{"id":"https://openalex.org/W7124163975","doi":"https://doi.org/10.2519/josptcases.2026.0208","title":"Diagnostic Challenges in a Novice Ultra-Cyclist: Transitioning From an Overuse Injury Hypothesis to HLA-B27\u2013Negative Axial Spondyloarthritis: A Case Report","display_name":"Diagnostic Challenges in a Novice Ultra-Cyclist: Transitioning From an Overuse Injury Hypothesis to HLA-B27\u2013Negative Axial Spondyloarthritis: A Case Report","publication_year":2026,"publication_date":"2026-01-14","ids":{"openalex":"https://openalex.org/W7124163975","doi":"https://doi.org/10.2519/josptcases.2026.0208"},"language":"en","primary_location":{"id":"doi:10.2519/josptcases.2026.0208","doi":"https://doi.org/10.2519/josptcases.2026.0208","is_oa":false,"landing_page_url":"https://doi.org/10.2519/josptcases.2026.0208","pdf_url":null,"source":{"id":"https://openalex.org/S4393919522","display_name":"JOSPT Cases","issn_l":"2767-2921","issn":["2767-2921"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JOSPT Cases","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5123022536","display_name":"Cedric Van den Bosch","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Cedric Van den Bosch","raw_affiliation_strings":[""],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5055595131","display_name":"Stijn Bogaerts","orcid":"https://orcid.org/0000-0001-5708-2439","observed_orcids":["https://orcid.org/0000-0001-5708-2439"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Stijn Bogaerts","raw_affiliation_strings":[""],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.02525403,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"6","issue":"1","first_page":"19","last_page":"24"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11092","display_name":"Spondyloarthritis Studies and Treatments","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11092","display_name":"Spondyloarthritis Studies and Treatments","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13328","display_name":"Osteomyelitis and Bone Disorders Research","score":0.0003000000142492354,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11571","display_name":"Sarcoidosis and Beryllium Toxicity Research","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/ultra-endurance-cycling","display_name":"ultra-endurance cycling","score":0.8569999933242798},{"id":"https://openalex.org/keywords/sacroiliitis","display_name":"sacroiliitis","score":0.902999997138977},{"id":"https://openalex.org/keywords/bone-marrow-edema","display_name":"bone marrow edema","score":0.8379999995231628},{"id":"https://openalex.org/keywords/overuse-injuries","display_name":"overuse injuries","score":0.8169999718666077},{"id":"https://openalex.org/keywords/groin-pain","display_name":"groin pain","score":0.6800000071525574},{"id":"https://openalex.org/keywords/stress-fractures","display_name":"stress fractures","score":0.4869999885559082},{"id":"https://openalex.org/keywords/tnf-alpha-inhibitor-therapy","display_name":"TNF-alpha inhibitor therapy","score":0.8330000042915344},{"id":"https://openalex.org/keywords/differential-diagnosis","display_name":"differential diagnosis","score":0.5699999928474426},{"id":"https://openalex.org/keywords/inflammatory-arthritis","display_name":"inflammatory arthritis","score":0.37700000405311584}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8930000066757202},{"id":"https://openalex.org/C2776737378","wikidata":"https://www.wikidata.org/wiki/Q41392","display_name":"Stress fractures","level":2,"score":0.5070000290870667},{"id":"https://openalex.org/C544519230","wikidata":"https://www.wikidata.org/wiki/Q32566","display_name":"Computed tomography","level":2,"score":0.4884999990463257},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.48240000009536743},{"id":"https://openalex.org/C126838900","wikidata":"https://www.wikidata.org/wiki/Q77604","display_name":"Radiology","level":1,"score":0.4668000042438507},{"id":"https://openalex.org/C2779967601","wikidata":"https://www.wikidata.org/wiki/Q211159","display_name":"Groin","level":2,"score":0.46560001373291016},{"id":"https://openalex.org/C2778579456","wikidata":"https://www.wikidata.org/wiki/Q2213687","display_name":"Sacroiliitis","level":3,"score":0.4366999864578247},{"id":"https://openalex.org/C2780886150","wikidata":"https://www.wikidata.org/wiki/Q152234","display_name":"Edema","level":2,"score":0.41440001130104065},{"id":"https://openalex.org/C2780007613","wikidata":"https://www.wikidata.org/wiki/Q546523","display_name":"Bone