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#433955 - 02/28/11 05:17 PM degenerative change in SI joints - really?
cemc Offline
Captain_AS_Kicker

Registered: 01/25/10
Posts: 1984
Loc: UK
Back in September last year I finally had an SI Xray done. They took one film, with me lying flat on my stomach on the table. It was reported in true NHS fashion in two sentences.
"SI Joints: Mild degenerative change with minimal sclerosis, the other bony appearances are within normal limits. Degenerative change involving the level L5/S1 with intervertebral space narrowing."

I asked on here about degenerative changes and got the answer back that SI is not a joint that is prone to degenerative changes unless you have either had trauma, or the joint has been stressed by pregnancy. I've never been pregnant and no trauma to that area.

I pointed out to GP that the report was fairly minimalist, didn't indicate if the sclerosis was unilateral or bilateral, didn't note if the joint space was enlarged or narrowed,etc. He agreed to ask for it to be reviewed, with particular reference to whether it showed sacroiliitis or not, and noting that I had never been pregnant.

I have just got the results of that review - done by the same person who initially reported it. I guess I was a bit naive thinking they would send it to a different radiologist. I've googled her and it seems her interest is primarily in clinical and interventional radiology in mostly Ob/gyn areas.

The report has come back with a single sentence as an addendum.
"Addendum: The finding is not typical for sacroiliitis, in case of persistent clinical problems x-ray of lumbar spine would be recommended".

Now what do I do? Is it really likely that it is just degenerative changes? Clinical problems are persistent, so is it worth having an x-ray of lumbar spine as suggested (when I currently have much more severe problems with thoracic and cervical areas anyway)?

Can someone point me to any information about degenerative changes in SI joints? or alternatively to something that says this is an unlikely cause.

Just for reference summary of my history is: lower back and butt pain since prob age 16, intermittent at first, becoming more persistent. Now aged 55, major disability for last 5 years. Limitations of spinal movement and less than 1 inch chest expansion. Morning stiffness relieved somewhat by exercise worse with rest. Respond to NSAIDs and NSD. Strong family history of lower back problems, pain in the butt, neck problems. Also strong fam. and personal history of "pinched nerves", carpal tunnel, non-specific gut stuff, etc. One male cousin diagnosed AS, everyone else with this kind of back stuff just degeneration. Strong family history of other autoimmune incl. RA. Other things in my sig. line.

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#433958 - 02/28/11 05:34 PM Re: degenerative change in SI joints - really? [Re: cemc]
Sue22 Offline
Very_Addicted_to_AS_Kickin

Registered: 01/13/08
Posts: 20604
Loc: Upstate NY
sounds similar to me........will dig up and report what my CT scan said, but it did say similar "degenerative changes".....my rheumy said "arthritis" but that he couldn't pin it down to what type (OA vs inflammatory) from this test alone. other things have pointed to inflammatory arthritis.

my current rheumy is like "hey, we know you have the enthesitis, we know you have problems with your SI joint, everything points to inflammatory arthritis / undiff spondy, so let's just find a drug to get rid of the inflammation and we'll get rid of all of these problems" and that is largely what happens, when i'm on either pred or a nsaid for the few days i can take one, all the symptoms improve, and the flector patch largely helps the SI joint, that wouldn't happen if it weren't an inflammatory issue as my rheumy says.

i'll report back with my details but it does sound very similar. and like you, no pregnancies, no trauma. and looks like probably no AS but undiff spondy yes.

more later.....
_________________________


sue

Spondyloarthropathy, HLAB27 negative
Humira (still methylprednisone for flares, just not as often. Aleve if needed, rarely.)
LDN/zanaflex/flector patches over SI/ice
vits C, D. probiotics. hyaluronic acid. CoQ, Mg, Ca, K.
chiro
walk, bike
no dairy (casein sensitivity), limited eggs, limited yeast (bread)

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#433996 - 02/28/11 11:13 PM Re: degenerative change in SI joints - really? [Re: cemc]
WendyR Offline


