MRI Results, your thoughts please :-)

General
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Hi everyone, I got the report on the first MRI on my left ankle/foot a couple of days ago, and am waiting for my rheumy to phone me back to share her take on things (she is overseas at a conference just now), but thought I’d ask you guys and gals for your thoughts on this, as in might this be, or is it unlikely to be, as a result of PsA or similar.

The conclusion at the end of the report reads:
Some tendinosis tendinopathy both within the flexor peroneal and extensor groups and of the achilles tendon.
Small ankle joint and subtalar joint effusion.
Note: Funny thing is I hadn’t noticed any problems with my achilles tendon, or the rear of my ankles, most pain/stiffness seems to be more focused on the front of and inside of them.

Also, further up the report there is mention of “trace of tendon sheath fluid” in a couple of the 4 tendons affected with tendinosis.

My understanding to date is that the effusion is likely a result of an inflammatory process, as is the tendinosis, but just wondering if this sounds about right to the rest of you.

Dr Google seems to report that tendinosis is likely to be from something other than inflammatory process, except in a systemic type issue, where it could well be as a result of systemic inflammation… this would make sense if this is PsA, or a similar type issue (given that many other joints are affected too).

It would appear that the radiologist has only reported on the ankle and hind foot, rather disappointing given that I also have issues in the mid and forefoot (although, I think, these are not as bad as the ankles themselves), but the rheumy nurse is going to see if the pictures can be put before the radiology team meeting next week to see what they can find, which might give more info (or not lol).

I’d be really keen to hear if any of you have had similar reports or are able to translate some of this for me, and yes I understand you are not doc’s or radiologists, but some of you have maybe had experience with this type of report :smile:

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That seems to be the key finding. A joint effusion is the presence of increased intra-articular fluid or in short inflammatory arthritis in the abscence of a known injury. Joint effusion is most common in the knee and is usually a birthday disease or overweight. Not so much in the Subtalar joint which has three facets and is a classic symptom of PsA. @Seenie should appear shortly to give you her lecture on that issue… The Subtalar joint is mid foot. The pain usually radiate toward the toes first. Heres a picture (Its surgical but ignore that and just look at the anatomy): image

Its also significant that he is referring to tendonosis as opposed to tendonitis. This is often Enthesitis which is also classic PsA. Have they suggested PsA as a diagnoses LOL???

The only confusing thing is “trace of tendon sheath fluid” which is more of an RA thing unless of course you were once a runner, in which case it could almost be expected. (or you wear really bad shoes)

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Awesome!! Thank you so much for your response @tntlamb, so very much appreciated!!! Exactly the clarification I needed today :smile:

From what I had read I had considered subtalar to be hind foot (just show’s you how dangerous a “little” knowledge can be :wink:)

Also thanks for the heads up on tendinosis being enthesitis, that has clarified the findings heaps more for me :smile:

The radiologist did not suggest any diagnosis, but when I phoned the rheumy nurse she did explain that effusion was inflammation (had kinda figured that out lol)… so far the diagnosis has been "inflammatory arthritis, ?PsA.

From what I could understand the rheumy ordered the MRI to help guiding further medication decisions, given that the MRI has picked these despite Mtx, Leflunomide and tilcotil, I’m kinda hoping the results might put me in line for a biologic… I could really do with some effective treatment about now :laughing:, although I’m not sure if the MRI findings will be considered sufficient to get through our Pharmac requirements for biologics… I guess I’ll need to see what the rheumy has to say about that :frowning: lol

Thanks again!! Your input is invaluable!!!

Afterthought Edit for @tntlamb :grin:: The forefoot issues I mentioned earlier are at MTP’s, haven’t noticed so much in the way toe issues on that foot, although it does look a little like big and 2nd toes on the right foot are pointing a little further to the right than they used to, and a small bunion seems to be popping up on that foot too (I probably should have chosen that foot for the MRI lol)

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I just noticed the bottom paragraph of your reply… no, I was never a runner (swimming was my thing in my school days), I used to always “rick” each ankle on the first 2 steps, which kinda put me off the whole idea :laughing:

I have always enjoyed dancing though and was involved in Rock’n’Roll for a few years (until my back went in 2000).

Initially when my ankles and feet started to play up (March 2016) I assumed it was as result of the sudden need to walk to town (about a 5km round trip), and carry groceries etc home after the stroke in late 2015 left me with a visual field issue significant enough to mean I wasn’t able to drive any more and I assumed the ankle problems were from the sudden overuse of my valgus type ankles (always had those, since a kid, but were never seen to). It wasn’t til my hands and wrists made their presence felt the following month that I gathered there was probably more going on lol
Perhaps the tendon sheath fluid may be as a result of damage through those months of walking (I have since been using taxis and a mobility scooter to get to town as ankles got too bad to keep walking that distance)

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Rock’n’Roll probably hasn’t helped. I was a dancing fool too. You’ve got to twist and shout. Especially twist.

I think this MRI might turn out to be a godsend for you. Here’s hoping!

(I don’t get what you say about knee effusions @tntlamb, they’ve always been my main symptom and much as I hated them, they were big enough and ugly enough to get me diagnosed. All the docs saw them as PsA through & through).

