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#127084 - 10/31/08 07:00 AM Spondylosis & Degenerative joint disease
justice Offline
Registered Visitor

Registered: 02/09/08
Posts: 236
Loc: Houston, Texas
I called my neurologist for the results of the MRI done of my neck and spine and the xray for my hips. The receptionist read the docs sticky note on the films that said, "Hips are normal. Neck shows degenerative joint disease in spasm with no surgical lesions. Mild spondylosis". My next appt. is not for two months and I can't pick up the report until next week so I am trying to figure out what this all means. My neurologist also noticed that an older xray done by my rheumy showed possible bone thinning and thinks I need a bone density test. I know these are common things found in most people as they age but I am still in my 30s. What does this mean? What should be my next step? Should I be concerned about an underlying issue that is causing my arthritis and pain? Also, it says mild spondylosis but I have terrible pain in my hips and neck and cannot get through the day with out medication. How will I feel in my 60s if I feel this bad now? Also, what is the difference between spondylosis, spondylitis, spondyloarthritis, spondyloarthropathy. Any feedback would be much appreciated.
37, mom of three
Houston, TX

#127098 - 10/31/08 09:26 AM Re: Spondylosis & Degenerative joint disease [Re: justice]

hi jill-as i just told someone on another post, my xray showed moderate spondylitis in two areas of the spine yet the si joints werent yet fuseed as of last fall close, but no cigar as the ol;d folks used to say. the next test i will take is ithe bone scan. bone density is kind of osteo arthritis. i don't like mris and i also can't make it through a day without a pain pill. if you are 30's and i am mid 50's and i figure i have had my disease (AS) at least as long as you are old, i think that you do have to be concerned. that you don't have tons of damage yet is just a gift. you need to find the right combo of meds or whatever so you don't end up like many of us in our 50's and 60's. see another doc for a second opinion, and take a bone scan if they will order one. that shows the enthestis at the tendons. sorry for your suffering. we can relate. prayers and peace, seqoia

#127103 - 10/31/08 09:32 AM Re: Spondylosis & Degenerative joint disease [Re: ]
jackieb Offline
Registered Visitor

Registered: 04/16/07
Posts: 1607
Loc: Saltville
I can tell you I had almost as much pain while I was in the mild mode as the moderate to severe mode I am in right now. Mild is their definition not yours.

#127105 - 10/31/08 10:20 AM Re: Spondylosis & Degenerative joint disease [Re: justice]
JenInCincy Offline
Registered Visitor

Registered: 05/19/08
Posts: 13279
Loc: Cincinnati, OH

I think I can help with some of your questions about definitions.

Degenerative disc disease is poorly named. It isn't a "disease", it's a process that happens to pretty much all people, starting in our 30s. Whether or not it produces pain is a very individual thing, and the pain may not match up with imaging studies. A lot of people have advanced DDD yet little or no pain. Disc degeneration means they are losing water and become wedge shaped, causing the vertebrae to rub together, which is spondylosis - spinal osteoarthritis.

Page explaining spondylosis: http://www.spineuniverse.com/displayarticle.php/article1440.html

Spondylitis refers to spinal inflammation - "itis" meaning inflammation. Spondylitis or spondyloarthropathy just means it's disease affecting the vertebrae. As you know, info on all the types of spondyloarthropathies can be found at spondylitis.org.

So spondylitis, spondyloarthritis, and spondyloarthropathy are essentially interchangeable terms.

So according to what they can see in the MRI, you have mild osteoarthritis in your neck. However, there are 2 caveats with MRI. Number 1, the severity as it LOOKS has NOTHING to do with the severity of your pain. Number 2, they can't see soft tissue problems like the enthesitis/tendonitis that is the hallmark of spondylitis diseases.

A normal hip x-ray just means you don't have any super-bad inflammation in your pelvis. But you might have the start of inflammation that a more sensitive imaging modality like bone scan or MRI might show. OR you might have connective tissue inflammation which would not show on an x-ray.

Bone scan and bone density test are two different things. Bone scan is a nuclear medicine test which shows increased areas of bone metabolism - where there is inflammation, or a fracture that is healing. Bone density test is a DEXA scan, which indicates if you have bone thinning (osteoporosis), which I think has its own causes and isn't necessarily related to either osteoarthritis or spondylitis.

