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The main clinical and diagnostic characteristics of patients with low back pain and sacroiliac joint diseases (results of the IOLANTA-II study)

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Objective: to investigate the clinical and diagnostic characteristics of patients with low back pain in the presence of sacroiliac joint (SIJ) disease.

Patients and methods. The investigation design involved three visits: V 1 (inclusion); V 2 (after 7 days), and V 3 (after 3 months); after the screening period, the investigation enrolled 259 patients aged 65.5 [62.5; 69.5] years; of them there were 165 (63.7%) women. At V 1 , according to magnetic resonance imaging findings, the patients were divided into two groups: 1) 157 patients without confirmed SIJ disease; 2) 102 patients with confirmed SIJ disease. During all visits, the investigators made general clinical and neurological examinations and assessed the intensity of pain syndrome according to a visual analogue scale (VAS) for pain in millimeters, a neuropathic pain component according to the DN4 questionnaire, by determining the blood parameters: transforming growth factor-β1 (TGF-β1), interleukin-1β (IL-1β), IL-6, Beta-Crosslaps, the indicator of bone matrix formation procollagen type 1 N-terminal propeptide (P1NP) and by estimating the urinary level of deoxypyridinoline.

Results and discussion. At all visits, Group 2 patients with higher VAS pain scores had a pain history that was statistically significantly longer (p<0.001). The ANOVA analysis showed that the patients in Group 2 had statistically significantly higher values of TGF-β1, IL-1β, IL-6, and bone resorption markers than those in Group 1, which suggests the relationship between pain syndrome and the presence of an inflammatoryresorptive process in patients with SIJ disease.

Conclusion. A high (39.4%) prevalence of SIJ disease was noted in patients over 60 years of age with low back pain. During the follow-up period, there was a decrease in bone resorption markers and cytokines; however, the SIJ disease group showed less pronounced changes with statistically significant differences in all parameters than in the non-SIJ disease group. It is advisable to consider an algorithm for diagnosing a patient over 60 years of age with low back pain, by mandatorily examining his/her SIJ. Treatment policy, including methods for correction with drugs, should be discussed based on the findings.

About the Authors

I. A. Zolotovskaya
Samara State Medical University, Ministry of Health of Russia
Russian Federation

Irina Aleksandrovna Zolotovskaya

89, Chapaevskaya St., Samara 443099

I. L. Davydkin
Samara State Medical University, Ministry of Health of Russia
Russian Federation
89, Chapaevskaya St., Samara 443099


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For citations:

Zolotovskaya I.A., Davydkin I.L. The main clinical and diagnostic characteristics of patients with low back pain and sacroiliac joint diseases (results of the IOLANTA-II study). Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):57-64. (In Russ.)

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)