Do these MRI finding sound like arthritis?

[ML2455]

Over the last 21 months, my 14 year old son has gone from being able to almost not able to walk due pain in his toes and heels.  We have seen an orthopedist, a podiatrist, a rheumatologist and others.  Initially, there was talk of Sever's, then tarsal coalition, but these diagnoses didn't stick.  All doctors so far seem uncertain about the cause.  The rheumatologist says my son may have a form of juvenile arthritis.  However, the rheumatologist seems uncertain saying his exam and symptoms are atypical.  My son’s last MRI shows non-specific edema in both feet at the base of the fifth metatarsal, the base of the first distal phalanx, and the heads of the second through fifth metatasals, and in the calcaneous.  Does anyone know if these type of mri findings are consistent with an early stage of arthritis? Are there other possible causes of such findings and/or another specialty that should evaluate this.  I want to know, e.g., can avascular necrosis present this way or any other conditions?  I'm just trying to understand whether this condition fits with something rheumatologic and ensure that we don't overlook something or find a year or two from now that we pursued the wrong type of help or treatment.  Thanks,

[spastic]

Hi Sweetie, I am glad you went to Imaging Consult, I love that site!  Ok, the recommendation from my friend was to take him to a Pediatric Academy Hospital, a teaching hospital.  Do you have access to the Mayo clinic or John Hopkins?  Those are the two I can think of off the top of my head.  I know you can go there as an emergency and they will get you in ASAP.  I have heard good things about these hospitals.

I'm sorry I am not able to give you more info.  Just want you to know I am thinking of you two.

Ada

[ML2455]

Thanks so much.  I really appreciate the tip/link to Imaging Consult.  That's a great website with lots of very good information.  ML

[spastic]

I just wanted you to know I privated msg'd my friend, I copied and pasted what you have written here in the msg so hopefully she will be able to get to it today.  She has extreme fatigue with the MS so it might be awhile yet.

I have been weeping for the two of you.  I have a 14 year old son too and I don't know what I would do if he was in the same situation.  I feel so bad for the both of you.  I have been googling like crazy, I found a few sites that may be helpful to you one is Imaging Consult.  This one I subscribed too, when I would search for mri showing edema in foot it took me to a lot of mri pictures. It referenced osteomyelitis, a Charcot foot and some others.  I would check this site out.  Its free to subscribe.

I just want you to know I am here if you need anything.

Ada

[ML2455]

Thanks for your helpful and kind posts.  

A pain management doctor said it's not Complex Regional Pain Syndrome, so that's one thing ruled out.  

Related to my question about edema on MRI, a couple doctors (podiatrist and allergist) suggested that it could be from athletic activity (pounding of feet on the ground).  To me, that doesn't make sense.  Though he's been better and worse (due to medications), in general, he just barely gets around on his feet since last summer (about 11 months).  He dropped out of all sports last summer.  He's not out playing with friends.  Other than swimming and physical therapy, he has spent the majority of the last year sitting or reclining.  Imaging over time shows more edema in more bones in the feet and that progression is occuring while he is inactive/not on his feet much at all.  Just mention that for what it's worth.  

Thanks again for your kindness, ML

[spastic]

I hope others here will give their expertise on the MRI matter.  I am not knowledgeable in that area.  I do talk to a retired peds Dr on the MS forum here and I will ask her about the MRI.  Sorry I can't be more helpful on that.

As far as the methotrexate goes it can take from 3-12 weeks for it to noticeably start working.  I know it seems like a drastic drug for your son to take but it seems that the Rheumy is trying to get whatever he has under control.  I wish it was a quicker acting drug.  

A speckled ANA is associated with SLE, Sjogren’s syndrome, scleroderma, polymyositis, rheumatoid arthritis, and mixed connective tissue disease.  The RF and ESR tests results will kind of point the way for a dx, I hope anyway.

I have read about something called Complex Regional Pain Syndrome, it is a pain condition that starts after a traumatic injury like broken bones, gunshots, surgeries, etc.  It is a truly bizarre condition.

I wish I could be of more help to you, I truly feel for you two.  I will be thinking of you two today.

Ada

[ML2455]

I forgot to reply to questions about son's blood tests, rashes, fever:   HLA B27 negative, ANA positive speckled, possible but not likely celiac lab and gene tests (endoscopy pending), RF factor and other test like mycoplasma and lyme's pending. No rashes.  Around the beginning of 8th grade (1.5 years ago), he had a metatarsal stress fracture.  He also had fever-like illness, which seemed to recur 3 x during the school year.  The 3rd time, he had dx of mycoplasma pneumonia.  No fevers since, just progressive, debilitating foot pain.  Sorry about the Still's, but thanks for mentioning.   I'll read up on Still's.  I'm very interested in hearing from anyone about the possible meaning of edema on mri and relation to arthritis or other conditions, how long it takes for methotrexate to work and/or thoughts about antibiotic protocol or anything anyone thinks may be helpful.  Thanks, ML

[ML2455]

Thanks.  It helps to know that we're not alone.  Sorry my initial question was too long.  Here's a shorter version.  Does anyone know if non-specific edema in the metatarsals (feet) is suggestive of arthritis or suggestive of other conditions?  May be someone reading here has similar findings.  About medication, last Fall, my son started with 20 mg. prednisone daily.  The ped. rheumy increased it to 40 mg daily and added voltaren.  That helped, but he developed elevated liver enzymes, and so the ped. rheumy took him off everything in preparation for a liver biopsy that a gastroenterologist said he should have.  Thereafter, his liver enzymes went back to normal and he had a normal MRI of the liver instead of the biopsy.  Liver is fine, but he had this huge increase in pain as he stopped Voltaren and discontinued prednisone.  He's no longer able to go to school and just basically in the house.  He's discouraged, not sleeping (and neither am I).  Four weeks ago, the ped. rheumy put him back on prednisone 40 mg per day and declining and added 10 mg. of methotrexate weekly with 1 mg folate daily.   He's now down to 10 mg prednisone daily, 10 mg. of methotrexate weekly, and 1 mg folate daily.  He seems no better (may be worse).   Does methotrexate sometimes not work at all, or take longer than 4 weeks to start working?  I can't believe I have to give something like this to him, and it's not working and the rheumy says things like he's not sure what this is.  Has anyone here tried antibiotic protocol and have information to share?  Again my thanks, just for listening/reading.  Have a good day.  ML

[spastic]

I am so sorry your son is going through this.  I don't have info about what the MRI results are but I have Still's disease and when it presents in children it is often called JRA.  Has the rheumy ran any blood work?  Does your son present with fever or rashes at all?  Have they given him any prednisone?

Sorry for all of the questions,  I hope you get answers soon.

Your Friend,

Ada

[smittygirl]

I need to get to bed but I wanted to at least touch base with you.  Until I can digest your post and give it the attention you deserve I will leave you with this.  Would it be possible to find a Dr, that specializes in JRA?  Sometimes the best way to get to the real dx is to rule out other diseases so you can move on to the next one.  Since you have been dealing with this for the last 21 months I don't have to tell you the patience we have all needed to get the dx we need so badly.  Welcome to our forum, we are all here for support and to share our collective experiences.  I am the CL here for this forum and we have a great group of compassionate and supportive folks here that will help you to the best of our knowledge.   Talk soon and once again welcome.

Sue
smittygirl