When can pain revoke after bone tuberculosis treatment?

Hello,

Welcome to icliniq.com.

I have gone through your reports (attachments removed to protect patient identity) and read your history and prescription. Your brother has ankylosing spondylitis, chronic painful condition. Waxing waning symptoms (periods of intense irritation that disappears relatively) and the chronic nature of pain are the characteristic features of ankylosing spondylitis. History and treatment revived till now is perfectly elaborated. However, to comment on the treatment, I would like to see X-ray of pelvis with both hips - anteroposterior view and x-ray lumbosacral spine both anteroposterior and lateral view. After seeing the current X-ray, according to the condition I can truly comment on the treatment received, preventive measures and the new treatment guidelines best suited.

Thank you.

Hello,

Welcome back to icliniq.com.

I have gone through the MRI images and the reports (attachments removed to protect patient identity) provided. They show minimal facet arthropathy and ligamentum flavum arthropathy. Before suggesting any treatment, I want to bring forward a few points.

1. Currently you have mentioned hip pain as the main site of pain, but the MRI is of lumbosacral region.
2. These investigations are three years old and do not truly represent the current pathological state.
3. No imaging or clinical examination findings pertaining to hip are available.

In my previous answer too, I have asked for X-ray pelvis with both hips anteroposterior view and X-ray lumbosacral spine both anteroposterior and lateral view. Kindly follow with same.

Thank you.

Hello,

Welcome back to icliniq.com.

I have gone through your current X-ray images attached with the query and the previous MRI images as well (attachments removed for patient's identity protection).

From the radiological point of view, your brother's condition is not severe. He is currently having pain because of a paravertebral muscle spasm.

By solidification of liquid material, your doctor meant calcification of the intervertebral disc. The process starts early in patients with ankylosing spondylitis but is not evident in these X-ray images. However, it may have been suggested by the clinical examination findings or the symptom of radiating pain.

The X-ray is of the limbo sacral region rather than the affected hip. The condition is not radiologically severe as the sacroiliac joint space is maintained, which is one of the early features of the disease.

The current treatment prescribed by the doctor is satisfactory and should be continued. Once the pain settles, you should ask your brother to maintain an active lifestyle involving physical activity like running, jogging, cycling, swimming, and yoga.

Kindly revert in case of doubt. Feel free to discuss further.

Regards

Hello,

Welcome back to iclinq.com.

I am sorry to disappoint you. The disease will gradually progress and not revert.

There are periods of exacerbation of pain and a period of remittance with decreased pain. Sulfasalazine is the standard treatment. Steroids can be prescribed to tide over the acute exacerbation, but their use has to be monitored to prevent adverse effects.

Biological therapies are a newer treatment option and are indicated if the condition cannot be controlled with anti-inflammatory drugs and physiotherapy. This is an expensive form of treatment and is usually prescribed by a rheumatologist. The treatment is for a short duration, and the effect is temporary. It is quite effective in controlling symptoms, but the treatment is not definitive.

My recommendation for your brother is to go with the treatment prescribed by his doctor.

I wish your brother good health and a speedy recovery. Feel free to ask further queries.

Thank you.