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<v ->Okay, and I show you now the last two cases tonight.

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The first one is a 65-year-old-man,

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reported age, of low back pain.

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He has asthenia and malaise, nocturnal sudoresis,

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probably unchecked fever.

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He has a prior colorectal neoplasia one year ago,

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and the orthopedic guy

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made the hypothesis of discitis or spondylodiscitis.

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So the guy was really feeling pain,

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and he came to the clinic

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and we began the examination.

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Wow, I don't see any sign of spondylodiscitis here.

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T2, T1.

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The axials of the spine.

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I thought it looks pretty normal.

1:26

Then I checked the FSE sequences.

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We can see lots of edemas.

1:40

I'll show you some images, then I'll make the comments.

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T2 FSE.

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He's a 65-year-old man.

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Coronal post-contrast.

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Surgical.

2:34

Post-contrast.

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And axial.

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And what you can see here

2:55

is many signs that Don just talked about.

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So we can see the Romanus lesions.

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We can see arthritis and osteitis of the epiphyseal joints.

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Arthritis.

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Osteitis.

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And enthesitis.

3:33

We can see sacroiliitis.

3:47

We can see enthesitis of the ligaments

3:54

of the sacroiliac joints.

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Enthesitis of the multifidus muscles.

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Arthritis and osteitis of the epiphyseal joints.

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And the costovertebral joints, too.

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Well, I think we have capsulitis, enthesitis, synovitis,

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and but the guy is 65 years old.

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We made the diagnosis of late onset spondyloarthritis.

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There is no established cutoff of delayed onset,

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50 years old, 55 years old, 45, 60.

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But most studies consider age of 50 years old,

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so, and older.

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So we think that 65 is, that's a good range.

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And the clinical presentation may be either

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typical axial disease with a more severe illness

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compared with a young onset disease.

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So this is axial and this for sure

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is more severe than we usually see.

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So that was our diagnosis.

5:37

Don, do you have any comments?

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<v ->Just one comment and one question for you.

5:44

Yeah, I've seen late onset and again,

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I don't have a definition for what particular age.

5:51

And in fact I think I showed those images

5:54

of the curvilinear syndesmophytes that,

5:57

that was in a patient who was pretty old

6:00

when the AnkSpon developed.

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That's why it was bulging of the disc.

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The question I have for you, I, you know, indicated,

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I don't count the fat corners.

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Do you, have you seen conversion of Romanus lesions

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to fatty corners of the vertebral body?

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Is that a common finding you've seen,

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and is there any significance to the number

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of fatty corners to help you with the diagnosis?

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<v ->Well, I didn't have the idea of three fatty corners,

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but I will try to count now,

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'cause look for more than these and more edema than fatty.

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<v ->Yeah, no, I've seen some with both edema

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and then some that look like they had been edema

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what were fatty, but,

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but it's interesting how many articles

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in the literature have stressed these fatty corners

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as indicating prior spondylitis.

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So it's something that I need to look for as well.

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But that's an interesting case.