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Q. MRI of which body parts will best reveal spondyloarthropathy?


 

Hello doctor,

I am a 31-year-old male and I was diagnosed with spondyloarthropathy seven years back. I am taking only Sulfasalazine tablets daily. Currently, I do not have any pain or stiffness. My HLA-B27 report is negative. Now, if I do the following MRIs, how much chances are there that any abnormality might be found in my body?

  • DL Spine MRI
  • Hip Joint MRI
  • Lumbosacral MRI

Please tell me only about these three MRI test as I need to show it to someone and I do not want to be caught with any disease.

Last week, I did a blood test and chest X-ray (PA view). The X-ray report was normal. ESR was 20 mm. TC and DC were normal. Please help. I have attached the MRI report for your reference.


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Dr. Naval Mendiratta
MBBS., MD MEDICINE., FELLOWSHIP IN RHEUMATOLOGY
Rheumatology

Hello,

Welcome to icliniq.com.

I am unable to find the attachment.

It is good to know that you are doing well on Sulfasalazine only.

But if you are doing well and have no symptoms with normal blood tests, I will not recommend MRI (magnetic resonance imaging) to be repeated. The MRI is only needed for doubtful diagnosis initially and to look for inflammation in the joints if there is a doubt.

For followup, we only do X-rays of the neck, mid spine and lower spine. That usually is good enough to see if there is any disease progression when we compare it to the previous ones. But if really you want to do an MRI and you have no symptoms, I am sure it will show improvement.

A look at the MRI report would be helpful. Do let me know if you have more queries.

For more information consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

 

Thank you doctor,

I only want the MRI to be clear and without any complications. I do not want to be seen as a man with this disease. Do you think my MRI will come clean?

 

Dr. Naval Mendiratta
MBBS., MD MEDICINE., FELLOWSHIP IN RHEUMATOLOGY
Rheumatology

Hello,

Welcome back to icliniq.com.

Well, there is a good chance that it will be normal. I could not view the earlier report, but possibly you would have had a resolution of the edema in the sacroiliac joints.

The other changes I cannot really predict like the syndesmophytes without really examining you.

These changes usually do not cause the symptoms but may be associated with restriction of activity. If that is not there you should be fine.

Eventually, we can reduce the Saaz (Sulfasalazine) dose as well.

Regards.

For more information consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

 

Thank you doctor,

I have done the MRI and got the reports today. I could not consult a doctor here due to lack of time. I have attached the MRI Reports in PDF format for you to check.

I need to tell you why I am so worried. Although my disease was diagnosed at a younger age, I got married a year ago. It was arranged marriage and I did not tell my wife regarding the disease fearing she will reject me. Now, one of my relatives has intentionally told her about the disease with many unwanted things and now she feels that she was cheated.

I tried to convince her that I am not severely ill but she did not believe and told me to do all the MRIs and she will herself consult a doctor. I am afraid that she might divorce me after seeing the MRI reports. My life is going to be shattered into pieces.

Now my questions are:

  • After seeing the MRI reports, do you feel that my case is severe? If she consults any doctor as per her choice, can that doctor tell her that my disease is severe?
  • Can it be possibly told from these reports that I have been suffering from this disease for a long time and I am under medication? If not, I can try to tell her that these are recent developments.
  • What treatments can I take to cure or alter all the problems mentioned in the MRI? What are the implications of these problems? Please help.
 

Dr. Naval Mendiratta
MBBS., MD MEDICINE., FELLOWSHIP IN RHEUMATOLOGY
Rheumatology

Hello,

Welcome back to icliniq.com.

Well, I have gone through your reports (attachment removed to protect patient identity).

The hemangiomas are more of an incidental finding. They usually do not cause any symptoms and maybe just found on a routine MRI (magnetic resonance imaging). So do not worry about that.

As for the lumbar spine which shows indentation at multiple levels that again is very nonspecific. Even if I get an MRI done, it would show the same as MRI reads every image very magnified. So it is bound to show some finding. You can ignore that too.

As for the pelvis is concerned, there is a bit of hyperintensity. It looks like a remnant of the old disease along with osteophytes. These both indicate the disease has left a bit of mark on your joints.

So next we need to see how much is the restriction in your movements. If there are no restrictions and no pain, we just need to work on exercise regime from here. All in all, I would say you are doing well and to just move ahead without giving too much importance to these findings. They will not halt your daily life.

Regards.

For more information consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

 

Thank you doctor,

I am going to ask you a couple of more questions. I am taking Saaz twice on a daily basis. My work is a desk job.

  • Do you think, in future as I grow old, this disease can modify my spine and joint disease even if I take the Sulfasalazine? If yes, what can I do to prevent this disease to progress and modify my bones?
  • Is there any option to reverse the damage in bone which has been already done? How can I prevent further degeneration of the bones?
  • Is there any way or any medicine to show better MRI reports if I do the X-rays and MRI again in two months?
  • Today, I have done some blood tests too. It was okay but the C-reactive protein is high. It is 30 mg/L whereas normal is 0-5 mg/L. I do not have any pain or joint stiffness. Then why this one is so high?
  • Will it be a correct decision to take a steroid injection like Depo-Medrol 40 mg/mL? I have attached my blood test report.

I have also uploaded my X-ray report. Could you please see this and give your valuable opinion?

 

Dr. Naval Mendiratta
MBBS., MD MEDICINE., FELLOWSHIP IN RHEUMATOLOGY
Rheumatology

Hello,

Welcome back to icliniq.com.

Well, I have gone through your blood reports and the other imaging reports (attachment removed to protect patient identity). I would like to clarify a few things:

Your CRP (C-reactive protein) levels are still high. It does indicate little disease activity is still going on. One thing we need to understand is radiological findings and the routine blood levels hardly correlate. Radiological progression is very very slow in your case. Some people with an aggressive disease would have shown advanced changes since the disease would have been 10 years long.

Your x-ray shows a bit of muscle spasm. That is the spine is a bit tight and there is a loss of curvature. This can be due to inflammation. A good part of the X-ray is there are no bridging syndesmophytes mentioned which is nothing but bridging the spine. So it indicates a milder version of the disease again.

So for now, I would suggest you repeat the CRP once more. Since you do not have any symptoms and it has shown a high level, we should recheck it.

If it is still high, continue your Sulfasalazine and we will keep painkillers on an as-needed basis. But if it persists to be high even after two to three months then we may need to accelerate the treatment. Consult your specialist doctor, discuss with him or her and with their consent take the medicines.

Regards.

For more information consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

 
 
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