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#209837 - 06/07/11 10:04 AM Quick diagnosis of SI joint from xray possible?
poodlegirl Offline
Registered Visitor

Registered: 12/01/07
Posts: 2242
Loc: Houston
Is it possible for a doctor to put up an xray of your pelvis and within seconds say "You have arthritis in your left SI joint."? When that wasn't even what you were complaining about?

It has always seemed to me that all the posts I have read about this have said that it takes someone specially trained to be able to see the arthritis in an SI joint. I just doubt the diagnosis because it was so quick. This doctor is an orthopedist. And just two years prior, I had everything x-rayed by a rheumy who trained under Dr. Reveille and she said everything was fine.

Sigh.



Edited by poodlegirl (06/07/11 10:05 AM)
_________________________
Brenda

peripheral spondyloarthropy, HLA-B27+, iritis, naproxen 500 mg, 2x/day, trochanter bursitis, Joint Hypermobility Syndrome, migraines, SI joint dysfunction/hypermobility, DDD L4/L5 and L3/L4, straightening of cervical spine, diabetes, sleep apnea.

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#209839 - 06/07/11 10:19 AM Re: Quick diagnosis of SI joint from xray possible? [Re: poodlegirl]
sequoia
Unregistered


wow, perhaps it was obvious. my rheumy dxd me based on the straightening of the spine and the si joint arthritis, coupled with all the other symptoms of iritis, stiffness, etc. my own dx is just really progressing. so i would say possible. take care, and sorry, probably means you are hurting more.

prayers, poodle, s.

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#209841 - 06/07/11 10:36 AM Re: Quick diagnosis of SI joint from xray possible? [Re: ]
michelly Offline
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Registered: 04/01/10
Posts: 453
Arthritis can show on an x-ray, inflamation doesn't. They can see if there's damage around the joint, but an MRI would give a more accurate picture.

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#209846 - 06/07/11 10:50 AM Re: Quick diagnosis of SI joint from xray possible? [Re: michelly]
avonldy Offline
Registered Visitor

Registered: 12/14/09
Posts: 2466
Loc: N. Sacramento Valley
My GP dxd me on the lower spine x-rays he had taken along with a long history of inflammatory arthritis, then my Rheumy followed up with an MRI and then confirmed the dx. It seems that some dr. will give a dx sooner then others who might be more cautious.
_________________________
Donna
Suffering since a teenager.Dx with AS Dec 2009. Dx with ulcerative colitis 1998, both knees replaced 2006. GP said I had "some kind of inflammatory arthritis" 25 years ago. It has taken 50 years to get a Dx.

Mobic, Nexium, Naproxin, Lipitor, 6-MP, Nexium, Miacalcam, MSContin and 2 Norco for break through pain

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#209847 - 06/07/11 10:54 AM Re: Quick diagnosis of SI joint from xray possible? [Re: avonldy]
JenInCincy Offline
Registered Visitor

Registered: 05/19/08
Posts: 13278
Loc: Cincinnati, OH
Yes, it is possible. The question is, what did he mean by "arthritis?" OA or spondy? It is very possible to have degenerative arthritis (OA) that is asymptomatic. I would say an ortho is definitely a type of doc with adequate training to quickly identify an obvious finding like arthritis on an x-ray. If this is OA then it would not have been relevant in your rheumy discussion 2 years ago.... and if it's spondy related it could definitely have developed since then, to the point of being more visible on x-ray.

Did you get any help for what you WERE there for?
_________________________
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

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#209875 - 06/07/11 01:51 PM Re: Quick diagnosis of SI joint from xray possible? [Re: JenInCincy]
poodlegirl Offline
Registered Visitor

Registered: 12/01/07
Posts: 2242
Loc: Houston
Thank you for all the quick responses! This was really helpful.

The xray that I am talking about was actually done in Sept of 2009. I went to this ortho because I was having trouble sitting due to butt and leg pain and he had previously said to me that I might have ischial bursitis. But he did the xray and made the comment about the arthritis but then ordered an MRI because of my leg pain. This is when they found the bulging disc. And I have been dealing with too much else since then to be concerned about the arthritis comment (since it wasn't really bothering me at the time).

However, the left side is what has been bothering me again lately. But it is the normal symptoms that I have had for years. I really think it is sciatica. I think most of my back problems are mechanical, so if I really do have arthritis in an SI joint, I tend to agree with Jen that it might be OA. Although I have a lot of pain from my back, I think it is mostly sciatica. My AS seems to be mostly iritis and peripheral.

I don't trust this doctor because when I flared up badly again last July, he was out of the office and I saw a different doctor in the group. He told me things about my MRI that the first doctor did not. So I think it is worth a second opinion on the arthritis. It is good to know that they can tell the difference between OA and inflammatory. So I will have it looked at again.

Thanks for helping me make this decision!
_________________________
Brenda

peripheral spondyloarthropy, HLA-B27+, iritis, naproxen 500 mg, 2x/day, trochanter bursitis, Joint Hypermobility Syndrome, migraines, SI joint dysfunction/hypermobility, DDD L4/L5 and L3/L4, straightening of cervical spine, diabetes, sleep apnea.

