Utility of magnetic resonance imaging in Crohn's associated sacroiliitis: A cross-sectional study

Fardina Malik*, Ellen Scherl, Ulrich Weber, John A. Carrino, Madeline Epsten, Stephanie Wichuk, Susanne J. Pedersen, Joel Paschke, Sergio Schwartzman, Georg Kroeber, Walter P. Maksymowych, Randy Longman, Lisa A. Mandl

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Objective: Prevalence of sacroiliitis in Crohn's disease (CD) is variable depending on defining criteria. This study utilized standardized sacroiliac joint (SIJ) magnetic resonance imaging (MRI) to identify sacroiliitis in CD patients and its association with clinical and serological markers. Methods: Consecutive adult subjects with CD prospectively enrolled from an inflammatory bowel disease clinic underwent SIJ MRI. Data collected included CD duration, history of joint/back pain, human leukocyte antigen-B27 status, Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index, Harvey Bradshaw Index (HBI) for activity of CD, Ankylosing Spondylitis Disease Activity Score, and various serologic markers of inflammation. Three blinded readers reviewed MRIs for active and structural lesions according to the Spondyloarthritis Research Consortium of Canada modules. Results: Thirty-three CD patients were enrolled: 76% female, 80% White, median age 36.4 years (interquartile range 27.2-49.0), moderate CD activity (mean HBI 8.8 ± SD 4.5). Nineteen subjects (58%) reported any back pain, 13 of whom had inflammatory back pain. Four subjects (12%) showed sacroiliitis using global approach and 6 (18%) met Assessment of SpondyloArthritis international Society MRI criteria of sacroiliitis. Older age (mean 51.2 ± SD 12.5 vs. 37.2 ± 14; P =.04), history of dactylitis (50.0% vs. 3.4%, P =.03) and worse BASMI (4.1 ± 0.7 vs. 2.4 ± 0.8, P ≤.001) were associated with MRI sacroiliitis; no serologic measure was associated. Conclusion: There were 12%-18% of CD patients who had MRI evidence of sacroiliitis, which was not associated with back pain, CD activity or serologic measures. This data suggests that MRI is a useful modality to identify subclinical sacroiliitis in CD patients.

Original languageEnglish
JournalInternational Journal of Rheumatic Diseases
Issue number4
Pages (from-to)582-590
Publication statusPublished - Apr 2021


  • back pain
  • Crohn's disease
  • cytokines
  • magnetic resonance imaging
  • sacroiliitis


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