What should I ask my Dr to do? I have had si joint pain that came right after my l5 s1 fusion. Xray noted osteoarthritis in both si joints one year after the lumbar fusion . Si pain continues daily but newest xray now says no si issues noted, but subchondral sclerosis in both hips. Plans were being made to treat the si joints but now I don't trust the diagnosis?
In order to answer your question we might need to review your images. Please follow this link, fill in the information and drag/drop your images onto the form. public.berlincaseviewer.com/askdrkay
Is focal narrowing of the antero- inferior aspect/ synovial component of bilateral si joint with similar symmetrical patterns. Subchondral bone irregularitis with erosive bone changes mainly involving iiliac side. The affected marrow demonstrated high signal change son STIR with significant enhancement following contrast, representing osteitis. This means is spondyloarthritis or condesus osteitis?
Thank you for your detailed question. The MRI findings you described-focal narrowing of the antero-inferior aspect/synovial component of the bilateral SI joints with symmetrical patterns, subchondral bone irregularities with erosive changes mainly involving the iliac side, and high signal changes on STIR with significant enhancement following contrast-are indeed suggestive of sacroiliitis. These changes are commonly seen in axial spondyloarthritis (axSpA). However, it is important to review the actual imaging studies to make a definitive diagnosis and understand the full extent of your condition or question. I would be happy to review your images and provide a more specific interpretation. Feel free to reach out if you have any more questions or need assistance with your case.
Very well explained presentation about the problems of sacroiliac joints. What about the cure for such different situations? Do some exercises will help in some cases or one needs invasive surgery in some other situations? Or should we live with the pain?
Exercises are helpful for many of these problems. While exercises and occasional painkillers are recommended for osteitis condensans and degeneration due to anatomical variants, it is now believed that stronger medication must be prescribed for axial spondyloarthritis, in parallel with physiotherapy. You should consult a rheumatologist.
The patient received NSAIDs, which he was taking daily. The disease improved noticeably in the first year. In the further course, however, the effectiveness decreased again. In the end, the decision was made to start biologics therapy.
Wonderful lecture, ladies and gentlemen! Please, is it necessary to use an x-ray and / or CT scan in order to confirm spondyloarthritis? Or an MRI 3 Tesla or 5 Tesla machines on their own will be enough to expose and confirm, together with your wealth of experience and knowledge in radiology, the correct diagnosis? Well done for your amazing work 👏 Thank you!
No CT or X-ray is needed on a routine basis. If MRI is available, use it. In some circumstances, however, CT reveals additional information about the bony structures. Those are sometimes difficult to analyze exacly by MRI, as MRI depicts bone only indirectly.
Hi, I understand you're not interested in providing me with a second opinion of my MRI scans. I just wonder if there's a way how to distinguish between sacroiliitis, Ankylosing spondylitis and bone marrow cancer, because all of these pathologies appear as high signal in bone marrow "oedema" on MRI - T2 - STIR sequence the same. Is there any pattern that can distinguish between bone marrow inflammation and cancer of the bone marrow in sacroiliac joint and iliac bone? Or only trepanobiopsy can tell? Regards
@berlincaseviewer Thank you so much dear professor, I know you are extremely busy with your clinical work, and I appreciate your help. I will upload the images or ask someone to help me, because, I'm not an expert on image and data transfer. Martin
Three rheumatologist diagnosed me with sodic arthritis One dermatologist diagnosed me with psoriatic arthritis and now I have somebody tell me that they don’t know that that’s what it is. I hate changing doctors and having to start over.
My doctor told me that an MRI will not show ligament damage, is that true? I’ve had undiagnosed SI joint/hip pain for 3+ years. I’ve had many MRI’s done and they are all normal. Physical therapy and manipulation help for a few days, but then my pelvis feels out of alignment again. Do you think there’s possibly an issue with my ligaments?
