Re: Fluffy looking Sacroiliac

[Guest guest]

In a message dated 6/3/02 10:51:36 AM Eastern Daylight Time,

jlanneau@... writes:

> Is there really a classical bone structure that shows up in x-rays? And if

> so exactly what is it?

Jeff, what doctors look for in diagnosing a spondy disease is evidence of

inflammation in the SI joints (lower spine). It is called sacroiliitis. It

shows up as a narrowing and squaring of the joints on Xray. In AS, it is

bilateral (both sides) and symmetrical (the same) and a patient usually is

not fully diagnosed until it shows up on Xray. There is a wide range of

degree to which AS will show up on Xray. 1-4, from nothing showing up yet-to

complete fusion with bamboo looking spine. In Reiter's or ReA, it is

" usually " symmetrical, but can be just on one side. 20%-30% of Reiter's

patients will show sacroiliitis on Xray. As you know, there are a triad of

other symptoms besides the sacroiliitis that may lead to a ReA dx. 20% of

Crohn's patients will show sacroiliitis. Psoriasis-43% symmetrical (both

sides.) Below are some Xray pictures of AS and Reiter's.

<A HREF= " http://www.cdaarthritis.com/ucla/uclan_84.htm " >Rheumatology - Chapter

9 Page 5 Salient</A>

<A HREF= " http://www.cdaarthritis.com/ucla/uclan_21.htm " >Rheumatology - Chapter

4 Page 4 AS</A>

<A

HREF= " http://www.xray2000.f9.co.uk/radpath/a/ankylosingsponylitis.htm " >Ankylosin\

g Spondylitis</A>

I had the following information in some of my personal files...Sorry, I don't

have the link for the information....but it will answer some of your

questions:

<<In ankylosing spondylitis (AS), a variety of destructive and reactive

changes affect axial and peripheral joints. Sacroiliitis, spondylitis and

spondylodiscitis are easily recognized by conventional radiography when bony

changes have already taken place. Advanced imaging techniques such as MR

imaging, CT and ultrasonography provide an advantage, due to their ability to

detect early changes.

Sacroiliitis

The anatomy of the sacroiliac joints, with the superior part being

ligamentous, is important for the evaluation of axial imaging because the

insertions of the ligaments cause irregularity and widening of the joint

space, and might also make interpretation of the subchondrium difficult.

Plain radiography is capable of visualizing bone changes but is not a

sensitive indicator of the features of early inflammatory changes. For the

detection of early bone changes, such as erosions and ankylosis, CT can be

superior to MR imaging. However, sclerosis and ankylosis can easily be over

diagnosed by CT. MR imaging is better in the imaging of cartilage, and

provides the possibility of dynamic measurements. The application of the new

imaging technique of dynamic MR imaging may provide a major progress in the

diagnosis of early sacroiliitis. The administration of gadolinium-diethylene

triaminepentacetic acid (DTPA) resulted in significant enhancement in the

sacroiliac joint and partly also the surrounding bone marrow and the joint

capsule in patients with sacroiliitis.

In the spine, the most prominent feature of AS consists of an enthesitis at

the insertion of the annulus fibrosus-longitudinal ligament complex.

Inflammatory tissue leads to the destruction of the attachment of ligament to

bone resulting in a superficial erosion known as Romanus lesion or

spondylitis anterior. If the inflammation spreads to the vertebral body,

erosions, but more often sclerosis, are detected on plain radiographs and

have been described as " shiny corners " and anterior spondylitis. Plain

radiography is capable of visualizing bone changes of AS but is not a

sensitive indicator of the features of early inflammation of soft tissue.

Bone sclerosis is very well detected by CT. With MR imaging technology, early

spondylitic lesions can be detected. Posterior spondylitis also can be

observed on MR images presenting with inflammation and calcification of the

posterior ligament and posterior syndesmophytes. Early spinal lesions in AS

mainly involving discal structures and vertebral edges can be demonstrated by

MR imaging.

Spondylodiscitis occurs in about 15% of patients with AS in the presence or

absence of spondylitis and is difficult to detect with plain radiographs. The

capacity of MR imaging to detect spondylodiscitis had been described in the

literature. Gadolinium-DTPA MR imaging is capable of reflecting the complex

and dynamic pathological changes that occur at the discovertebral junctions

in AS.

