Dr. K. Shanmuganandan
Rheumatology
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Patient's Query
Hi doctor,
I have severe pain in my sacroiliac joints (eight years). The doctors focused only on my lumbar sacral spine, and it has got fused for two years. However, the pain persisted. I found after surgery that bilateral sacroiliitis showed up on MRI for two years. I saw a rheumatologist for the first time who diagnosed me with ankylosing spondylitis and started treatment. For the past 12 months, we have tried different things to treat it. I also feel so sick of myself. I also have a low-grade temperature, nausea, dizziness, and fatigue. Currently, I am taking Gabapentin, Palexia, Midon, Xarelto, and Zofran.
Hi,
Welcome to icliniq.com.
You have spondyloarthritis.You may benefit from TNF (tumor necrosis factor) blockers. They will help in controlling your disease. What is your HLA-B27 status?
Thank you.
Patient's Query
Hello doctor,
I have tried Cosentyx, Humira, and Infliximab infusions. Nothing has worked. I also had my sacroiliac joints injected (cooled and numbed). The blood test for AS was negative. My CRP and ESR are not very high. After two weeks, I went to another hospital. I had another MRI. I asked how can sacroiliac joints be treated. The doctor told me there is no inflammation. But, still, I have pain in the sacroiliac joints.
Hi,
Welcome back to icliniq.com.
For sure, you are having pain in sacroiliac joints. But if it is ankylosing spondylitis, it would have gone with Humira (Adalimumab) or Infliximab. Since it is resisting beyond these medications, you need to take anti-inflammatory drugs and anti-pain medications to quell the pain. Alternatively, mild stretch and yoga can help. Please send me the MRI (magnetic resonance imaging) report when you get it and the scan pictures for me to analyze. If the pain is too much, put in a local analgesic cream and take Pregabalin. Also, send me the reports of ESR (erythrocyte sedimentation rate), and CRP (C-reactive protein).
Thank you.
Patient's Query
Hello doctor,
Is there any other scan that would assess the joint better such as a CT scan? If it is not AS then, could it be anything else?
Hi,
Welcome back to icliniq.com.
A CT scan can give the status of your bones and sacroiliac joints. The bone scan can help to see the inflammation. However, I still require ESR, CRP, and MRI reports. If it is not AS (ankylosing spondylitis), it can be due to the sacralization of a vertebra which can be diagnosed by an X-ray or CT scan.
Thank you.
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Rheumatology
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