Registered: 12/23/08
Posts: 5096
Loc: BC, Canada
Hi Cemc,

I've read a number of papers that suggest that degenerative changes in the SI joints are not that uncommon. Here is a short quote from one website:

"Many problems can cause degenerative arthritis of the SI joints. It is often hard to tell exactly what caused the wear and tear to the joints. One of the most common causes is an injury. The injury can come from a direct fall on the buttocks, a motor vehicle accident, or even a blow to the side of your pelvis. The force from these injuries can strain the ligaments around the joint. Ligaments are the tough bands of connective tissue that hold joints together. Tearing of these ligaments can lead to too much motion in the joint. The excess motion can lead to wear and tear of the joint and pain from degenerative arthritis. Injuries can also cause direct injury of the cartilage lining the surfaces of the joint where motion occurs. Over time, this will also lead to degenerative arthritis in the joint."

Note the link between tearing of ligaments, loose joints and degenerative arthritis. My understanding is falling onto your butt can be enough to do this - it doesn't necessarily mean a serious trauma like a car accident. I've fallen on my backside a number of times in my life and I'm sure many people have. If you're unlucky, I believe torn or stretched ligaments can be the result.
_________________________
Wendy

Rheumatoid Arthritis
Methotrexate, Celebrex, Plaquenil

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#434004 - 03/01/11 02:50 AM Re: degenerative change in SI joints - really? [Re: WendyR]
cemc Offline
Captain_AS_Kicker

Registered: 01/25/10
Posts: 1984
Loc: UK
Thanks for that Wendy. I guess that means I probably need to just give up on getting any treatment for inflammatory arthritis or a spondy disorder. I don't show any inflammatory markers (though I wonder if that is because I am on full doses of NSAIDs), my HLA B27 was reported as negative (though I believe the specimen should have been rejected by the lab because it didn't meet with the usually required criteria for collection and testing), and neither neurologist or urologist is prepared to even suggest that my neurogenic bladder dysfunction has any relationship to anything spinal even though it clearly started at the time of major increase in lower back and SI pain and muscle spasm.

Sue - I might have a chance if someone did notice the enthesitis, but thus far I have had one doctor discover a number of fibromyalgia tender points were sensitive, and no-one else (rheumies included) has actually done a full body examination or a full history of aches and pains, stiffness, or a range of motion exam. My good response to NSAIDs has been put down to their analgesic effect and not any antiinflammatory action (in spite of other analgesic drugs not having as significant effect). I'm thinking I might have to go off NSAIDs anyway because my liver is starting to get stressed as well as my kidney function (eGFR) having dropped to below 60.

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#434021 - 03/01/11 08:11 AM Re: degenerative change in SI joints - really? [Re: cemc]
LATH Offline
Decorated_AS_Kicker

Registered: 04/11/10
Posts: 716
Loc: California, USA
Originally Posted By: cemc
...I guess that means I probably need to just give up on getting any treatment for inflammatory arthritis or a spondy disorder. I don't show any inflammatory markers (though I wonder if that is because I am on full doses of NSAIDs), my HLA B27 was reported as negative...
What?! Don't give up. We often have many battles. And one is to find the right doctor. I'm HLA B27 negative and I've been tested about three times with each doctor on my path. You have a problem and you need to keep insisting that someone help you. Can you go to a different doctor? If you find you are not getting anywhere with your doctor and if you need a referral then go to your doctor and say "please send me to someone who knows what they are doing." Maybe that may sound a little strong but I did just that a long time ago with a stubborn doctor when I needed his referral and he was absolutely doing nothing for me. And when I told this doctor to give me a referral I knew who I wanted to see. So, I told him, "Please refer me to Dr. xyz." He did make the referral and I never went to see him again after making another change to my primary care doctor.