Other Joints The term " enthesitis " refers to inflammation at sites where

ligament, tendon, joint capsule, and fascia are attached to bone, and it is a

major feature of AS. Coexistent synovitis and enthesitis in synovial joints

in AS is well recognized. MR imaging is capable of early detection of

enthesitis and synovitis. Ultrasonography is also established technique for

detection of enthesitis.>>

Best regards, Connie (Granny)

[Guest guest]

> Jeff, what doctors look for in diagnosing a spondy disease is

evidence of

> inflammation in the SI joints (lower spine). It is called

sacroiliitis.

Connie-Thanks..that's exactly what i was looking for..it's always

represented a gaping hole in the formulation and understanding of

how Reiter's can be diagnosed..And just based on my experience

since '96 when i was told i had ReA all of the Rheumatologists wanted

to include results of x-rays or MRI..I read that it occurs 25% with

reiter's and much more in AS,,I plan to spend more time going over

your post..there's a lot to it..And by the way, the pictures were

remarkably clear..

Just one favor. I'd like to read a little more of Dr Potter's MRI ltr

and maybe you could just tell me the significance of her wording..

I'm doing this for my own purpose but i'm sure others can benefit...

This has turned out to be a very important document in many ways.

I'm going to read most of this (only 100 words)because if you or

anybody understand the language in 1st para i'd really like to know:

'Magnetic resonance imaging of the pelvis was performed in the

coronal plane using long TR and short TE and fat suppressed

long TE sequencing.Axial long TR and short TE sequencing were

also obtained.'

'Examination demonstrates irregularity of the sacroiliac joints,

bilaterally, at their anterior inferior aspect also seen on the

concurrent MR examination of the lumbar spine. This is consistent

with a spondyloarthritis.. there are comments about hip fluid but

no evidence of occult errosive disease of hips..And finally, she

says, Mild right greater trochenteric bursitisis seen.'..That's it..

jeff Lanneau,Reactive Arthritis (ReA) formerly Reiter's Syndrome(RS)

[Guest guest]

In a message dated 6/4/02 9:25:36 AM Eastern Daylight Time,

jlanneau@... writes:

> 'Magnetic resonance imaging of the pelvis was performed in the

> coronal plane using long TR and short TE and fat suppressed

> long TE sequencing.Axial long TR and short TE sequencing were

> also obtained.'

>

>

Jeff, this 1st sentence explains how the MRI was obtained using technical

terms only the MRI technician or doctor who reads the MRI would understand or

have a need to know what they mean. No significance to you as to your

condition, etc.

The second sentence explains the results of the MRI. You show that you do

have bilateral (both sides) sacroiliitis (an inflammation of the SI joints),

which is consistent with a spondy. She doesn't say which spondy...that would

be determined by your other complains...whether it is Reiter's ReA (with the

triad of other symptoms) or whether it is frank AS. Your hips don't seem to

be involved yet. There is a slight inflammation of the bursa of the upper

right thigh bone (this is another feature that many of us have.) Maybe the

hip fluid is from that? It can cause pain to radiate down the right leg,

soreness in that area, etc. Hope this helps.

Best regards, Connie (Granny AS/IBD/Uveitis)

[Guest guest]

Connie (Granny),

Thanks, I knew someone would come to my rescue with the proper

information. When things get this " technical " I have to let

someone else lead the way!! I appreciate your research and

information found.

Ray

[Guest guest]

Hope this helps.

> Best regards, Connie (Granny AS/IBD/Uveitis)

Yes, Connie, it helps me a great deal..i've always waited for the

right time to get into the xrays, MRI's and significance.You saved me

a lot of research and more importantly i now have a clear

understanding of most medical meaning behind all the emphasis (at

least in my case)on the mri..

just one last thing, this may be way out of your interest, but the

second rheumatologist who confirmed ReA diag said that believe it or

not, all the urinary symptoms were related or due to the inflamed

sacroiliac..he held up x-ray and pointed to sacroiliac and says this

is what is causing all difficulty i'd been having with urethritis as

well a prostatitis...Of course i didn't believe him because it seemed

almost impossible that one could be connected to the other..But then

that was before joining this Group where i have learned that there

were lots of wackey connections..e.g. conjunctivitis and urethritis--

two of the legs of the triad. And furthermore the more i learn about

details of Reiter's the more bizarre this aliment becomes..So maybe

there is a direct cause/effect between sacroiliac and chronic

prostatitis..

thanks again

jeff lanneau

[Guest guest]

Dear Granny,

HI...... nice of you to actually show and tell us what we need to know.

