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Arthritis (Expert Forum)
Sacroiliac arthritis
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Sacroiliac arthritis
by mohair3, May 14, 2007 12:00AM
Hi,
It all started with severe lower back pain after being hospitalized for Pelvic
Inflammatory Disease/salpingitis/cervicitis/cystitis. Within a few weeks of that hospitalization, I had knee pain so bad that I couldn't put weight on it but it was not swollen. It cleared up. I next started having eye problems and was diagnosed with nothing, then blepharitis, dry eyes, conjunctivitis and now I have recurrent episodes of episcleritis and corneal tears. I was misdx'd with lupus at one time, but my ANA was always negative. I finally got a Rheumatologist to xray my sacroiliac joints and his opinion in looking at the xrays was that I either had Reactive Arthritis or Inflammatory Bowel Disease (colitis). I had a colonoscopy and everything was normal except for a small polyp which was removed. After many, many years I now have decreased range of motion of my spine, and loss of lumbar lordosis, and one doctor suggested that I have the beginnings of spondylitis from a chronic reactive arthritis.
I have no diarrhea. I do have episodic IBS (constipation type)but it is controlled with vitamins and avoiding a lot of chocolate. The IBS is a recent event and the sacroiliac arthritis was first seen in 1989 on CT scan.
My question is what should the doctor be doing to positively diagnose which disease I actually have? Isn't what he has done already enough to diagnose? Based on what I have told you, which diagnosis would be most likely?
Thank you so much!
Cheryl
It all started with severe lower back pain after being hospitalized for Pelvic
Inflammatory Disease/salpingitis/cervicitis/cystitis. Within a few weeks of that hospitalization, I had knee pain so bad that I couldn't put weight on it but it was not swollen. It cleared up. I next started having eye problems and was diagnosed with nothing, then blepharitis, dry eyes, conjunctivitis and now I have recurrent episodes of episcleritis and corneal tears. I was misdx'd with lupus at one time, but my ANA was always negative. I finally got a Rheumatologist to xray my sacroiliac joints and his opinion in looking at the xrays was that I either had Reactive Arthritis or Inflammatory Bowel Disease (colitis). I had a colonoscopy and everything was normal except for a small polyp which was removed. After many, many years I now have decreased range of motion of my spine, and loss of lumbar lordosis, and one doctor suggested that I have the beginnings of spondylitis from a chronic reactive arthritis.
I have no diarrhea. I do have episodic IBS (constipation type)but it is controlled with vitamins and avoiding a lot of chocolate. The IBS is a recent event and the sacroiliac arthritis was first seen in 1989 on CT scan.
My question is what should the doctor be doing to positively diagnose which disease I actually have? Isn't what he has done already enough to diagnose? Based on what I have told you, which diagnosis would be most likely?
Thank you so much!
Cheryl
Doctor's Answer
by Kevin Pho, MD, May 15, 2007 12:00AM
, May 15, 2007 12:00AM
I agree with the testing that has already been done. Further evaluation of the spine can be done with an MRI of the affected area.
You could also consider blood test like an HLA B-27 level to rule out rheumatologic diseases like ankylosing spondylitis. Repeating the ANA and rheumatoid factor levels can be considered as well.
A referral to an orthopedist can be considered to further look at the spine, as well as a consultation with a physiatrist to investigate rehabilitation potential.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
You could also consider blood test like an HLA B-27 level to rule out rheumatologic diseases like ankylosing spondylitis. Repeating the ANA and rheumatoid factor levels can be considered as well.
A referral to an orthopedist can be considered to further look at the spine, as well as a consultation with a physiatrist to investigate rehabilitation potential.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
It says:
Mild degenerative end-plate changes.
L5-S1 herniated disk extrusion minimally effecting the thecal sac.
Facet joint hypertrophy is seen in the lower lumbar spine without significant stenosis.
ANA has been repeated several times over several years.
Wouldn't the cervicitis/salpingitis infection and the acute knee arthalgia within weeks of the initial infection, indicate that it was a reactive arthritis more so than an inflammatory bowel disease?
The order of events was:
Cervicitis
Hemorrhagic Cystitis
Salpingitis/PID
Acute knee Pain
Lower back pain and eye pain
I can not figure out how the inflammatory bowel disease could even be considered at this point. How would an MRI rule out the IBD????????
Thanks
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We tend to think of arthritis as an "old age" disease. Perhaps that's because the most common form of arthritis – the "wear and tear" degenerative condition known as osteoarthritis (OA) – is most often seen in people over 60. But OA is not the only form of arthritis. Although many of us refer to it as if it were a single disease, arthritis is actually a catchall term that covers more than 100 medical conditions, including rheumatoid arthritis (RA), systemic lupus, gout, and scleroderma. Arthritis can strike at any age, often without warning. In its various forms, arthritis affects more than 70 million adults and 300,000 children in America alone.
Some Common Types Of Arthritis
Osteoarthritis
The most prevalent form of arthritis, it is marked by degeneration of the cartilage that covers the ends of bones. Cartilage loss results in pain and difficulty of movement as bone begins to rub against bone.
Rheumatoid Arthritis
An autoimmune disease in which the body’s immune system becomes hyperactive and attacks and inflames the joint lining. Rheumatoid arthritis affects mostly women, and can be severely disabling and disfiguring.
Gout
Usually results from a metabolic defect. Gout can be extremely painful, and most often attacks small joints, especially the big toe and ankle.