MRI on a good day?

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Hi. I've been getting lower back and hip pain on and off for a couple of years now. For the last few months it's been getting worse and waking me up in the very early morning, I can't turn over and am very stiff. As soon as I get up, it eases off and I maybe get a little pain during the day if sitting for a while.

There's a tender spot in my right SI region, my lower back and hip often crack and pop when I get up from sitting. I've had quite bad achilles tendon pain recently. I often get pain in the buttocks on the same side, right knee, and sometimes the pain goes down the back of my thigh on the same side. Hip x-ray was normal.

I have had pain and swelling in a few fingers, pain in my feet and ankles, heel pain, and also get a stiff and crunchy/popping neck sometimes. I am being treated for inflammatory arthritis, but don't have a definite diagnosis. All my blood tests are normal. I've been taking sulfasalazine for a few months and the finger/hand pain has improved but this does not seem to help my back, hip, or achilles pain.

I'm having an MRI of my pelvis soon. I don't tend to have pain once I'm up and moving around, and sometimes have good days when the pain goes away completely. So, if the morning pain is caused by sacroliliitis/AS, will the MRI show anything if I'm having a good day? And how likely is it to pick something up if it's in its early stages?

I'm a woman in my late 30s. 

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11 Replies

  • Posted

    Hi, difficult one to answer. If it’s in it’s very early stages and just inflammation showing, with no damage, then there is a chance it may not show anything. If you are already showing typical destruction of bones or discs caused by AS you should be fine. When I had my MRI my Rheumy asked me to reduce all meds and induce a flare for the MRI. This was challenging as I lived 200 miles from my Rheumy and had to travel in the train in severe pain, but it was worth it to get a diagnosis. 

    You certainly sound typical AS so fingers crossed for you. 

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    • Posted

      Thanks - that's pretty much as I suspected really. I've been up so many blind alleys test-wise that I'm not expecting it to show anything, even though I *know* this pain is not normal. 

      I considered stopping medication but I am still having blood tests for the sulfasalazine so it seems a bit risky doing it without the doctor's knowledge. He did tell me to avoid anti-inflammatories for 5 days before though.

      I am already being treated at least, but a proper diagnosis would be nice. Looking at my history knowing what I now know about AS, it seems to make sense. My rheumatologist was pretty useless but luckily she went on maternity leave and I saw someone else who joined the dots straight away.

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    • Posted

      I think sulfasalazine is like Methotrexate, it takes weeks to get to a therapeutic level, that stopping now won’t make much difference. Fingers crossed it gives you some answers 🤞 

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  • Posted

    This is of real interest to me also as I have an MRI scheduled for the next few weeks and I am currently in the best place I've been for a while as far as symptoms are concerned (I had chest and lower back pain). So like the OP I'm worried the MRI might be fairly clear.

    One suggestion here is to induce a flare, which seems quite an extreme way to proceed to get a diagnosis. Would a flare show immediately on an MRI? Is there a direct correlation between the pain being felt at a specific time and disease activity? I have no knowledge of the pathology of inflammatory pain so this would be good info.

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    • Posted

      It depends on each patient I suppose. If it means you get the right treatment that you might not otherwise get, it might be worthwhile. In my case, it might not be as my treatment might not change.
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    • Posted

      I was fortunate enough to receive advice from a NASS adviser who suspected AS. I was on long term steroids and stable at 10mgs, I was advised to get to 5mgs if I could to induce a flare. I was in a lot of pain the day of the scan, but it resulted in a scan showing lots of inflammation and a confirmed diagnosis of AS. I am not sure if stoping other meds would have similar results
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    • Posted

      I don't know the answer to your other questions but would like to, too. Obviously a clear MRI ought to be a good sign, but you reach a point where a negative test is frustrating rather than reassuring. Keep us posted.

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  • Posted

    The more I learn about AS, and the more I read about other people here, the more everything I have been going through for the last three years makes sense. 

    Looking back, I noticed 15 years ago that I would often wake in the second half of the night with agonising pain in my lower back and hips. It almost always happened if I didn't sleep in my own bed. I began to dread going anywhere overnight, visiting friends, staying in hotels, because I knew I would wake up in agony.

    But I never thought it signified anything because I didn't really have any other problems. I thought I was just being a princess all that time, because my mattress always had to be 'just so'.  Until about three years ago, when I started to get inflammatory joint pain elsewhere, neck problems and paraesthesia. Even then, I brushed off the back/hip problems as unrelated because I'd had them so long and they would come and go.

    I am dreading the utter deflation I am going to feel if my MRI is normal.

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  • Posted

    Your comment that you dread having the MRI done and getting negative findings is funny.   Not often that someone hopes to find signs of illness but in this case I understand 100%.  I've been there.  You want proof of what your feeling and diagnosing this monster is very difficult at times.

    ?Having said that though, I would disagree with the notion that you have to induce a flare to see results on an MRI.  If your disease has progressed to the point where it will show up on imaging studies whether you are actively in pain should be irrelevant.  There is a distinct pattern of erosion in the SI joint that shows up after chronic inflammation has started to do it's damage.  That evidence does not come and go with your pain.  Maybe the transient specific evidence of inflammation may come and go but the damage evidence is permanent and once it's there - it's there for good.  

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    • Posted

      Well the MRI didn't show anything and I am devastated. I wake up early in agony and can't turn my body, sitting for prolonged periods is agony, I can't bend fully, there's tenderness, stiffness, my hip burns with pain, my hip and lumbar spine crack and pop when I stand and it hurts... and now it seems there's nothing more that can be done for me without proof that something's wrong. 

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