Esp. on the testing we have to endure. I found that along with my

Ankyspondlitis, PA/ and ReA/ I have Scoliosis., with a 30% rotation as well

as the other. I have spoken of this several times. One person said her

doctor told her she couldn't be in all of that pain. I beg to differ with

her doctor, GREATLY !!! my first MRI the tech just put me up there and gave

me a locker and said hop up here. When it was through he said, " How long

have you been like this, " he was truly amazed. I said well for years. He

handed me my clothes out of my locker because he didn't want me to even bend

over. I look back and laugh at that every time I go through this type of

stuff. When a tech who does these day in and day out says stuff like this

they are really concerned. I am grateful I can still walk some and have as

good of help that keeps me moving.

I retreat to my wheel chair at the hard times. But, I also am grateful

GOD gave me a sense of humor about the human condition.

These diseases are a pain in more ways than one. I hate new doctors who want

to take you off of all meds so they can HEAL you.

But, they are trying to help you as well. We can be on meds for years and

not seek more help or the latest of treatment. I go for what works for me.

We are all learners and we also are teachers.

This world needs the information we carry within our bodies and our treatment

of it. So, if you get down and out over the treatment and pain you suffer

remember there are those who have been here before you, and have contributed

to your treatment you have today.

A pound of GRATITUDE is healthy. Granny is a wealth of good treatment and

the one we turn to for such important answers.

So thanks Granny for caring and sharing your own life and dedication to the

human condition.

Brie

[Guest guest]

> Dear Granny,

> HI...... nice of you to actually show and tell us what we

need to know.

A pound of GRATITUDE is healthy. Granny is a wealth of good

treatment and

> the one we turn to for such important answers.

> So thanks Granny for caring and sharing your own life and

dedication to the

> human condition.

> Brie

***

I would just like to second what Brie just wrote..Ever since

the first week of being a member, i was just struck by the incredible

talent contributing to this Group..We really are fortunate to have

people like Rick,Ray,, +Dave,some others whose name escape me

and i apologize; and then there is Granny,To be honest when i opened

the question up i was half-hoping tht Connie Abbey would take it on

and the answers that came back gave me such great info so that if

anyone tries to question or challenge my diagnosis, i feel secure

enough about bilateral sacroilitis and everything else having to do

with backache and lombar region,that i wcould go to the mat over any

attempts to alter my diagnosis..I know this sounds a little

melodramatic, but i've had lots of people question whether i really

had ReA or something like SAPHO or just plain

old 'undifferentiated 'whatever,..Point is, i get one new doctor per

year.sometimes 2 in one year. sometimes my doctor shares me with

others in Rheumatology and things do not always go according to

plan..I am really very fond of the place where i go for

treatment..i'm really grateful for the treatment i do get..But every

once in awhile i'm temp assigned to another doctor rotating through

the system,,On one such occassion of talking with one of these

newbies, when the exam was over i noticed she forgot to give me any

refills on methotrexate and when asked her response was, 'you don't

want to take that..it's very bad for you'..that happens very seldom,

but because of the rotation system i always felt vulnerable...just to

cut this short, i'd say i feel vulnerable no more..That's the honest

truthi feel like i've got every base covered now..enough so that i'll

stop worrying..so thanks again Granny..

jeff lanneau RS,AS,FMS HLA-B27neg

[Guest guest]

WOW, Brie and Jeff, with all the praise I almost felt like God for a few

seconds! ;-) Don't give me too much credit...just a lot of years dealing

with this mess, a bunch of siblings and my own children with AS, and the

wealth of knowledge that has been given from others on the list over the last

7-8 years+. Everyone would benefit much if you would go through our many

years of archives from the many members in the group who have far more

knowledge than I, who have come and gone, and others like Rick, Ray, Matt,

Dave+, Priscilla, , (I know you both are still with us) Walter,

Z, Kay B, who have been here pretty much from the inception. Like

Jeff, I know I have forgotten some of you...I blame that on Indocin fog. To

those of you that are lurking and have never introduced yourselves, we would

love to hear from you. We gain knowledge from sharing with each other.

