Novel insights into the anatomy and histopathology of the sacroiliac joint and correlations with imaging signs of sacroiliitis in case of axial spondyloarthritis

Clément Prati; Thierry Lequerre; Benoît Le Goff; Bernard Cortet; Hechmi Toumi; Anne Tournadre; Hubert Marotte; Eric Lespessailles

doi:10.3389/fphys.2023.1182902

Novel insights into the anatomy and histopathology of the sacroiliac joint and correlations with imaging signs of sacroiliitis in case of axial spondyloarthritis

Front Physiol. 2023 May 11:14:1182902. doi: 10.3389/fphys.2023.1182902. eCollection 2023.

Authors

Clément Prati¹, Thierry Lequerre², Benoît Le Goff³, Bernard Cortet⁴, Hechmi Toumi⁵, Anne Tournadre⁶, Hubert Marotte⁷, Eric Lespessailles⁵

Affiliations

¹ Department of Rheumatology, Besançon University Hospital, PEPITE EA4267, University of Franche-Comté, Besançon, France.
² Department of Rheumatology, Rouen University Hospital, Inserm 1234, CIC/CRB 1404, Rouen, France.
³ Department of Rheumatology-CHU de Nantes, Nantes, France.
⁴ Department of Rheumatology, MABLAB ULR 4490, CHU Lille, University Lille, Lille, France.
⁵ Department of Rheumatology, Translational Medicine Research Platform, PRIMMO, University Hospital Center of Orleans, Orleans, France.
⁶ Department of Rheumatology, CHU Clermont-Ferrand, UNH UMR1019 INRAE-Université Clermont Auvergne, Clermont-Ferrand, France.
⁷ Department of Rheumatology, University Hospital of Saint Etienne, INSERM, SAINBIOSE U1059, Saint-Etienne, France.

Abstract

For a better understanding of the pathophysiology of spondyloarthropathy (SpA), a detailed anatomical description of the sacroiliac joint is required because sacroiliitis is the earliest and most common sign of SpA and an essential feature for the diagnosis of ankylosing spondylitis. Beyond the anatomy, the histopathology of sacroiliac entheses and immunological mechanisms involved in sacroiliitis are crucial for a better understanding of disease causation. In this narrative review, we discuss the core anatomical, histological, and immunohistological observations involved in the development of sacroiliitis, focusing particularly on imaging-based information associated with sacroiliitis. Finally, we try to answer the question of whether at the sacroiliac joint, enthesitis precedes synovitis and subchondral bone changes in SpA.

Keywords: MRI; ankylosing spondylitis; enthesitis; immunometabolism; sacroiliac joint; sacroiliitis; spondyloarthropathy; structural progression.

Publication types

Review