Case 328

Area of Science:

• Rheumatology
• Radiology
• Immunology

Background:

• A 45-year-old female with a history of human leukocyte antigen B27-negative spondyloarthritis presented with chronic, worsening low back pain.
• Previous diagnosis was based on bilateral erosive sacroiliitis confirmed by radiography and bone scintigraphy.
• The patient had a history of effective treatment with a tumor necrosis factor-α inhibitor but was lost to follow-up for 8 years.

Observation:

• Current symptoms include diffuse osteoarticular pain, fatigue, and depressed mood.
• Incidental finding of nonobstructing kidney stones on ultrasound.
• Laboratory tests showed a slightly elevated C-reactive protein and low vitamin D levels.

Findings:

• Updated imaging included noncontrast MRI of the spine and sacroiliac joints, and CT of the abdomen and pelvis.
• Radiographic findings are detailed in Figures 1-4 (not provided in the text).
• The imaging aimed to evaluate the extent of disease and potential causes for worsening pain.

Implications:

• This case underscores the chronic and relapsing nature of spondyloarthritis.
• The importance of regular follow-up and updated imaging in managing patients with spondyloarthritis.
• Potential multifactorial causes for worsening pain in spondyloarthritis patients should be considered.