this disease exhibits 
 autosomal dominant inheritance , and its clinical course is usually asymptomatic2 , 3 . its radiological findings are 
 typical and include diffuse , small round or ovoid , symmetric sclerotic bone areas4 . the coexistence of opk with 
 spondyloarthritis1 , 5 , 6 or spinal stenosis7,8,9 is rarely reported . here , we report the case 
 of a 27-year - old male who suffered from back and leg pain and was diagnosed with opk , 
 spondyloarthritis , and spinal stenosis . a 27  year - old male patient was referred to the physical medicine and rehabilitation 
 outpatient clinic with a history of posterior bilateral buttock pain and back pain radiating 
 to the legs for one month . as spinal stenosis was considered as a preliminary diagnosis , 
 magnetic resonance imaging ( mri ) of the lumbar spine was performed . lumbar mri showed 
 obvious degenerative changes in the lumbar facet joints incompatible with his age ; bulging 
 discs at the l34 , l45 , and l5s1 levels ; and spinal stenosis . lumbar mri also showed 
 compression of bilateral l5 and s1 nerve roots and relative spinal stenosis . his pain 
 improved with nonsteroidal anti - inflammatory drugs ( nsaids ) and physical therapy . he described his pain level as moderate according 
 to a 4-point likert scale . upon reexamination , a plain anteroposterior radiograph of pelvis was taken and revealed numerous round 
 and oval sclerotic bone areas of varying size at the ilea , ischia , sacrum , around the 
 acetabulum of the pelvis , and proximal femur bones ( fig . pelvic radiograph showing bilateral sclerotic bone areas at the ilea , ischia , 
 sacrum , around the acetabulum of the pelvis , and proximal femur . investigations of knee joints showed similar findings , and the patient was 
 therefore diagnosed with opk ( fig . mri of the 
 sacroiliac joints showed bilateral involvement with narrowing of both sacroiliac joints and 
 multiple nodular sclerotic foci . post - contrast images showed contrast enhancement in both 
 joint spaces and periarticular areas ( fig . t1-weighted mri showing bilateral involvement with narrowing of both sacroiliac 
 joints and multiple nodular sclerotic foci . b. post - contrast images showing contrast 
 enhancement in both joint spaces and periarticular areas ) . laboratory evaluations were as follows : erythrocyte sedimentation rate , 2  mm / h ; 
 c - reactive protein , 0.13  mg / dl ( reference range 00.5  mg / dl ) ; leukocytes , 
 7.8610/l ; platelets , 269 10/l ; and hemoglobin , 15.4  g / dl . serum urea , creatinine , alkaline phosphatase , and electrolytes levels were normal , and the 
 hla b-27 test result was negative . this case study complied with the ethical standards of 
 the declaration of helsinki ( 1975 , revised 1983 ) . pelvic radiograph showing bilateral sclerotic bone areas at the ilea , ischia , 
 sacrum , around the acetabulum of the pelvis , and proximal femur . b. bilateral knee 
 radiograph showing multiple sclerotic bone lesions a. t1-weighted mri showing bilateral involvement with narrowing of both sacroiliac 
 joints and multiple nodular sclerotic foci . b. post - contrast images showing contrast 
 enhancement in both joint spaces and periarticular areas according to the assessment of spondyloarthritis international society ( asas ) criteria10 , the patient was diagnosed with 
 seronegative spondyloarthritis . treatment included asemetasin 60  mg twice daily for four 
 weeks and exercise therapy . these foci are usually distributed 
 symmetrically in periarticular areas within the epiphyseal and metaphyseal regions4 . as mentioned above opk has been reported to be associated with various developmental 
 malformations such as coarctation of aorta , pubertas praecox , diabetes mellitus , 
 dacryocystitis , chondrosarcoma , synovial chondromatosis , otosclerosis , syndactyly , and 
 klippel - feil syndrome8 , 9 , 11,12,13,14 . rheumatic diseases reported in patients with opk include reactive 
 arthritis15 , rheumatoid arthritis16 , juvenile arthritis2 , discoid lupus erythematosus , spondyloarthritis1 , 5 , 6 , psoriatic arthritis17 , raynaud phenomenon1 , antiphospholipid syndrome , livedoid vasculitis , undifferentiated 
 connective tissue disease18 , familial 
 mediterranean fever5 , 19 , fibromyalgia3 , 20 , myofascial pain syndrome3 , adhesive capsulitis11 , spinal stenosis7,8,9 , and de quervain syndrome21 . the group includes ankylosing 
 spondylitis , psoriatic arthritis , reactive arthritis , and enteropathic arthritis . because of 
 the long delay between symptoms onset and the diagnosis of spondyloarthritis , the asas 
 developed new classification criteria for spondyloarthritis ; these criteria aim to provide 
 earlier and more accurate diagnosis for both early and established cases . these criteria 
 include mri as an important tool to detect active inflammation for early diagnosis10 . we made the diagnosis of 
 spondyloarthritis according to the asas criteria in the present case on the basis of the 
 following : low back pain with a duration of at least three months , onset at less than 
 45  years of age , active inflammatory lesions of sacroiliac joints on mri , and good response 
 to nsaids . the patient had a negative hla b-27 test result . in patients with spinal stenosis , the space within the spinal canal narrows due to the 
 reduced volume of the central canal , lateral recesses , and/or neural foramina caused by 
 degenerative changes or congenital causes23 . degenerative changes including disc dehydration , disc herniation , 
 disc space narrowing , facet joint hypertrophy , and ligamentum flavum thickening are the most 
 common causes of spinal stenosis . radiographic changes associated with stenosis are very 
 common with aging , especially in people older than 50  years . the major symptoms include back 
 and buttock pain , weakness , numbness , and neurogenic intermittent claudication24 , 25 . patients with unusually early onset of degenerative spinal changes , 
 as in the present case , should be investigated for underlying congenital pathologies . clinicians should investigate the existence of other possible coexisting medical conditions 
 in symptomatic patients with opk in order to shorten the time to diagnosis and provision of 
 appropriate treatment .
[ purpose ] osteopoikilosis is a rare hereditary bone disease that is usually asymptomatic . 
 it is generally diagnosed incidentally on plain radiography . the coexistence of 
 osteopoikilosis with seronegative spondyloarthritis or spinal stenosis is rarely reported . 
 here 
 , we report the case of a 27-year - old male patient with osteopoikilosis , seronegative 
 spondyloarthritis , and spinal stenosis . 
 [ subject ] a 27-year - old male patient with buttock 
 pain and back pain radiating to the legs . 
 [ methods ] a plain anteroposterior radiograph of 
 the pelvis revealed numerous round and oval sclerotic bone areas of varying size . 
 investigation of the knee joints showed similar findings , and the patient was diagnosed 
 with osteopoikilosis . 
 lumbar magnetic resonance images showed spinal stenosis and 
 degenerative changes in his lumbar facet joints . 
 magnetic resonance images of the 
 sacroiliac joints showed bilateral involvement with narrowing of both sacroiliac joints , 
 nodular multiple sclerotic foci , and contrast enhancement in both joint spaces and 
 periarticular areas . 
 hla b-27 test was negative . 
 [ results ] the patient was diagnosed with 
 osteopoikilosis , seronegative spondyloarthritis , and spinal stenosis . 
 treatment included 
 asemetasin twice daily and exercise therapy . 
 [ conclusion ] symptomatic patients with 
 osteopoikilosis should be investigated for other possible coexisting medical conditions ; 
 this will shorten the times to diagnosis and treatment .