Lower back, SI joints and toes

[stbernhard]

Hello, I am after some of your experiences. Since last December I have been dealing with at times debilitating lower back / SI joints pain. I now finally have an appointment within an interdisciplinary MSK clinic. Over the last few weeks I also have had 10 out of 10 pain in a toe and metatarsal joint. At the back of the queue again waiting for an ultrasound scan. I have noticed some post recently with queries about MRI scans in connection with SI joints and some post about Morton's neuroma.

I would dearly like to hear from people who have had their scans, to find out what treatment plan has resulted. Thank you all.

[Matilda7]

Treatment plan?? Multidisciplinary team?? I wish! Have had US scans of both feet, organised by GP, which showed multiple bursae and Morton's neuromas...and was recommended to go back to consultant (which took months) who suggested biologics might help IF there was inflammation associated with the bursae and Morton's neuroma.....but if not....no other suggestions...am trying the podiatrist yet again but no one here seems to have anything very helpful to suggest, and certainly nothing resembling a treatment plan!

I would also be very interested to hear if anyone has found a good way to deal with these painful problems.

[stbernhard in reply to Matilda7]

Watch this space. You never know, miracles still happen. I am determined to get a treatment plan. I'll refuse to be fobbed off. MSK appointment at the end of the month. I'll keep you up to date. I wish you all less pain.

[helixhelix]

I'm hesitant to reply as can't offer any great hope. My MRI of my lumbar spine/SI joints resulted in a vague expression of sympathy from my consultant but no actual treatment plan. Which might have been partly my fault as I said to start with that I wasn't keen on spinal surgery until it was my only option. So painkillers, physio and exercise. For my feet (which just have damage, not neuroma) the ultrasound resulted in improved insoles made from casts of my feet rather than the previous ones just put together by guess work, and exercises. Which have all helped to a degree, as has the passage of time as I'm sure that some natural fusion has taken place which has stabilised my back slightly. I can now drive over sleeping policemen without shrieking.

[stbernhard in reply to helixhelix]

That is pretty much what I expected, so I'm not disappointed by your reply. Thank you for doing it anyway. It makes me even more determined to get a treatment plan. I know of the importance of exercise and try to do mine regularly. I'm hopeful that physio is all it will take for my SI joints and am sure something can be done about the foot/toe. Just reluctant to go to a physio without being able to point them in the right direction, past bad experience. We just have to stay optimistic. Thanks again.

[earthwitch]

Lower back and sacroiliac pain generally points to spondyloarthritis (ankylosing spondylitis, or Psoriatic arthritis are two of this group of seronegative inflammatory arthritis), which would be confirmed by an MRI of the SI joints that showed evidence of inflammation and/or fusing of the joints. The treatment plan for that usually starts with NSAIDs (taken regularly at full prescription doses) and/or MTX or SSZ - as they are the only DMARDs that really make any difference for spondy. Most folk can only take NSAIDs for a couple of years, though some people tolerate them for longer. Once you have run out of the cheap options (NSAIDs and DMARDs) then its a jump straight to antitnfs, as long as you meet xray/MRI imaging criteria for diagnosis.

Just out of interest, plantar fasciitis (foot pain) and achilles tendonitis (ankle/heel pain) are extremely common with spondy, as it is a form of enthesitis (inflammation at the point where tendons meet bone) which is the type of inflammation that is very common in spondy. Both plantar fasciitis and achilles tendonitis would show up on an ultrasound.

[stbernhard in reply to earthwitch]

After six years of RA all the options in your first paragraph have been covered. Thank you very much for your effort and help. I'll keep you up to date.