marrow","level":2,"score":0.32510000467300415},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.3240000009536743},{"id":"https://openalex.org/C2911105243","wikidata":"https://www.wikidata.org/wiki/Q1753467","display_name":"Insufficiency fracture","level":3,"score":0.30970001220703125},{"id":"https://openalex.org/C2993471631","wikidata":"https://www.wikidata.org/wiki/Q4116663","display_name":"Musculoskeletal pain","level":2,"score":0.2759999930858612},{"id":"https://openalex.org/C2777402515","wikidata":"https://www.wikidata.org/wiki/Q52849","display_name":"Ankylosing spondylitis","level":2,"score":0.2549999952316284},{"id":"https://openalex.org/C143409427","wikidata":"https://www.wikidata.org/wiki/Q161238","display_name":"Magnetic resonance imaging","level":2,"score":0.2517000138759613}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.2519/josptcases.2026.0208","doi":"https://doi.org/10.2519/josptcases.2026.0208","is_oa":false,"landing_page_url":"https://doi.org/10.2519/josptcases.2026.0208","pdf_url":null,"source":{"id":"https://openalex.org/S4393919522","display_name":"JOSPT Cases","issn_l":"2767-2921","issn":["2767-2921"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"JOSPT Cases","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"sustainable_development_goals_aurora":[{"score":0.64906245470047,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/case-report","display_name":"Case Report"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":26,"referenced_works":["https://openalex.org/W1578120065","https://openalex.org/W1969691303","https://openalex.org/W2010640059","https://openalex.org/W2014353184","https://openalex.org/W2014719251","https://openalex.org/W2028128758","https://openalex.org/W2057800456","https://openalex.org/W2118596556","https://openalex.org/W2160696596","https://openalex.org/W2310625947","https://openalex.org/W2519537507","https://openalex.org/W2883476241","https://openalex.org/W2902841843","https://openalex.org/W2907973648","https://openalex.org/W2922201903","https://openalex.org/W2949358713","https://openalex.org/W3134943536","https://openalex.org/W3180665742","https://openalex.org/W4214902242","https://openalex.org/W4378221255","https://openalex.org/W4382397129","https://openalex.org/W4385985622","https://openalex.org/W4396227254","https://openalex.org/W4396805808","https://openalex.org/W4397004606","https://openalex.org/W4402857068"],"related_works":[],"abstract_inverted_index":{"BACKGROUND:":[0],"Ultra-endurance":[1],"cyclists":[2],"frequently":[3],"present":[4],"with":[5,51,100,128],"overuse":[6,125],"injuries,":[7],"yet":[8],"bone":[9,48],"marrow":[10,49],"edema":[11,50],"at":[12],"the":[13,35,58,88,118],"medial":[14,46],"ilium":[15],"is":[16],"highly":[17],"uncommon":[18],"and":[19,86,104],"may":[20],"indicate":[21],"underlying":[22],"pathology.":[23],"CASE":[24],"PRESENTATION:":[25],"A":[26],"31-year-old":[27],"cyclist":[28],"developed":[29],"atraumatic":[30],"groin":[31],"pain":[32],"migrating":[33],"to":[34,91,107],"gluteal":[36],"region.":[37],"Despite":[38,80],"targeted":[39,83],"physical":[40],"therapy,":[41],"symptoms":[42,132],"persisted.":[43],"MRI":[44],"showed":[45],"iliac":[47],"a":[52],"suspected":[53],"stress":[54],"fracture":[55],"line.":[56],"Given":[57],"low-impact":[59],"nature":[60],"of":[61,74,120,143],"cycling,":[62,82,130],"further":[63],"evaluation":[64],"was":[65,72,98],"pursued.":[66],"The":[67],"subsequent":[68],"computed":[69],"tomography":[70],"scan":[71],"suggestive":[73],"unilateral":[75],"sacroiliitis.":[76],"OUTCOME":[77],"AND":[78],"FOLLOW-UP:":[79],"reduced":[81],"stabilization":[84],"exercises,":[85],"NSAIDs,":[87],"condition":[89],"progressed":[90],"bilateral":[92],"sacroiliitis":[93],"on":[94],"repeat":[95],"MRI.":[96],"He":[97],"diagnosed":[99],"HLA-B27\u2013negative":[101],"axial":[102],"spondyloarthritis":[103],"responded":[105],"well":[106],"TNF-\u03b1":[108],"inhibitor":[109],"therapy.":[110],"DISCUSSION:":[111],"This":[112],"case":[113],"illustrates":[114],"that,":[115],"even":[116],"in":[117],"presence":[119],"substantial":[121],"risk":[122],"factors":[123],"for":[124],"injuries":[126],"associated":[127],"ultra-endurance":[129],"persistent":[131],"that":[133],"cannot":[134],"be":[135],"adequately":[136],"explained":[137],"by":[138],"overload":[139],"should":[140],"prompt":[141],"consideration":[142],"alternative":[144],"etiologies,":[145],"including":[146],"inflammatory":[147],"pathologies.":[148],"JOSPT":[149],"Cases":[150],"2026;6(1):19-24.":[151],"Epub":[152],"14":[153],"January":[154],"2026.":[155],"doi:10.2519/josptcases.2026.0208":[156]},"counts_by_year":[],"updated_date":"2026-09-26T08:19:03.415552","created_date":"2026-01-15T00:00:00"}