• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annrheumdAnnals of the Rheumatic DiseasesView this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. Feb 2000; 59(2): 135–140.
PMCID: PMC1753076

Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis— cellularity correlates with the degree of enhancement detected by magnetic resonance imaging


OBJECTIVE—Sacroiliitis is a hallmark of the spondyloarthropathies (SpA). The degree of inflammation can be quantified by magnetic resonance imaging (MRI). The aim of this study was to further elucidate the pathogenesis of SpA by quantitative cellular analysis of immunostained sacroiliac biopsy specimens and to compare these findings with the degree of enhancement in the sacroiliac joints (SJ) as detected by dynamic MRI.
METHODS—The degree of acute sacroiliitis detected by MRI after intravenous administration of gadolinium-DTPA was quantitatively assessed by calculating the enhancement observed in the SJ and chronic changes were graded as described in 32 patients with ankylosing spondylitis (n=18), undifferentiated SpA (n=12) and psoriatic arthritis (n=2). Back pain was graded on a visual analogue scale (VAS, 0-10) and disease duration (DD) was assessed. Shortly after MRI, SJ of patients with VAS > 5 were biopsied guided by computed tomography. Immunohistological examination was performed using the APAAP technique; only whole sections > 3 mm were counted.
RESULTS—By MRI, chronic changes [less-than-or-eq, slant] grade II were detected in nine patients (group I, DD 2.5 (SD 2.9) years) and > II in 13 patients (group II, DD 7.3 (SD 4.8) years), while enhancement < 70% was found in eight (group A, DD 5.6 (SD 3.3) years) and > 70% in 12 patients (group B, DD 4.7 (SD 5.8) years). The relative percentage of cartilage (78-93%), bone (7-18%) and proliferating connective tissue (1-4%) was comparable between the groups (range). There were more inflammatory cells in group I compared with group II (mean (SD) 26.7(20.1) versus 5.3 (5.2), p=0.04) and group A compared with B (21.8 (17.3) versus 6.0 (5.6), p=0.05) cells/10 mm2), T cells (10.9 (8.5)) being slightly more frequent than macrophages (9.6 (16.8/10 mm2)). Clusters of proliferating fibroblasts were seen in three and new vessel formation in seven cases.
CONCLUSION—This study shows that T cells and macrophages are the most frequent cells in early and active sacroiliitis in SpA. The correlation of cellularity and MRI enhancement provides further evidence for the role of dynamic MRI to detect early sacroiliitis.

Full Text

The Full Text of this article is available as a PDF (209K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Braun J, Sieper J. The sacroiliac joint in the spondyloarthropathies. Curr Opin Rheumatol. 1996 Jul;8(4):275–287. [PubMed]
  • Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, Sieper J. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum. 1998 Jan;41(1):58–67. [PubMed]
  • Sieper J, Braun J. Pathogenesis of spondylarthropathies. Persistent bacterial antigen, autoimmunity, or both? Arthritis Rheum. 1995 Nov;38(11):1547–1554. [PubMed]
  • Braun J, Bollow M, Eggens U, König H, Distler A, Sieper J. Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum. 1994 Jul;37(7):1039–1045. [PubMed]
  • Bollow M, Braun J, Hamm B, Eggens U, Schilling A, König H, Wolf KJ. Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology. 1995 Feb;194(2):529–536. [PubMed]
  • Braun J, Bollow M, Seyrekbasan F, Häberle HJ, Eggens U, Mertz A, Distler A, Sieper J. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and followup by dynamic magnetic resonance imaging. J Rheumatol. 1996 Apr;23(4):659–664. [PubMed]
  • Blum U, Buitrago-Tellez C, Mundinger A, Krause T, Laubenberger J, Vaith P, Peter HH, Langer M. Magnetic resonance imaging (MRI) for detection of active sacroiliitis--a prospective study comparing conventional radiography, scintigraphy, and contrast enhanced MRI. J Rheumatol. 1996 Dec;23(12):2107–2115. [PubMed]
  • Braun J, Bollow M, Neure L, Seipelt E, Seyrekbasan F, Herbst H, Eggens U, Distler A, Sieper J. Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum. 1995 Apr;38(4):499–505. [PubMed]
  • van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984 Apr;27(4):361–368. [PubMed]
  • Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivieri I, Pasero G, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991 Oct;34(10):1218–1227. [PubMed]
  • Calin A, Porta J, Fries JF, Schurman DJ. Clinical history as a screening test for ankylosing spondylitis. JAMA. 1977 Jun 13;237(24):2613–2614. [PubMed]
  • Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol. 1996 Aug;35(8):767–770. [PubMed]

Figures and Tables

Figure 1
Detailed comparison of relative cell counts of sacroiliac biopsies between patients with different degrees of enhancement in MRI.
Figure 2  Figure 2
MRI and SJ biopsy specimen of a 16 year old HLA B27+ uSpA patient with unilateral IBP located in the left buttock. (A) T1 weighted gradient echo sequence five minutes after application of gadolinium-DTPA showing some chronic changes and definite ...
Figure 4  Figure 4
MRI and SJ biopsy specimen of a 17 year old female uSpA patient with unilateral inflammatory low back pain located to the right side and a disease duration of 1.5 years. (A) T1 weighted gradient echo sequence three minutes after application ...
Figure 5  Figure 5
MRI and SJ biopsy specimen of a HLA B27+ 16 year old male juvenile AS patient with bilateral inflammatory low back pain and a disease duration of 7.5 years. (B). T2* weighted gradient echo sequence showing bilateral chronic changes with ...
Figure 6  Figure 6
CT and SJ biopsy of a 28 year old female HLA B27+ AS patient with a disease duration of 4.9 years and severe IBP mainly right side. (A) CT showing definite chronic changes in the right SJ (chronicity grade III-IV, activity grade b, not ...
Figure 7  Figure 7
MRI and SJ biopsy specimen of a 36 year old female HLA B27+ AS patient with a disease duration of 10 years with bilateral inflammatory low back pain. (A) T2* weighted gradient echo sequence showing definite chronic changes with bilateral ...
Figure 3  Figure 3
MRI and SJ biopsy specimen of a 35 year old man HLA B27+ uSpA patient with a disease duration of 1.8 years and severe IBP. (A) STIR sequence showing definite acute changes in the right sacroiliac joint (chronicity grade I, activity grade ...

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...