Doctors Lounge - Rheumatology Answers
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Forum Name: Rheumatology Topics
Question: Ankylosing Spondylitis or not?
|Kristin82 - Fri Jul 31, 2009 8:36 pm||
Let me apologize in advance for the length of this post. I'm 27, female, and HLA-B27 negative. In 2004, I developed bulging disks L4-L5 and L5-S1. In 2005, I was diagnosed with fibromyalgia by a rheumatologist. In 2007, I had a CT scan of my pelvis because of something unrelated, and as an incidental finding it showed "bilateral asymmetry and sclerosis of the SI joints with partial fusion of the right SI joint." I showed this to my rheumy, she said she did not think I had AS, but would do an MRI (closed, 1.5 Tesla) to make sure. When the report came back, she told me there was no active inflammation and that "it was just osteoarthritis." I never saw a copy of the report, I took her word for it, and I was relieved and moved on. I don't know if she ever looked at the actual films.
An x-ray of my lumbar region done for my disability case showed loss of normal lordosis, a Schmorl's node, and something about chronic apophysitis. A few months ago, I started having pain in my neck, MRI showed two right paracentral osteophyte complexes and cervical straightening.
Recently, I moved to a different part of the state, and got a new rheumatologist. He took one look at the CT and MRI reports and said he thought I had AS. It turns out the MRI report from 2007 says that, while there was no active inflammation, there was "partial fusion of the right SI joint via an osseous bar." I wanted a new MRI, he said he didn't think it was necessary, and was all ready to put me on Remicade. I asked my PCP for an MRI, wanting to be sure. She ordered it, but for some reason ordered it as an OPEN MRI (half the magnet strength). The report came back this week, showing "No active sacroiliitis, slight asymmetry of the SI joints, with mild narrowing and predominantly iliac sided subchondral sclerosis of the right SI joint."
I faxed it to the new rheumy, he got the CD of the films and showed it to a radiologist. The radiologist feels confident that the report it right and that there is no need to get a closed MRI, which is what I wanted. I am having the CD of the 2007 films (the closed MRI showing fusion) sent to him so he review that next week.
I feel like I'm on an emotional rollercoaster. I'm totally lost. Can anybody shed some light on all of this? Or tell me what I should do next? Thank you for your help, Kristin
|Tom Plamondon PA-C - Mon Aug 03, 2009 9:05 pm||
This description sounds like you may have AS but I would defer to the rheumatologist for definite diagnosis. The issue of whether or not this is AS comes into play when deciding on second and third line medications (e.g. methotrexate and Remicade respectively)
First treatment options are exercise and NSAIDs.
Since the spine with AS straightens (decreased lumbar lordosis) and fusion of SI joint, mobility / AROM exercises are important. For the lumbar spine, do extension exercises.
The other issues that comes into play with AS are potential systemic problems such as:
colitis (inflammation of the colon)
aortic problems and arrhythmia
more spine problems (e.g. subluxation of the upper cervical vertebrae)
I think the imaging so far is sufficient to move forward into treatment but again working with the rheumtologist is key.
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