Presentation
Active young male. Lower back pain interfering with work. ESR 32. CRP 27. Family doctors noticed psoriatic rash on examination.
Patient Data
High STIR signal in the pedicles bilaterally at L4 and L5, and L3 on the right. The L4 and L5 pedicular changes are more pronounced on the left.
Minor diffuse disc bulges at L4/L5 and L5/S1 with tiny annular tears in the posterior discs.
The central canal and exit foramen are capacious at both levels. No nerve root impingement.
Irregularity of both sacroiliac joints, with altered bone marrow signal in the posterior aspect of both iliia.
No sacroiliac joint effusion.
Case Discussion
The appearances of the sacroiliac joints and lumbar pedicles are in keeping with inflammation, in particular sacroiliitis. Given the presence of cutaneous psoriasis, this is in keeping with psoriatic arthropathy.
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