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

Rogelio A. Coronado, Charles Z. Sheets, Chad E. Cook, William C. Boissonnault

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and Purpose. Patients with inflammatory spinal conditions related to spondylarthritis 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 spondylarthritis, 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 spondylarthritis associated with inflammatory bowel disease. Outcomes. The patient initiated treatment with anti-tumor necrosis factor medication to address the spondylarthritis. Medical management resulted in significant improvement in all outcome measures. Discussion. Clinical suspicion of spondylarthritis is raised when specific historical, examination, and imaging findings are present. The posttest probability of spondylarthritis 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.

Original languageEnglish (US)
Pages (from-to)784-792
Number of pages9
JournalPhysical Therapy
Volume90
Issue number5
DOIs
StatePublished - May 2010
Externally publishedYes

Fingerprint

Spondylarthritis
Buttocks
Crohn Disease
Pain
Inflammatory Bowel Diseases
Referral and Consultation
Piriformis Muscle Syndrome
Sacroiliitis
Referred Pain
Therapeutics
Back Pain
Primary Health Care
Anti-Inflammatory Agents
Tumor Necrosis Factor-alpha
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Coronado, R. A., Sheets, C. Z., Cook, C. E., & Boissonnault, W. C. (2010). Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease. Physical Therapy, 90(5), 784-792. https://doi.org/10.2522/ptj.20090172

Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease. / Coronado, Rogelio A.; Sheets, Charles Z.; Cook, Chad E.; Boissonnault, William C.

In: Physical Therapy, Vol. 90, No. 5, 05.2010, p. 784-792.

Research output: Contribution to journalArticle

Coronado, RA, Sheets, CZ, Cook, CE & Boissonnault, WC 2010, 'Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease', Physical Therapy, vol. 90, no. 5, pp. 784-792. https://doi.org/10.2522/ptj.20090172
Coronado, Rogelio A. ; Sheets, Charles Z. ; Cook, Chad E. ; Boissonnault, William C. / Spondyloarthritis in a patient with unilateral buttock pain and history of Crohn disease. In: Physical Therapy. 2010 ; Vol. 90, No. 5. pp. 784-792.
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