Pregnancy-related pain may be associated with sacroiliac joint (SIJ) changes, detectable by magnetic resonance imaging (MRI).
Purpose
To analyze the prevalence and course of SIJ MRI and clinical findings in women referred with low back pain and relate these to pregnancy.
Material and Methods
A retrospective follow-up study from a longitudinally collected cohort comprising 328 women.
Results
Women reporting debut of pain in relation to a pregnancy (PP group) tended to have a higher baseline prevalence of all investigated MRI findings, cumulated positive SIJ tests, and a potential fulfilment of the spondyloarthritis diagnosis compared to remainders. The prevalence of subchondral bone marrow edema (BME), any SIJ MRI finding, and potential fulfilment of the spondyloarthritis diagnosis were significantly higher in the PP group compared to women who had not been pregnant. In the total study group, the prevalence of ≥1 MRI finding increased over the four-year study period from 34% to 47% (P<0.001), driven by increasing prevalence of BME (25% to 32%; P=0.008) and fatty marrow deposition (FMD) (20% to 25%; P=0.020). In addition, the BME volume score increased. Over time, the PP group had persisting high prevalence of buttock pain and total MRI findings and their FMD volume score increased, but there were no between-group differences in MRI variables at follow-up.
Conclusion
Overall, the prevalence of MRI findings increased over time. Although the PP group had different clinical and SIJ MRI characteristics cross-sectional at baseline compared to remainders, longitudinal analyses revealed that these diminished over time.
VleemingAAlbertHØstgaardH, et al.
European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J2008;
17:794–819.
2.
SembranoJPollyD.How often is low back pain not coming from the back?Spine2009;
34:27–32.
3.
HodgeJCBessetteB.The incidence of sacroiliac joint disease in patients with low-back pain.Can Assoc Radiol J1999;
50:321–323.
4.
SchwarzerAAprillCBogdukN.The sacroiliac joint in chronic low back pain. Spine1995;
20:31–37.
5.
BernardTKirkaldy-WillisW.Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res1987;
217:266–280.
6.
AlbertHBGodskesenMWestergaardJG.Incidence of four syndromes of pregnancy-related pelvic joint pain.Spine2002;
27:2831–2834.
7.
ØstgaardHCAnderssonGKarlssonK.Prevalence of back pain in pregnancy.Spine1991;
16:549–552.
8.
KristianssonPSvärdsuddKvon SchoultzB.Back pain during pregnancy: a prospective study. Spine1996;
21:702–709.
9.
BergströmCPerssonMNergårdKA, et al.
Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum. BMC Musculoskelet Disord2017;
18:1–13.
10.
ØstgaardHAnderssonG.Previous back pain and risk of developing back pain in a future pregnancy.Spine1991;
16:432–436.
11.
WurdingerSHumbschKReichenbachR, et al.
MRI of the pelvic ring joints postpartum: normal and pathological findings. J Magn Reson Imaging2002;
15:324–329.
12.
HermannKGAHalleHReisshauerA, et al.
Peripartale veränderungen des beckenringes : wie sinnvoll ist die magnetresonanztomografie? Peripartum changes of the pelvic ring: usefulness of magnetic resonance imaging. Rofo2007;
179:1243–1250.
13.
EshedIMiloh-RazHDulitzkiM, et al.
Peripartum changes of the sacroiliac joints on MRI: increasing mechanical load correlating with signs of edema and inflammation kindling spondyloarthropathy in the genetically prone. Clin Rheumatol2015;
34:1419–1426.
14.
de WinterJde HoogeMvan de SandeM, et al.
Magnetic resonance imaging of the sacroiliac joints indicating sacroiliitis according to the assessment of SpondyloArthritis international Society definition in healthy individuals, runners, and women with postpartum back pain. Arthritis Rheumatol2018;
70:1042–1048.
15.
AgtenCAZublerVZanettiM, et al.
Postpartum bone marrow edema at the sacroiliac joints may mimic sacroiliitis of axial spondyloarthritis on MRI. AJR Am J Roentgenol2018;
211:1306–1312.
16.
SevenSØstergaardMMorsel‐CarlsenL, et al.
Magnetic resonance imaging of lesions in the sacroiliac joints for differentiation of patients with axial spondyloarthritis from control subjects with or without pelvic or buttock pain: a prospective, cross-sectional study of 204 participants. Arthritis Rheumatol2019;
71:2034–2046.
