagnosed with inflammatory sacroiliitis showed improvement and full recovery with aspirin treatment.
- No long-term sequelae were observed in either case, indicating a benign and transient disease course.
- The condition is rare in young children and may be misdiagnosed as septic arthritis.
Implications:
- Inflammatory sacroiliitis in children is a self-limiting condition that requires prompt recognition and appropriate management.
- Distinguishing inflammatory sacroiliitis from septic arthritis is critical to avoid unnecessary aggressive treatments.
- Further research into the etiology and optimal management of pediatric inflammatory sacroiliitis is warranted.
Abstract:
A 27-month-old boy and a 10-month-old girl with unilateral inflammatory sacroiliitis are described. Both presented with refusal to walk or to stand. Increased erythrocyte sedimentation rate and negative HLA-B27 were found in both cases. There were no laboratory findings to suggest an underlying rheumatic disease. Radiograms of the sacroiliac (SI) joints, lumbosacral spines and the hip joints were normal. Joint/bone scan revealed increased radionuclide activity over the involved SI joints in both cases. Computerized tomograms of the SI joints were abnormal in one patient. Both patients improved with aspirin, recovered and had no sequelae. Inflammatory sacroiliitis appears to be transient and benign. It is a rare event in young children. Possibly some of them are being treated as though they had septic arthritis.