Hope that helps. I'm sorry you're not getting answers. I know what that is like!!
Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates

#127107 - 10/31/08 10:25 AM Re: Spondylosis & Degenerative joint disease [Re: JenInCincy]

right on jackieb. mild vs moderate vs severe is only a state of pain. and everyone's body takes pain differently. that is my opinion. i didn't even go toa doc for my AS until i could barely get around. when the xrays were taken of my spine, my xray tech said with amazement - how did you stand the last few years in that much pain. i had just been ignoring it. now i call it what it is. usually5-6. peace and prayers to all. sequoia

#127140 - 10/31/08 01:50 PM Re: Spondylosis & Degenerative joint disease [Re: ]
Ides Offline
Registered Visitor

Registered: 09/15/04
Posts: 635
Loc: WA
I think Jen's explanation was terrific. I want to offer one disagreement and one expansion on what she wrote.
2 caveats with MRI. Number 1, the severity as it LOOKS has NOTHING to do with the severity of your pain. Number 2, they can't see soft tissue problems like the enthesitis/tendonitis that is the hallmark of spondylitis diseases.

I have had many, many MRIs on various areas. Enthesitis has been identified on knee and pelvic/lumbar MRIs. Tendonopathy of both hamstring tendons appears on every MRI I have had of that region. This tendon problem was caused by a medication, not my AS.

My rheumy uses ultrasound to examine for enthesitis. It is more cost effective and better identifies the issue. just this AM I had my shoulder examined due to increased pain and decreased mobility over the last 10 days. I have busitis in two bursa and a "really ratty" tendon. My bad tendon is frayed. It is too diseased to be repaired.

Bone density tests do indeed exam for thinning of the bones. Anyone that has taken prednisone for their AS or other issues, especially repeat stints on the meds, need to have bone density tests. Prednisone is a known cause of bone thinning.
Besides, AS, dealing with Crohn's, peripheral neuropathy, avascular necrosis,, PAD, and a host of other issues.

#127152 - 10/31/08 06:27 PM Re: Spondylosis & Degenerative joint disease [Re: Ides]
Mark D Offline
Registered Visitor

Registered: 10/02/03
Posts: 1804
Loc: Austin, TX
A lot of good information above. I agree that that the term "mild" can be very misleading and sounds wrong to someone who is suffering. But my disease was mild for many years and then suddenly turned vicious. I am much worse, but the doctors are still calling it "moderate" because I don't have fused vertebrae yet (I am getting there though). The radiology tests are important even if the reports can't pinpoint an obvious pain source, because they do show the progress of the disease over time. Especially in AS, doctors should always treat the pain based on the patient's complaint, rather than waiting to find an obvious abnormality. Unfortunately, they do not feel our pain and it may take a lot of convincing. Good rheumatologists should understand this. If they balk at treating your pain especially, I would find another one.

Back to Justice's questions: "What to do?" and "How will I be in my 50s?" My advice is to live your life as best as you can each day, knowing that you may get worse over time. Many people with AS stay mild/moderate over their entire lives, but in general you should expect to get worse over time. If you have a career that would be difficult to continue with more severe AS, you should consider trying to switch to something more flexible and amenable, hopefully with good health insurance (I realize how tough this is for most of us). It is believed that some medicines can slow the disease, but that has not been my experience. Although NSAIDs alone worked well for me for a long time, I got much worse after I started using biologicals, which were offered to me as wonder drugs. Nice theory, but just remember that TNF blockers are not a cure for AS, only a help. And they do not help everybody. And they are extremely expensive. I am 46 years old and still able to work thanks to a combination of drugs, but I have severe pain and worsening condition. If there is one thing I could have done differently up until now, it would be more exercise. Although every day for me now is tougher than it was when I was in my 30s, I still live my life to its fullest and this disease cannot take away the things that are most important to me -- my wife and child, my faith in God, or my determination to do my best.
DXed with AS 30 years ago

#127158 - 10/31/08 07:59 PM Re: Spondylosis & Degenerative joint disease [Re: Mark D]
babster Offline
Registered Visitor

Registered: 03/12/06
Posts: 318
Loc: Chicago
Just because your appointment isn't for a few months, doesn't mean that you can't talk to your doctor on the phone about your results. Call him or her back and leave a message that you want to speak with the doctor. Perhaps there is something that can be started or other tests that you may need before you go for your follow up appointment. This will possibly give you some answers.
Take care,


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