Not worth having a spine MRI scan?!

I have RA and it is thought that I have inflammation in my sacroiliac joints and maybe some wear and tear of the facet joints due to limping for the best part of 5 years! A few weeks ago, I was in a real pain crisis, so went to my GP who was concerned and referred me for an MRI scan of my spine.

I've since spoken to my rheum team who think there is no point in having the scan. They said that I am already on the right track treatment wise (only on week 7 of Humira) and that SI joints don't tend to erode away like other joints. They also said that lower back problems are common and again, apart from physio and pain relief, there is nothing to gain from seeing what a scan says. At 26 years old, I disagree that I should be having such severe and disabling back pain but I do see their point about the scan probably not showing us anything that we don't always know/suspect.

I feel really confused and not sure where to go from here.

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6 Replies

  • Rather than arguing for the MRI, it might be more worthwhile if you could get a second opinion assessment from an ankylosing spondylitis clinic or specialist. I'm guessing thats what your GP was thinking when they requested the MRI. Not all rheumatologists are really up with spondy,and from the sounds of what you have been told, your rheumatologist is one of the ones that doesn't understand it well.

    Your rheumatologist is right though in that humira should make a difference, as it is one of the antitnfs approved for AS and PsA. One difficulty in switching your diagnosis right now from RA to AS would be that AS requires different criteria, and as they are based on actual damage showing up on xray or MRI of SI joints, many people don't meet criteria until they have had problems for 8-10 years or more, so it could result in you being taken off Humira if your diagnosis was changed. Also there are far less antitnfs approved for spondy than for RA.

    The good news is that your GP clearly does think you need assessment of your SI joint, so perhaps try again with them and ask about a second opinion referral to a proper AS clinic.

    If you want more info on AS, the website has some excellent info, including downloadable exercises you can do as self help - the right kind of exercise is one of the best things you can do to limit the damage of AS.

  • Thank you, earthwitch.

    I do wonder if I have psoriatic arthritis as I have psoriatic nails but rheum felt it was unlikely due to there usually being skin involvement.

    Rheum team said that actually sacroiliacs are sometimes affected with RA? Is this common?

    I am loathe to challenge my dx, purely because I don't know if I have the energy anymore. I know I have some kind of severe inflammatory arthritis, I just want it settled. :(

  • Sacroiliitis is actually the hallmark of AS - not RA. It does seem that rheumatologists in the UK are far less likely to consider spondyloarthritis, and even where they suggest PsA, they seem to want to treat it exactly the same as RA (going through all of the DMARDs first), which really isn't always the best strategy. They also seem far more likely to diagnose seroneg RA than spondy too. The cynic in me would say that its because RA treatment is a whole lot cheaper than treatment for AS (which is NSAIDs for as long as you can take them which isnt often more than a couple of years, then straight into antitnfs, whereas with RA there are loads of DMARDs and different combinations of them to try first). Also, I don't know where your rheum is coming from when they say "there is usually skin involvement" - that really isn't the case - in fact you can have absolutely minimal psoriasis (including having it years ago and not now) or just the nail involvement to meet criteria for a PsA diagnosis.

    The usefulness of getting the correct diagnosis is in getting access to the right treatments and slowing down the disease process. If you have managed to get onto anti-tnfs already, then in some ways you might as well just leave it with the diagnosis you currently have as you will be able to try a lot more than the limited number approved for AS. If you have bad sacroiliitis and you are only on DMARDs, then there is really no medical evidence for DMARDs helping spinal inflammation (including sacroiliitis), though a couple of them (MTX and SSZ for AS and possibly one or two of the other DMARDs for PsA) can be a useful addition for helping with peripheral arthritis due to spondy (in hands and feet).

    If you do want to see how bad the sacroiliitis is, then your GP can order a plain film xray of the SI joints asking the radiologist to look for sacroiliitis. They have a way of grading the damage, and if its grade 2 bilateral or grade 3 on one side, then that would meet criteria for AS.

    Definitely check out the NASS website for the exercises though - they are the absolute essential and best thing you can do for self help to limit future damage.

  • Hi Crashdoll

    Strange how different Rhemy said diferent things, my Rhemy is sending me for MRI scan and x-rays due to sevre back pain. I have suffered from RA for four years,

    I hope you get some help with your back pain.

  • Thank you for the helpful and detailed replies.

    It's been agreed now that an MRI might be a good idea for a baseline of my SI joints for years to come. It can't cause any harm, so I think I am going to go ahead as agreed by my GP.

    I have a lot of inflammatory activity in my wrists, shoulders, jaw, feet and ankles, so I s'pose the DMARD and anti TNF combination covers all bases.

  • Forgot to add: I am already undergoing a personalised exercise plan with the specialist rheumatology physio at my local hospital, so at least that area is going to be covered.

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