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HomeAnswersRheumatologyspondyloarthropathyWhich MRI will best reveal spondyloarthropathy?

Which body part’s MRI can best reveal spondyloarthropathy?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At December 9, 2017
Reviewed AtMay 16, 2024

Patient's Query

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, what chances are there that any abnormality might be found in my body?

  1. DL Spine MRI.
  2. Hip Joint MRI.
  3. Lumbosacral MRI.

Please tell me only about these three MRI tests 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.

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 follow-up, 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.

Thank you.

Patient's Query

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?

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.

Thank you.

Patient's Query

Thank you doctor,

I have done the MRI and got the reports today. I could not consult a doctor here due to a 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 about the disease fearing she would 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 was 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:

1. 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?

2. 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.

3. 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.

Hello,

Welcome back to icliniq.com.

Well, I have gone through your reports (attachment removed to protect the patient's 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 will show the same as MRI reads every image very magnified. So it is bound to show some findings. 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 a mark on your joints.

So next, we need to see how much the restriction in your movements. If there are no restrictions and no pain, we just need to work on an 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.

Thank you.

Patient's Query

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 the 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 from progressing and modify my bones?

Is there any option to reverse the damage to the bone which has already been 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 the normal range is 0 mg/L to 5 mg/L. I do not have any pain or joint stiffness. Then why is this one 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?

Hello,

Welcome back to icliniq.com.

Well, I have gone through your blood reports and the other imaging reports (attachment removed to protect the patient's 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 slow in your case. Some people with an aggressive disease would have shown advanced changes since the disease would have been ten 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.

Thank you.

Patient's Query

Hello doctor,

I have done my CRP test again, and now it is 1.1. However, I had pain in my ribs and shoulder that was more in the early morning. So, I got an X-ray done, which suggests that I have developed cervical spondylosis. I am attaching the reports for your reference. I have some questions:

1. Is cervical spondylosis related to ankylosing spondylitis?

2. Can cervical spondylosis occur at the age of 32?

3. Is it a serious condition, and will it make me handicapped?

4. Is there any cure for cervical spondylosis?

5. Can the disc spaces be rehydrated again?

Kindly advise.

Hello,

Welcome back to icliniq.com.

I have reviewed your reports (attachment removed to protect the patient's identity).

Your reports suggest you have a muscle spasm causing stiffness, which can be due to ankylosing spondylosis.

Also, the disc space is normal. Do not worry about spondylosis; it will not handicap you.

I suggest you do exercises and take anti-inflammatory medicines to relieve the spasm.

I hope this helps.

Regards.

Patient's Query

Hello,

Thank you for the reply.

I am attending physiotherapy sessions which include exercises of the neck. However, I am experiencing pain in my ribs during movement and deep breathing. What should I do? Kindly suggest.

Hello,

Welcome back to icliniq.com.

This looks like enthesitis due to tendon involvement. It commonly affects the ribs.

I suggest you take tablet Nucoxia 90 mg (Etoricoxib) once daily for seven days. Consult a specialist doctor, talk to him or her, and start the medicine with their consent.

I hope this helps.

Thank you.

Patient's Query

Hello doctor,

Does enthesitis mean calcification occurring in my rib joints or bones? If yes, is there a way to stop it?

Hello,

Welcome back to icliniq.com.

Enthesitis is a swelling of the tendons. Only if your spine is affected, it can cause calcification.

If it does not improve with anti-inflammatory medicines like tablet Nucoxia, we will have to go for biological drugs.

Also, keep doing aerobic exercises like swimming.

I hope this helps.

Regards.

Patient's Query

Hello doctor,

Today I got an X-ray of my chest PA view and lumbar spine. I have attached the report as well as X-ray images. Can you please check them and give your opinion? Regarding biologic drugs, does it increase the chance of having cancer since they are immunosuppressants? After taking biological drugs for some months, can I return to tablet Sazo 1000 again if symptoms improve?

Hello,

Welcome back to icliniq.com.

I have reviewed the reports (attachments removed to protect the patient's identity). The X-ray of the chest is normal. But, the lumbar spine shows straightening and squaring of the vertebra, which could be the reason for your stiffness. Biologic drugs do not cause cancer. However, there are a few side effects with every drug which we cannot predict. TNF Blockers, which we use in treating ankylosing spondylitis, can be used in cancer patients. Cancer usually occurs due to dysfunctional immunity rather than immunosuppression. We normally give it for a short course of six weeks to three months.

Thank you.

Patient's Query

Hello doctor,

Is the straightening of lumbar spine and squaring of vertebra happening due to ankylosing spondylitis or any other reason? Is it a bad thing? Is there anyway to stop it? Will taking NSAIDs stop or cure it? What should I do now?

Hello,

Welcome back to icliniq.com.

Straightening can be due to active disease or due to flare-up. However, squaring is usually due to a long-standing disease. Therefore, we must keep repeating your X-rays yearly to see if the changes are constantly evolving. Secondly, NSAIDS and biologic drugs are good for stopping the disease. However, nothing cures the disease. Your reports are mostly fine, but you can experience intermittent flares that need to be tackled. So, if you have last year's X-rays, we can compare whether any changes have progressed or are they the same.

Regards.

Patient's Query

Hello doctor,

I have a query. Recently, I joined a gym to lose fat in my belly and breast areas as fat has been deposited in these areas for a long time. I also want to get a toned body. Could you please tell me what type of exercises I should avoid? Also, please list them so that I will be more cautious.

Thank you.

Hello,

Welcome back to icliniq.com.

I suggest the below exercises:

1. Aerobic exercises.

2. Muscle strengthening.

3. Light weight training.

If there is pain in the neck, avoid lifting objects over the head, heavy weight training, or anything which may sprain your neck. So, I suggest you start them slowly and increase them gradually depending on how your body reacts.

I hope this helps.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Naval Mendiratta
Dr. Naval Mendiratta

Rheumatology

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