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Osteitis Condensans Ilii

Osteitis condensans ilii results in recurrent axial low-back pain. It mostly affects women and is found incidentally on plain X-ray by observing iliac bone sclerosis and a normal sacroiliac joint.


Presentation

Osteitis condensans ilii (OCI) is a benign cause of low-back pain that is self-limiting and has an unknown etiology. It lacks pathological or clinical evidence of inflammation.

The major clinical presentation in OCI is low back pain of mechanical character that is aggravated by activity and relieved upon resting. The patients often describe the non-radicular back pain as radiating down to the posterior thighs.

Usually, the iliac bone near the sacroiliac joint is affected in a bilateral and symmetric process. OCI is predominant in women of child-bearing age. However, rare incidents of men and nulliparous women with OCI is possible. OCI may be unilateral [1].

The sacrum may also be involved since the changes are not always limited to the iliac bones. The joint spaces are generally normal. However, an occasional lipping, and narrowing of the lower margin or minimal irregularities may be observed. Cases have long remissions and even though the onset can be associated with pregnancy, subsequent pregnancies do not necessarily worsen the symptoms. There are no collateral and consistent systemic disturbances or physical and radiological findings [2].

The pregnancy-associated ligamentous laxity of the sacroiliac joint (SIJ) can result in persistent instability and sclerosis of the joint in some cases. This can later present as SIJ tenderness. The course of the disease is chronic and it may relapse.Therefore, OCI should be differentiated from other inflammatory or non-inflammatory disorders of the sacroiliac joint [2] [3].

Coarctation of the Aorta
  • See other definitions of OCI Samples in periodicals archive: Various developmental malformations have been reported to be associated with osteopoikilosis, including: coarctation of the aorta, double ureter, pubertas praecox, urogenital defects, growth[acronymfinder.com]
Bone Disorder
  • This case report highlights ... 8 Ozdemirel Ali Erhan - - 2011 Osteopoikilosis (OPK) is a rare, autosomal dominant bone disorder, characterized by multiple, discrete round or ovoid radio densities scattered throughout the axial and appendicular skeleton[biomedsearch.com]
Fear
  • In 1985, 34% of all cigarette advertisements placed in magazines appeared in women's publications. 1 It cannot be inferred that these campaigns are a cause of the current high smoking rate among women, but many physicians note that the fear of gaining[consultant360.com]
Dystonia
  • Interventions: Not applicable Main Outcome Measures: Clinical examination Results or Clinical Course: Most patients (92%) presented with focal dystonia, followed by 5% with segmental dystonia, 2% with multifocal dystonia and 1% with generalized dystonia[kundoc.com]

Workup

The diagnostic criteria of OCI includes [3] [4]:

  • Unilateral or more commonly bilateral
  • Sclerosis of the lower margin of the iliac bone and a normal sacroiliac joint on radiological imaging
  • Predominance in females
  • Normal inflammatory parameters
  • Negative HLA-B27 antigen
  • Normal bone scan
  • Absence of bone erosion or destruction

In addition, a thorough history and physical examination can help differentiate OCI from ankylosing spondylitis, sacroiliitis, seronegative spondyloarthropathies, primary hyperparathyroidism, renal osteodystrophy, Paget's disease, bone secondaries and lymphoma [3] [5] [6] [7] [8]. Normal blood tests and seronegativity can exclude most of these conditions.

The radiographical appearance of OCI is described as a well defined triangular sclerosis of the iliac bone in the sacroiliac joint. Eburnation can be observed in the inferior part of the bone. Sclerosis can extend to the auricular portion of the iliac bone. Unlike other forms of sacroiliitis, the joint space is not obliterated in OCI and the articular margins remain intact. The radiological features of OCI can resolve over time [9].

In a small group of patients affected with OCI, polyarthralgia in the peripheral joints has been reported. However, significant inflammatory articular changes are usually absent.

Treatment

  • Balancing multiple theoretical approaches and healing paradigms in a diagnostic and treatment context, Alon Marcus offers a sophisticated text for practitioners applying these insights.[books.google.de]
  • Of 100 patients revielled, eight showed no response to treatment and twenty-three were somewhat improved; in sixty-seven patients conservative treatment afforded either complete relief or marked amelioration of symptoms.[insights.ovid.com]
  • Due to the inefficacy of the medical and physical treatment, two patients underwent surgical resection of the osteitic bone; then followed by a 45 days cast immobilization and a 3-4 months with restricted load.[moh-it.pure.elsevier.com]

Prognosis

  • Treatment and prognosis It carries a benign prognosis and may even resolve spontaneously.[radiopaedia.org]
  • Prognosis in osteitis condensans ilii. Radiology. 1959 Feb;72(2):234-7. Jenks K, Meikle G, Gray A, Stebbings S. Osteitis condensans ilii: a significant association with sacroiliac joint tenderness in women. Int J Rheum Dis. 2009 Apr;12(1):39-43.[roentgenrayreader.blogspot.com]
  • KEY POINTS ETIOPATHOGENESIS PREVALENCE CLINICAL MANIFESTATIONS PHYSICAL EXAMINATION DIAGNOSTIC INVESTIGATIONS DIFFERENTIAL DIAGNOSIS TREATMENT PROGNOSIS KEY POINTS The diagnosis of AS should be strongly considered if four or more of the following clinical[hss.edu]