MRIs are perfectly suitable for visualizing ligaments. It is important that a specialized radiologist looks at the images for the complex pain syndrome you have described. We are available for a second opinion. Upload the images here: cases.berlincaseviewer.com/secondopinion
Have you spoken to your rheumatologist about this? There are a number of medications you can try. You also need to consider whether the diagnosis is correct. It may be necessary to get a second opinion on the images. Kind regards
Treating psoriatic arthritis (PsA) is tricky because this disease affects both the skin and joints. PsA treatment includes a combination of medication and non-drug therapies like exercise, massage, heat and cold. It’s personalized to your symptoms and the severity of your disease. You may need to see a team of specialists, including a rheumatologist to manage joint pain and a dermatologist for skin symptoms. Medicines are an important part of treating PsA and managing flares. Psoriatic arthritis medications may include some or all of the following: NSAIDs (ibuprofen, naproxen), Biologics ((Humira), etanercept (Enbrel, Remicade, Simponi, Cimzia, and many more…), DMARDs (methotrexate, some newer drugs as well …), topical treatments (creams & ointments, please refer to a dermatologist).
you can talk to your reumatologist about Talz .20 years of psoriasis and the last 2 diagnosed with PSA .im 2 years on talz and with exersise and good food im managing pretty well , no pain(only after gym or yoga) and some fatigue .Hope that helps.
The exact cause of axSpA IS NOT CLEAR. Researchers believe that people with certain genes develop axSpA when they are exposed to a virus, bacteria or another trigger. Many people with axSpA have a gene called HLA-B27. But most people that have the gene never develop axSpA.
In this case, that's easy. We have the information about the inflamed sacroiliac joints and the L3 vertebral lesion on the anterior edge. It would be very unlikely if now at L2 there is no inflammatory lesion in axSpA, but a Schmorl's nodule with concomitant inflammation. But of course, if only the spine is present and there is only one affected segment, then you are in a fix. Some people say that you can differentiate by the location of the osseous defect within the endplate. Still others claim that the fluid content of the adjacent nucleus pulposus can be used. Overall, it is difficult and I have seen all variants of Schmorl nodes.
We always welcome guests here in our department. However, first schedule an appointment with a skilled rheumatologist who should double check your situation.
Can a radiology doctor buy a high end android phone with the best display and use a digitized radiology book in it to diagnose people after completing his or her MD in radiology? Can he or she classify that as medical investment As an AI language model, I must emphasize that I am not a legal or financial advisor, and my responses should not be considered as professional advice. However, I can offer some general information on this topic. The use of a high-end Android phone with a top-notch display to view digitized radiology materials, such as medical textbooks or diagnostic images, can indeed be beneficial for a radiology doctor. Many medical professionals use digital devices and software for educational and diagnostic purposes. However, there are certain considerations to keep in mind: 1. Legal and Ethical Considerations: It is essential to ensure that the use of digital resources complies with the laws and regulations of the country or region in which the radiologist practices. Additionally, medical professionals must adhere to the ethical guidelines of their respective medical boards or associations. 2. Accreditation and Approval: The use of digital devices for diagnostic purposes should meet any necessary accreditation or approval requirements. Regulatory bodies may have specific standards regarding the use of technology for medical diagnosis. 3. Software and Display Quality: To maintain accuracy and reliability, it is crucial to use reliable software and a high-quality display that meets the standards for medical imaging. The display should have the necessary resolution, brightness, and color accuracy for precise diagnosis. Regarding classifying the purchase as a medical investment, it might be possible to claim certain expenses related to medical practice as tax deductions or business expenses, depending on the local tax laws. However, tax laws vary by country and jurisdiction, so it's essential to consult with a qualified accountant or tax professional for accurate advice. Overall, while using a high-end Android phone with a top display for diagnostic purposes is practical and could be seen as an investment in improving medical practice, it is essential to comply with all relevant regulations, ethical guidelines, and tax laws. Medical professionals should consult with their legal and financial advisors to understand their specific situation and make informed decisions. ChatGPT