Edited by LATH (03/01/11 08:58 AM)
_________________________
John

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#434027 - 03/01/11 08:58 AM Re: degenerative change in SI joints - really? [Re: cemc]
Sue22 Offline
Very_Addicted_to_AS_Kickin

Registered: 01/13/08
Posts: 20604
Loc: Upstate NY
what john (LATH) said yes

more later, have a proposal due today and tweaked my SI joint yesterday so very uncomfortable spasms in the whole pelvic region, should go conserve my energy, just focus on the proposal........but more later............
_________________________


sue

Spondyloarthropathy, HLAB27 negative
Humira (still methylprednisone for flares, just not as often. Aleve if needed, rarely.)
LDN/zanaflex/flector patches over SI/ice
vits C, D. probiotics. hyaluronic acid. CoQ, Mg, Ca, K.
chiro
walk, bike
no dairy (casein sensitivity), limited eggs, limited yeast (bread)

Top
#434034 - 03/01/11 09:25 AM Re: degenerative change in SI joints - really? [Re: cemc]
WendyR Offline


Registered: 12/23/08
Posts: 5096
Loc: BC, Canada
Hi Cemc,

There are other factors to consider besides your SI joints. You have described the fact that you have a close relative with AS, a family history of autoimmune disorders and reduced chest expansion. All these factors are equally as important as your SI joints when it comes to diagnosis.

So I don't think you need to give up at all. I think you need to be persistent with your doctor that there is "something" wrong and try to give all symptoms without putting an emphasis on any single one.

In these days of internet knowledge, it has become common for people to self-diagnose and then present to their doctors just those symptoms that support their self-diagnosis. (I'm not suggesting you are doing this - just that some do.) As a result it's possible to miss the real diagnosis. So my personal opinion is that we need to work with our doctors, be open to other ideas and be honest about all symptoms.

So I encourage you to be persistent. It's not impossible that your SI joint is suffering from degenerative problems but you still have an autoimmune disorder causing the other issues.
_________________________
Wendy

Rheumatoid Arthritis
Methotrexate, Celebrex, Plaquenil

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#434044 - 03/01/11 10:42 AM Re: degenerative change in SI joints - really? [Re: WendyR]
alohaben Offline
ironchef

Registered: 08/16/03
Posts: 2717
Loc: Connecticut, USA
you could also ask quite pointedly which diagnostic criteria your doctor is using and how he ascribes points...

diagnosis is an evaluative process...any degenerative changes are serious and lot of doctors can't see the difference between a hefalump and an elephant. degerative changes are an indicator of sacroilitis...

you're in scotland...can you see a competitor for second opinion.
_________________________

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#434054 - 03/01/11 11:50 AM Re: degenerative change in SI joints - really? [Re: alohaben]
cemc Offline
Captain_AS_Kicker

Registered: 01/25/10
Posts: 1984
Loc: UK
Yes, I'm in Scotland but on one of the wee islands, so in some ways it might be just as easy to try and see someone in New Zealand. I'm back there for a month in June/July and was going to try and either get a private appointment at QE hospital in Rotorua (a specialist rheumie one), or my mums rheumie in Napier.

my GP wanted my 2 year old Lumbar spine MRI (done in NZ) looked at again as well - he thinks the central disc herniation at L5/S1 could be causing bladder symptoms. I was really reluctant to go this route in the NHS because, as I said to GP, they will just look at the lumbar spine and won't look at anything else, and at the moment an area in the thoracic spine as well as my neck are causing me much worse problems. They are also likely to just look at the MRI without doing any kind of clinical exam, and as I am already well recorded in NHS notes as being an attention seeking hypochondriac (not quite sure how they got this, because I really haven't had much in the way of tests, exams or referrals) that is what they will refer to. I can't get GP to do anything in the way of checking for sore patches, or range of movement, etc.

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#434065 - 03/01/11 02:25 PM Re: degenerative change in SI joints - really? [Re: cemc]
Inanna Offline
Very_Addicted_to_AS_Kickin

Registered: 11/15/01
Posts: 17807
Loc: Toronto, Ontario
Hi there, wow, what a road you're on. Wendy has given you some truly good advice, so I'm not even going to try to add to it. I just wanted to add my shoulder.

Hugs,
_________________________
Kat



"Frost Moon" by Nene Thomas

A life lived in fear is a life half lived.
"Strictly Ballroom"


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