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Doctors Lounge - Rheumatology Answers

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Forum Name: Rheumatology Topics

Question: Cervical spondylosis


 SusanB - Tue Jan 24, 2006 1:00 pm

Calling any doctor on the forum. I am a 50 year old female who was diagnosed and treated for seronegative nondegenerative inflammatory polyarthritis for five years. In this period of time due to location I have been treated by two rheumatologists who concurred with this diagnosis. I recently moved and am seeing a new rheumatologist who concludes that the other two rheumatologists I have seen in the past were wrong and I have osteoarthritis. After an MRI of my cervical spine due to numbness and radicular symptoms, a neurologist added the diagnosis of peripheral neuropathy and cervical spondylosis. Two questions. I.) The radiology report states, at the skull base upper cervial spine junction, mild degenerative change effects the odontoid anterior arch c1 articulation with pannus formation. After research, I can only find the mention of pannus formation in regards to rheumatoid arthritis not osteoarthritis. Does pannus form in osteoarthritis? Could this be helpful in determining the type of arthritis I have?
Question 2.) At level c4-c5 through c6-c7 inclusive degenerative disc disease is present with desiccation of the discs, moderate loss of disc space height at the two most lower levels and abnormalities of the disc space at all levels. At level c4-c5, a mild 2mm bulge of the posterior disc margins is present with mild indentation on the dural sac. Foramina are patent. At level c5 - c6 2 mm broad-based bulge of the posterior disc margin is present with prominent degenerative osteophytes arising from the outer disc margin bilaterally, with moderate severe narrowing of the left intervertebral foramina and moderate narrowing of the right foramina. At level c6- c7 2 mm generalized bulge of the posterior disc margin is present with mild indentation of the anterior aspect of the dural sac. Degenerative change and osteophyte arising from the outer disc margin bilaterally leads to mild narrowing of the medial aspect of the intervertebral foramina bilaterally. I have constant occiptal headaches, muscle pain and guarding and numbness and radicular pain in my right arm and hands as well as numbness in my right foot. I have been treated with medrol dose packs, muscle relaxants and pain relievers and have gone to physical therapy for six weeks without significant change. At PT while working to strengthen my neck muscles the exercises cause a flare and I revert back to my original condition. PT included electrical stim. Sitting for more than an hour will bring on a headache. The muscle relaxants and pain meds work to alleviate symptoms but cause excessive drowsiness. This has been getting progressively more painful over the last six months. What other treatments should I pursue? I cannot work and will need to file for disability if this does not resolve itself. In your experience does this seem like a valid disability claim?
 Dr. P. M. Aries - Tue Jan 24, 2006 4:50 pm

User avatar Unfortunately it is not possible to presume your diagnosis by internet if the three doctors before haven´t been able before.
Concerning this, I can state only some things in general:
there are defined differences between osteoarthritis and arthritis, also some people may have both.
You are right that panus arround the dens axis sounds more like arthritis then osteoarthritis. Before giving an advise what therapy you should use, diagnosis should be done before. However, I would suggest to ask for rheumatoid factor, anti-CCP- antibodies, nuclearscan and an nomal X-ray of the hands and feets. Having this, one should determine if you have RA or OA. After having diagnosis, we can talk about best treatments.
 SusanB - Fri Jan 27, 2006 1:59 pm

Thank you for such a promt reply Dr. Aries. I have had the RA factor test several times and it has been negative at all times. I do not find the anit-ccp-antibodies in my records and will ask the rheumatologist about this. Could you explain the purpose of a nuclearscan? I have had an MRi with and w/out contast of my hand when the first Rheumatologist wanted to confirm her diagnosis. They found minimal capsular thickening and edema of the 2nd and 3rd MCP joints with subtle enhancement of 3rd mcp joint capsule. Subtle synovial thickeneing or edema at the PIP of the long finger consistent with mild inflammatory change Two of the rheumatologists believed this to be clearcut evidence of nonerosive inflammatory polyarthritis. The 3d Rheumatologist says it means nothing. Is this MRI the same as a nucelar scan or would it give more information than this MRI?
Susan
 Dr. P. M. Aries - Sat Jan 28, 2006 5:33 am

User avatar THe MRI can give information only for very small region of the body. A nucelar scan is an imgaging of the whole body and can detect subclinical inflammation of all joints. Important information gives the scan after 5 min and 120 min. Inflammation will accumulate the nuclear technetium very early after a vew minutes because of the hyperemia, osteoarthriis don´t. If osteoarthritis in prominet, accumulation will take 1-2 hours.
Even if the technique is not the only test that can descriminate between RA and OA, it gives important information about the present status.

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