Bone Marrow Edema as an Indicator for PsA, Inflammatory Athritis

Has anyone been told or discussed at length how bone marrow edema in a joint can be an indicator of inflammatory arthritis? I know it occurs with OA and RA, but does anyone have any other experience? I have absolutely zero indicators of RA…

This discussion came from my checkup at the rheumatologist last Friday. My Dr has gone back & forth regarding whether I have PsA or some other inflammatory arthritis, with little evidence to prove or disprove a diagnosis. However, there’s circumstantial evidence at each visit to suggest some type of inflammatory arthritis (random swollen wrist, random swelling in my foot, etc). Nothing ever lasts for long though, and my bloodwork is negative for everything each time. This has been the case for 5+ yrs now. I started seeing her for extremely rapid degeneration of my knee, at the request of my my wonderful Orthopedic surgeon who said my knee (both actually!!) simply doesn’t make sense.

This time though, she mentioned her detailed analysis of my MRI/Arthrogram on the “good” knee last August. (She hadn’t received it yet at my September appt)…She said the bone marrow edema from one of the cartilage defects on my kneecap is something rheumatologists look for as an inflammatory arthritis indicator, so for now, she recommends continuing the Plaquenil.

At my previous visit, she had suggested we stop the Plaquenil to see what happens symptom-wise, as I’m still not a verified PsA (or anything else) sufferer. However, this new information led her to think there’s still a good chance it IS an inflammatory type of arthritis and not just OA resulting from hypermobility.

Any thoughts?

–Lisa

Yes and no. Yes it is an indicator of Inflammatory arthritis, No its not helpful when it is found in a knee as it is one of the MOST common causes of Knee problems even when there is no arthritis. Its does show up on a good MRI (there are lots of bad MRIs) problem is it take multiple MRIs (and multiple$$$$$) to get there as far as inflammatory arthritis goes as you have to look at multiple areas to really know.

Here what I would tell your Doc: "it make no sense to spend boatloads of money, live in misery for months if not years to find out if aggressive treatment works. lets try another DMARD (Plaquenil is a poor drug most of the time but has place) If it works fine, if not I’m gold to try Biologics with my insurance - any insurance. We try that and we’ll know. all your screwing around will only make things worse, in time, when we could KNOW in a few months.

If your doc looks at you like you have 3 eyes get another opinion. Make sure you practice your pitch so he KNOWS you are in control of your problems. When a surgeon tells you to look for more answers as yours did, that is BANK. He only make money in the OR, he looses money in the office.

2 Likes

#word :fist:

2 Likes