Etiology

  • Osteitis condensans ilii (OCI) is a benign cause of low-back pain that is self-limiting and has an unknown etiology. It lacks pathological or clinical evidence of inflammation.[symptoma.com]
  • Etiology: The cause is unknown. It may be owing to increased mechanical stress across the sacroiliac joint during pregnancy. It is usually associated with pregnancy but has also been reported in those with hydroxyapatite crystal deposition disease.[rheumaknowledgy.com]
  • The nature of the etiology is not clear; the pathogenesis is unknown; and the clinical significance is debatable.[journals.lww.com]
  • Further investigation regarding the etiology and the pathology of this condition is under way. 2.[insights.ovid.com]
  • Although no clear etiology has been identified, the prevailing theory is that mechanical strain affects the auricular portion of the ilium and causes premature arthritis.[ncbi.nlm.nih.gov]

Epidemiology

  • Berker, “Epidemiology and Risk Factors for Low Back Pain,” Turkish Journal of Physical Medicine and Rehabilitation, Vol. 5, No. 44, 1998, pp. 8-12. J. D. Heckman and R.[file.scirp.org]
  • Although several studies (as well as common “wisdom”) suggest that people who quit smoking will gain weight, 2 epidemiologic data from the US National Health and Nutrition Examination Survey (NHANES II) suggest that this gain may not be excessive. 3 Ex-smokers[consultant360.com]
  • These are employed in epidemiologic studies in an attempt to standardize an AS diagnosis. Table 39-1.[hss.edu]
  • (Level 1A) [6] Epidemiology /Etiology Spondyloartropathies : Ankylosing spondylitis , reactive arthritis , psoriatic arthritis , arthritis of chronic inflammatory bowel disease and undifferentiated spondyloarthropathy.[physio-pedia.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of OCI has been described as unknown and the research is vague. It has been postulated that the gravid uterus may compress the abdominal aorta and cause ischemia in the inferior portion of the ilium.[clinicalmaze.com]
  • The pathophysiology of OCI has still not been fully established with the most commonly accepted reasoning being that the mechanical stress of pregnancy itself or uterus causes compression of abdominal aorta resulting in bony remodeling due to ischemia[austinpublishinggroup.com]

Prevention

  • MAINTENANCE AND RELAPSE PREVENTION Although the cessation attempt is relatively straightforward when patients are motivated to quit, data suggest that maintenance strategies and relapse prevention techniques must be considered from the start.[consultant360.com]
  • Transplantation Substance Use and Addiction Surgery Surgical Innovation Surgical Pearls Teachable Moment Technology and Finance The Rational Clinical Examination Tobacco and e-Cigarettes Toxicology Trauma and Injury Treatment Adherence United States Preventive[jamanetwork.com]
  • If it is preventing your movement and is one yr out from surgery you may want to consider consulting with the surgeon to see if surgery to remove some of the ossification is of use. ...Read more Dr. Martin Raff Dr.[healthtap.com]
  • To have strong bones when you are young, and to prevent bone loss when you are older, you need to get enough calcium, vitamin D, and exercise. You should also avoid smoking and drinking too much alcohol. Bone diseases can make bones easy to break.[icdlist.com]

References

Article

  1. Vadivelu R, Green TP, Bhatt R. An uncommon cause of back pain in pregnancy. Postgrad. Med. J. 2005;81:65-67.
  2. Thompson M. Osteitis Condensans Ilii and its differentiation from Ankylosing Spondylitis. Ann Rheum Dis. 1954;13(2):147-156.
  3. Mitra R. Osteitis condensans Ilii. Rheumatol Int. 2010;30(3):293–296.
  4. Rodríguez-Pla A, Moreno Muelas JV, Urgell JR, Benach JO, Roldós EA. Osteitis condensans Ilii: a cause of low back pain? A case-controlled, retrospective study. J Musculoskelet Pain. 2004;12(2):65–70.
  5. Jenks K, Meikle G, Gray A, Stebbings S. Osteitis condensans ilii: a significant association with sacroiliac joint tenderness in women. Int J Rheum Dis. 2009;12(1):39–43.
  6. Cidem M, Capkin E, Karkucak M, Karaca A. Osteitis condensans ilii in differential diagnosis of patients with chronic low back pain: a review of the literature. Mod Rheumatol. 2012;22(3):467–469.
  7. Shipp FL, Haggart GE. Further experience in the management of osteitis condensans ilii. J Bone Joint Surg. 1950;32A:841–847.
  8. Thompson M, Newton DR, Grainger RG. Discussion of the clinical and radiological aspects of sacro-iliac disease. Proc R Soc Med. 1957;50(10):847–858.
  9. Numaguchi Y. Osteitis condensans ilii, including its resolution. Radiology 1971;98:1–8.

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Last updated: 2018-06-21 22:26