Bone erosion of sternomanubrial joint - please help

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Hi, 

I am a 20 year old male who has often kept reasonably fit, however as of recent I have been absolutely debilitated due to quite an abrupt and significant erosion of the sternomanubrial joint within my chest. The pain began subtly around 6 months ago, however become rapidly acute in severity a couple of weeks later and is now constantly excruciating with difficulty sleeping and picking up/moving objects,

I have been to numerous doctors now, musculoskeletal specialists, rheumatologists etc. had numerous scans through CT and MRI scans in which showed considerable irregularity of the joint, including areas of subchondral sclerosis and central erosions, with a trace of subarticular bone marrow oedema. MRI and CT scans are suggestive of an inflammatory aetiology. 

Haemotology reports show normal ranges for ESR and CRP inflammatory factors, with negative results for HLA-B27 testing (ankylosing spondylitis), with rheumatoid factor <14 (normal range).. 

My current diagnosis is based around some form of arthritis, and have been issued a CT guided cortisone injection in the area, in which caused me significant pain post treatment along with no improvement whatsoever, as well as being prescribed Proxen SR 1000 (Naproxen 1000mg) for inflammation.

At University I had my blood lactate tested during a learning laboratory, in which my blood lactate levels were substantially higher than anyone elses, displaying 3.8mmol/L in which the average was between 0.5-1.5mmol/L. My blood lactate was also tested after fasting for 14 hours, with no physical activity performed within the last week. After telling my rheumatologist of this, and him disregarding it as nothing substantial or related to my condition, I have began to do some research for myself, so if anyone could help to elaborate or extend on this, it would be more than appreciated.

In my opinion, this high level of blood lactate may be relevant, and may be indicative of some form of hyperlactaemic condition, creating increased levels of acidity in my blood. And as the lactate is being produced in the absence of oxygen from the Cori cycle, the remaining hydrogen ions are creating an acidic environment, to which calcium ions may efflux from bone in the process to buffer these hydrogen ions. My increased lactate levels after 14 hours of fasting would also indicate that my body may not be converting this lactate back to glucose correctly and therefore creating a backlog of inflammation. Please correct me if I am wrong, because I am in no means a professional, but i have been struggling to find an answer to my pain and can only assume based on my own research.

ANY opinions, or recommendations would be absolutely beneficial and greatly appreciated, as I want to get to the source of my pain, and not simply continue to bandaid the issue, furthering my pain and potentially ruining my life as a 20 year old.

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  • Posted

    I'm so sorry your going through this at such a young age. Its very concerning.. I do not have any experience with this, but I wonder - did they do any tests for lymphoma? I just did a little research (my nurse brain...) and this can be a serious issue with either infection or possible lymphona. I should hope they stop poo-pooing it and find out what is going on asap. Best of luck to you with getting answers soon.

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  • Posted

    Hi Chris, I don't have any experience with this also. I just wanted to say I am so sorry you are going through this and hope and pray the docs can help you. Good luck.

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  • Posted

    Hi Chris,

    I hate to see such a young person going through this but its good to see that you're being proactive and persistant. Not sure where you live and your insurance but I was told Columbia has a great Rheumotology Department as well as John Hopkins. If you can, call them up. Are the doctors leaning to a particular Autoimmune disease? If they are, I would call the Foundation for that particular disease and see whom they recommend for further testing. I once contacted the Scleroderma Foundation because my Rheumotologist thought thats what I had. Turns out it wasn't. The Foundation was awesome and gave me a list of doctors near me specializing in the disease. Don't give up but be quick so that you may be on your way to a treatment and remission. I will keep you in my prayers. God bless. Get well soon.

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    • Posted

      I'm from Perth, Western Australia but thank you very much I will see if I can contact some more departments that may have a better opinion and view on these kind of things

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