All included patients have given written informed consent and completed a questionnaire regarding their obstetric history at the time of MRI acquisition: number of children, birth method (vaginal delivery/C-section), and date of the last delivery. This retrospective single-center cohort study was approved by the local ethics committee. Therefore, the purpose of this study was to investigate the long-term (more than 24 months after last childbirth) effect of pregnancy/childbirth on BME and subchondral sclerosis of SIJ in comparison to SpA-induced changes and furthermore, to test if the birth method (vaginal delivery or cesarean surgery) and/or number of children have an impact on these SIJ-MRI changes. However, not yet addressed issues are as follows: (a) if SpA-related subchondral sclerosis differs from pregnancy/birth-related subchondral sclerosis in the late postpartum period and (b) if birth method (vaginal delivery or cesarean surgery) and/or number of children have an impact on the extent of sclerosis. Very recently it has been shown that pregnancy/delivery can cause persisting SIJ-subchondral sclerosis in the late postpartum period (≥ 2 years after childbirth), whereas pregnancy-/birth-related BME along the SIJ seems to vanish after the first postpartum year. This often poses a diagnostic dilemma in female patients with a history of pregnancy and childbirth, because overcalling these findings would lead to unnecessary treatment and costs, whereas to consider them as always normal after childbirth may delay treatment and reduce patient outcome in cases of actual axSpA. caused by pregnancy/childbirth or physical activity in athletes can cause subchondral BME and subchondral sclerosis of the SIJ which may be indistinguishable from axSpA. due to lumbar disc herniation, as well as mechanical stress on the pelvic girdle, e.g. It is known that non-inflammatory causes of back pain, e.g. Typical MRI changes in axSpA are active inflammation, expressed by bone marrow edema (BME), and structural changes such as subchondral sclerosis, fatty bone marrow replacement, erosions, and ankylosis of the SIJ. Especially in the young to middle-aged adult population, important differential diagnoses are inflammatory pathologies such as axial spondyloarthritis (axSpA), manifesting often as sacroiliitis. Hence, due to the high prevalence of low back pain, a substantial number of patients will undergo MR imaging. It may be difficult to distinguish various causes of low back pain based merely on history and/or clinical examination and further diagnostic work-up is often needed. Low back pain originates in particular from either the lumbar spine or the sacroiliac joints (SIJ). The differential diagnosis is broad, particularly comprised degenerative, mechanical (e.g., stress-related), traumatic, and inflammatory pathologies. Low back pain is a common health problem in the general population with a point prevalence of 12-33%. Birth method yields no effect on SIJ sclerosis. Number of children is positively correlated with SIJ sclerosis. ConclusionPregnancy/CB has no impact on long-term BME on SIJ, however, may cause long-term subchondral sclerosis-similar to SpA-associated sclerosis. In non-SpA patients with CB, number of children ( p = 0.001) was an independent predictor of sclerosis score, while birth method yielded no significant effect ( p = 0.75). Both CB (phi = 0.13, p = 0.02) and SpA diagnosis (phi = 0.23, p < 0.001) were significantly associated with a positive ASAS criterion for sacroiliitis. CB was not associated with a higher confidence level in diagnosing SpA based on MRI ( p = 0.07), whereas SpA diagnosis was associated with a higher score ( r = 0.61, p < 0.001). Both CB ( r = 0.21, p < 0.001) and SpA diagnosis ( r = 0.33, p < 0.001) were correlated with a higher sclerosis score. ResultsCB did not correlate with BME score ( p = 0.38), whereas SpA diagnosis was associated with a higher BME score ( r = 0.31, p < 0.001). Further, an 11-point “global assessment score” representing the overall confidence of SpA diagnosis based on MRI was evaluated in addition to the ASAS (Assessment of Spondyloarthritis International Society) criterion of “positive MRI” for sacroiliitis. Two musculoskeletal radiologists scored the presence of BME and sclerosis on SIJ-MRI using the Berlin method. Four subgroups were formed based on SpA diagnosis and childbirth (CB) history. Materials and methodsThis is a retrospective cohort study with 349 women (mean age 47 ± 14 years) suffering low back pain. ObjectiveTo investigate long-term effects of pregnancy/childbirth on bone marrow edema (BME) and subchondral sclerosis of sacroiliac joints (SIJ) in comparison to MRI changes caused by spondyloarthritis (SpA) and assess the influence of birth method and number of children on SIJ-MRI changes.
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