17.
HoballahALukasCLeplatC, et al.
MRI of sacroiliac joints for the diagnosis of axial SpA: prevalence of inflammatory and structural lesions in nulliparous, early postpartum and late postpartum women. Ann Rheum Dis2020;
79:1063–1069.
18.
RensonTDepickerADe CraemerAS, et al.
High prevalence of spondyloarthritis-like MRI lesions in postpartum women: A prospective analysis in relation to maternal, child and birth characteristics. Ann Rheum Dis2020;
79:929–934.
19.
LambertRGWBakkerPACVan Der HeijdeD, et al.
Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: Update by the ASAS MRI working group. Ann Rheum Dis2016;
75:1958–1963.
20.
Arnbak B, Jensen TS, Egund N, et al. Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain. Eur Radiol 2016;26:1191–203.
21.
Arnbak B, Grethe Jurik A, Hørslev-Petersen K, et al. Associations between Spondyloarthritis Features and Magnetic Resonance Imaging Findings: A Cross-Sectional Analysis of 1,020 Patients with Persistent Low Back Pain. Arthritis Rheumatol 2016;68:892–900.
22.
MannicheCAsmussenKLauritsenB, et al.
Low Back Pain Rating scale: validation of a tool for assessment of low back pain. Pain1994;
57:317–326.
23.
RolandMMorrisR.A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine1983;
8:141–144.
24.
BrooksRRabinRde CharroF, editors. The measurement and valuation of health status using EQ-5D: a European perspective.
Dordrecht:
Springer Netherlands; 2003.
25.
SieperJRudwaleitMBaraliakosX, et al. The Assessment of SpondyloArthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009;
68(Suppl. 2):1–44.
26.
RudwaleitMVan Der HeijdeDLandewéR, et al.
The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis2009;
68:777–783.
27.
27. Madsen KB, Jurik AG. Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint. Arthritis Care Res 2010;62:11–8.
28.
Arnbak B, Jensen TS, Manniche C, Zejden A, Egund N, Jurik AG. Spondyloarthritis-related and degenerative MRI changes in the axial skeleton An inter- and intra-observer agreement study. BMC Musculoskelet Disord 2013;14:274.
29.
KentPKongstedAJensenTS.SpineData – a Danish clinical registry of people with chronic back pain. Clin Epidemiol2015;
7:369–380.
30.
30. Arnbak B, Jensen TS, Schiøttz-Christensen B, et al. What Level of Inflammation Leads to Structural Damage in the Sacroiliac Joints? A Four-Year Magnetic Resonance Imaging Follow-Up Study of Low Back Pain Patients. Arthritis Rheumatol 2019;71:2027–33.
31.
BerthelotJMle GoffBMaugarsY, et al.
Sacroiliac joint edema by MRI: Far more often mechanical than inflammatory?Jt Bone Spine2016;
83:3–5.
32.
WeberULambertRGWPedersenSJ, et al.
Assessment of structural lesions in sacroiliac joints enhances diagnostic utility of magnetic resonance imaging in early spondylarthritis. Arthritis Care Res (Hoboken) 2010;
62:1763–1771.
33.
BaraliakosXRichterAFeldmannD, et al.
Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years. Ann Rheum Dis2020;
79:186–192.
34.
SongIHHermannKGHaibelH, et al.
Relationship between active inflammatory lesions in the spine and sacroiliac joints and new development of chronic lesions on whole-body MRI in early axial spondyloarthritis: Results of the ESTHER trial at week 48. Ann Rheum Dis2011;
70:1257–1263.
35.
IlleezOGAtıcıAUlgerEB, et al.
The transitional vertebra and sacroiliac joint dysfunction association. Eur Spine J2018;
27:187–193.
36.
Weber U, Jurik AG, Zejden A, et al. MRI of the sacroiliac joints in athletes: Recognition of non-specific bone marrow edema by semi-axial added to standard semi-coronal scans. Rheumatology 2020;59:1381–1390.
37.
MaLGaoZZhongY, et al.
Osteitis condensans ilii may demonstrate bone marrow edema on sacroiliac joint magnetic resonance imaging. Int J Rheum Dis2018;
21:299–307.
