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Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease.

Publication ,  Journal Article
Coronado, RA; Sheets, CZ; Cook, CE; Boissonnault, WG
Published in: Phys Ther
May 2010

BACKGROUND AND PURPOSE: Patients with inflammatory spinal conditions related to spondyloarthritis are rarely seen by primary care practitioners. However, patients with a history of inflammatory bowel disease and chronic low back or buttock pain should be examined carefully for the presence of spondyloarthritis, as proper management may include referral to a rheumatologist and appropriate medical intervention. CASE DESCRIPTION: A 27-year-old woman with a 6-month history of posterior buttock pain was referred for physical therapy with a diagnosis of piriformis syndrome. During the second physical therapy visit, a nonmechanical source of lumbopelvic pain was suspected, and the patient was referred for medical consultation. The patient underwent evaluation by a rheumatologist and was eventually diagnosed with spondyloarthritis associated with inflammatory bowel disease. OUTCOMES: The patient initiated treatment with anti-tumor necrosis factor medication to address the spondyloarthritis. Medical management resulted in significant improvement in all outcome measures. DISCUSSION: Clinical suspicion of spondyloarthritis is raised when specific historical, examination, and imaging findings are present. The posttest probability of spondyloarthritis is increased with the presence of inflammatory back pain and specific spondyloarthritic features, such as a positive history of inflammatory bowel disease, radiographic evidence of sacroiliitis, and improvement with anti-inflammatory medication. Referral of patients with these findings for a rheumatological evaluation is warranted, as these diseases are managed effectively with specific treatment.

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Published In

Phys Ther

DOI

EISSN

1538-6724

Publication Date

May 2010

Volume

90

Issue

5

Start / End Page

784 / 792

Location

United States

Related Subject Headings

  • Spondylarthritis
  • Rehabilitation
  • Physical Therapy Modalities
  • Pain Measurement
  • Pain
  • Humans
  • Female
  • Disability Evaluation
  • Diagnosis, Differential
  • Crohn Disease
 

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Coronado, R. A., Sheets, C. Z., Cook, C. E., & Boissonnault, W. G. (2010). Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease. Phys Ther, 90(5), 784–792. https://doi.org/10.2522/ptj.20090172
Coronado, Rogelio A., Charles Z. Sheets, Chad E. Cook, and William G. Boissonnault. “Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease.Phys Ther 90, no. 5 (May 2010): 784–92. https://doi.org/10.2522/ptj.20090172.
Coronado RA, Sheets CZ, Cook CE, Boissonnault WG. Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease. Phys Ther. 2010 May;90(5):784–92.
Coronado, Rogelio A., et al. “Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease.Phys Ther, vol. 90, no. 5, May 2010, pp. 784–92. Pubmed, doi:10.2522/ptj.20090172.
Coronado RA, Sheets CZ, Cook CE, Boissonnault WG. Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease. Phys Ther. 2010 May;90(5):784–792.
Journal cover image

Published In

Phys Ther

DOI

EISSN

1538-6724

Publication Date

May 2010

Volume

90

Issue

5

Start / End Page

784 / 792

Location

United States

Related Subject Headings

  • Spondylarthritis
  • Rehabilitation
  • Physical Therapy Modalities
  • Pain Measurement
  • Pain
  • Humans
  • Female
  • Disability Evaluation
  • Diagnosis, Differential
  • Crohn Disease