A mini thread / ‘observational’ tweet (because the numbers are nice and neat!) -
1. I have now seen 10 patients in the last 12 months with bilateral flitting buttock pain who have had sacroiliitis (either with acute inflammatory changes or acute-on-chronic).

2. I have seen 10 patients with band like lower back pain with associated flitting bilateral buttock. these all had florid Modic 1 changes around lower 2 LSp disc segments. Age range 25-60.

3. I feel a valid conclusion / lesson here is that buttock pain is a key symptom of interest (?flag) vs LBP alone and should lower threshold for imaging, especially in men, in the context of a seronegative condition work up.

4. In these cases if deciding to MRI the LSp request SIJ protocol as well to fully evaluate. The relevance of Modic 1 disc changes & rship with pain has been debated on Twitter numerous times, but this pt series does seem to be consistent with a pain pattern of LBP into buttocks.

5. I know this will polarise opinion but i feel knowing about Modic 1 changes is helpful - it strongly hints that the pain is discogenic in nature (vs eg facet); seem to be responsive to pharm input; suggests an irritable segment & likely to respond poorly to aggressive loading

I’d welcome other peoples’ experiences with this (often challenging) group, reflections / comments ....

(this patient has ulcerative colitis)