Brie, I have scoliosis ( a curvature of spine to the left or right). Also, I

have the typical kyphosis (a bend forward of the spine/hunching) that is

associated with AS, but not as bad as some. I get upset when I see articles

that say you can " avoid " this typical posture by proper exercises, sleeping

postures, etc. Exercises are very good for mobility and strengthening our

back muscles, but if the disease progresses, it will not prevent the typical

posture of AS. We have enough stress by dealing with a chronic disease

without someone " blaming " us for our posture. My father, when I was young,

would pound on my back and tell me, " Stand up straight. " It was simply

ignorance on his part. You cannot help having a certain gene that predisposes

you to scoliosis or kyphosis. One of my children wore a Milwaukee brace for

kyphosis and scoliosis (not related to a spondy) for several years during her

teen years...unfortunately, like many, it did not help. Two of my brother's

children had surgery with a rod implanted in their spines. Scoliosis and

kyphosis can be both congenital or it can be associated with our disease of

the spine. Most advanced AS patients have kyphosis and it can be so bad that

they are unable to look forward or skyward and they find it hard to drive a

car. There are some very good pictures of the typical posture of AS...showing

the advancing stages, some picture of conjunctivitis and uveitis (very good),

and a picture of ReA knee listed below.

Best regards, Connie (granny)

<A HREF= " http://www.emedicine.com/OPH/topic721.htm " >eMedicine - HLA-B27

Syndromes : Article by A a Di Lorenzo, MBBCh</A>

[Guest guest]

> WOW, Brie and Jeff, with all the praise I almost felt like God for

a few

> seconds! ;-) Don't give me too much credit...

i knew when i wrote the words of praise to you and others it would

either seem obsequeous, patronizing, or just sucking up to a mentor;

but truth is i had none of the above in mind while posting..there was

no ulterior motive..at least i don't think so..i'm just glad that

there are probably a dozen members who can field about anything

thrown at them and that's the truth..i have gone back into archives

and always manage to learn something ..there was at least one member

i passed over yesterday and that's Robbie (now in FL)He's really

missed wherever he may be..

And given fact that there are at least 140 active members, if anyone

wants to participate, it would certainly be welcomed..it doesn't have

to be some earthshaking topic..anything..just a hello and maybe some

brief description of your affliction and things you've learned which

help you to cope..doesn't have too technical, deeply personal..I

found three things with help of my rheumy and occupatipnal therapist

which have made such a big difference...just a couple of handy

devices i had no idea even existed until they spoke up: i was having

so much trouble leaning over and getting up, one suggested

a " grabber " then a cane, and a sock-aide, and several other items

which have made a big difference..there are all kinds of helpers and

prosthetic devices which can make days so much easier..point being i

learned about all this because someone mentioned it.i had no prior

knowledge and that's the kind of info which is exchanged here..the

more participation, the better for us all.and remember as someone who

moderates this list has often said, 'there are no dumb questions'

and noone should ever feel they are being judged or

scrutinized..there is none of that here..

jeff lanneau, Reiter's Syndrome(RS)AKA Reactive Arthritis (ReA)

[Guest guest]

I know your sincerity, Jeff. Amen to all that you said. We have really had a

great bunch of people and it is all the little tips that help each of us so

much.

My daughter and her six kids are coming to visit us for a week...you all know

what that means. The paradox of trying to give high spirited and energetic

kids a good time in the mountains and our having to live in these pain ridden

bodies. Being type A personality, I don't like sitting on the sidelines and

watching all the fun. However, some things I will forego...like rafting and

horseback riding. My husband and I will gladly keep busy with the two little

ones that aren't old enough to go. :-)

Everyone, have a pain free weekend. Connie (granny)

[Guest guest]

Have a great week Connie, Diane. ReA, crohns disease.