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#209894 - 06/07/11 06:50 PM Re: Quick diagnosis of SI joint from xray possible? [Re: poodlegirl]
taberge Offline
Registered Visitor

Registered: 05/25/09
Posts: 457
Loc: Sulphur,La. USA
Two years is a long time between x-rays. And yes he can see fusing which is the damage done from AS. If you truly have AS, then fusing of your SI joints is the definitive symptom of AS in clinical terms.

What I am confused about is in your first post you claims:

"Is it possible for a doctor to put up an xray of your pelvis and within seconds say "You have arthritis in your left SI joint."? When that wasn't even what you were complaining about?"

Then you state:

"However, the left side is what has been bothering me again lately. But it is the normal symptoms that I have had for years. I really think it is sciatica. I think most of my back problems are mechanical, so if I really do have arthritis in an SI joint, I tend to agree with Jen that it might be OA."

Also in your comment you have SI joint dysfunction. That is the exact term the chiropractor wrote for me when he was treating me before I sought help from a medical doctor.

Pain in your butt can be and is for me my SI joints fusing.

Yes I have been told by Dr. Reveille that reading x-rays for arthritic changes is something most radiologist don't do very well because it is not covered as well as the trauma sections in their studies. He has told me that the one guy who does the best job is the guy who read mine for the TASC study I am taking part in.

One thing everyone can do to avoid the confusion about test results is to request a copy of the results before you discuss them with the doctor. I think a lot of the times the doctors skip over things they feel is unimportant or not relevant.

From the last set of x-rays done to me, the doctor reported to me that no damage was seen to my SI joints and the previous set read by the TASC guy indicated total fusion. When I request a copy of the that report, it clearly stated that due to bowel gas the SI joints were obstructed. So basically any comments were a guess at best. For me obstructed view and no damage seen is a huge difference.

If your trust is already compromised with this particular doctor then by all means get a second opinion.

P.S. inflammation is usually seen in MRI's when contrast is used so it makes a difference what type of MRI you had.

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#209896 - 06/07/11 06:51 PM Re: Quick diagnosis of SI joint from xray possible? [Re: taberge]
CarlaRN Offline
Registered Visitor

Registered: 12/21/10
Posts: 82
Loc: Ohio
Yes, mine was dx with a pelvic xray and bloodwork....SI joints were fused.
_________________________
Ankylosing Spondylitis Dx 12/20/10, Age 40
HLA B27+, meloxicam 15mg, Humira 40mg ~ 2/13/11

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#210072 - 06/09/11 10:48 AM Re: Quick diagnosis of SI joint from xray possible? [Re: CarlaRN]
poodlegirl Offline
Registered Visitor

Registered: 12/01/07
Posts: 2242
Loc: Houston
Hi, Taberge. Thanks for your reply. I didn't realize that 2 years is a long time between xrays. That is good to know.

When I went to the new rheumy in Dec 2007, she actually told me that everything looked fine on xray, and since I didn't show any damage at my age (50+), that I would not have any in the future. And she made me feel like I was really wasting her time. So I decided that I must be mostly in remission. I haven't even had much of an iritis flare since about 2001. But I guess I need a second opinion on this.

I know it seems confusing that I said the left side wasn't bothering me at the time. But the left SI joint wasn't, as far as I knew. My rear (sitting bone area) was bothering me as was the back of my leg. But the area of the SI joint was not. So I didn't understand why he was looking at the SI joint. I think the pieces are coming together in my mind and I understand now that sciatic pain can come from either the SI joint or a disc. So that might be why he was looking at both things.

The SI joint dysfunction in my case is hypermobility. He said that my SI joints were still open, but that he saw some arthritis.

I am convinced that I need to take one more pass at having a rheumy look at my SI joints. I do need to know what is going on for sure whether it is OA or inflammatory damage. It could be OA because of my hypermobility, but could be inflammatory so I need to find out for sure. Just to make sure the doctor was right when she said if I didn't have any fusion by now, I won't ever have any.

Thanks again!

_________________________
Brenda

peripheral spondyloarthropy, HLA-B27+, iritis, naproxen 500 mg, 2x/day, trochanter bursitis, Joint Hypermobility Syndrome, migraines, SI joint dysfunction/hypermobility, DDD L4/L5 and L3/L4, straightening of cervical spine, diabetes, sleep apnea.

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#210077 - 06/09/11 11:19 AM Re: Quick diagnosis of SI joint from xray possible? [Re: poodlegirl]
JenInCincy Offline
Registered Visitor

Registered: 05/19/08
Posts: 13278
Loc: Cincinnati, OH
Originally Posted By: poodlegirl
I am convinced that I need to take one more pass at having a rheumy look at my SI joints. I do need to know what is going on for sure whether it is OA or inflammatory damage. It could be OA because of my hypermobility, but could be inflammatory so I need to find out for sure. Just to make sure the doctor was right when she said if I didn't have any fusion by now, I won't ever have any.


Nobody can say with certainty that you will never fuse. There are degrees of likelihood but no perfect prediction. As far as I've seen on here, SIJ fusion has little or no impact on people's lives. It's the spinal fusion that can cause functional issues with mobility etc. I agree that checking in periodically with a rheumy is a good idea.

But Brenda, I am pretty sure the SIJs don't have to do with sciatica. Sciatica has to do with nerve roots coming out of the lumbar spine. Sounds to me as though your pain in your rear could either be sciatica (from your pinched lumbar nerve) OR referred/radiating pain from your inflamed SIJ. Or maybe you have some of both! Clear as mud?! smile
_________________________
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

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