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Thanks @Sybil!!! I sure am hoping the MRI will prove the need for more effective meds… I guess I’ll need to wait and see what the rheumy has to say when she comes back from the conference (I’m guessing early next week, but have no idea really lol).

As for the Rock’n’roll isn’t it supposed to be “good exercise” well… so I kept getting told… until my back went from being pulled around by a novice dancer lol We weren’t even doing fancy jumps or anything (never got that carried away) lol.

If the MRI ends up being the pathway to a biologic trial you’ll hear me yahoo-ing from the roof tops :laughing: I’d be surprised though as there is still no sign of bony erosions or other bony/cartilage damage (I guess therefore NO osteo) for which I have to say I am grateful!!

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Fantastic exercise for sure! Just probably not the best for joints long-term. But then nor is football. I want to dance again tra-la!

Oooh, you really shouldn’t ‘need’ erosions to get started on the biologics, but then you know that, I know that, we all know that … and if your rheumy sites that as a reason for not starting them I think you’d do well to argue fiercely.

Anyway, maybe it’s just 'cos it’s a sunny morning, but my money’s on you getting sorted sooner rather than later.

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Awww… I’d love to be able to dance again… would take heaps to build my fitness again now though :frowning:

I don’t really think we “need” erosions as such to get through Pharmac requirements, but as my CRP and ESR levels are always within “normal” I have a feeling I may need to do 3 months on prednisone before I qualify for biologic (as the prednisone would upset tests for CRP and ESR so those results would no longer count), well… as near I can make out :slightly_frowning_face: It’s all just a numbers game I guess… I might be wrong about all of that though.

Next appt with rheumy was supposed to be next month, but that clinic is cancelled so has been rebooked for the 20th July… here’s hoping my rheumy can get the ball rolling, on where ever things go next, before then lol

When I was talking to the rheumy nurse I did say it’s great to see there’s no erosions, and it’d be really nice to keep it that way!!! lol She agreed :smile:

Your mention of knee effusions has brought up memory of what I would now say were exactly that… back when I was 17… hmmm… the more things add up the longer I think I’ve been dealing with all of this (although mostly at a background level).

Thanks so much for your support!! Your positivity sure does rub off :smile:

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Are we the dancing twins?? I was 16 when my knee first blew up lol!

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You’re both definitely the dancing twins! And I hope the MRI report sorts you out on coherent medication @janson. Jeez though waiting till end of July seems quite a long time.

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Thank you, @Poo_therapy. I too hope this might be the gateway to getting something more effective… waiting till July would be a nuisance, but these ankles have been a consistent problem since March 2016, and as there has been little change in that time, I suspect those effusions have been there all that time… what’s another couple of months? :slight_smile:

It might not be that long, depending on what my rheumy says/can do when she phones, hopefully sometime this week.

I must admit, my patience is running a little thin these days though lol

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Sorry, janson, I’m slow on the uptake because I was (still am) on holidays. I may be a bit more “visible” now that I have good internet access, but I do have holiday company who are relentlessly and enthusiastically active, which is good and fun, but distracting. LOL

Well, as far as a technical/medical opinion goes, I’ll defer to tnt every time. As much as we hate to admit it (not!) he’s usually right on the mark. From a less educated perspective, but with one backed up with a fair amount of disease experience, I don’t know why these people just don’t add “consistent with psoriatic arthritis” as the bottom line of the report. Achilles tendon problems? Joint effusions? Duuuuhhhhh.

I think I’ve missed some of your story: you had the MRI to figure out why your rear/midfoot has been giving you pain, although you’ve previously been diagnosed with PsA? The simplest explanation is usually the one that is most likely to be correct. That’s probably your PsA kicking you in the heel.

For me, this set of developments would ring the alarm bells, not so much because it could signal that your disease is more serious that previously thought, but because of where the activity seems to be. Hips, knees, shoulders, elbows and lots of other parts can be repaired/replaced. But feet … oh, feet are so important, and so hard to fix.

My first PsA symptom was dactylitis of the big toe, twice. (That was twenty years before diagnosis.) That disappeared, and I never had toe problems again, although I had lots of other things wrong/sore. I did, though, have consistent mid-foot pain which eluded diagnosis until finally an x-ray showed damage. Then, I had “inflammatory arthritis” narrowed down after that to PsA.

I had a GP and a rheum who decided (I think) that I was OCD and drug seeking, so they kept telling me that my PsA was mild and not to worry so much. I was terrified that my feet were going get damaged worse than they already were. They fiddled. My feet burned. I just wish I’d pulled the alarm long before things had got that bad. Unfortunately, I wasn’t diagnosed, and had eventually come to agree with my GP that I was whingeing whining drug-seeking middle aged OCD and menopausal. Knowing what I know now (that is, having serious foot damage is a terrible handicap) I would have been more persistent about finding a cause. How I would have done that is beyond me, as I was already a nutcase.

So, knowing that you have PsA, please push to have the safe assumption made: this new stuff is probably PsA too, and getting into dangerous territory. Getting your PsA under control should be top priority. They need to pull out all the treatment stops to get this thing under control. Just my humble opinion.

If I’ve misunderstood what’s going on with you, please set me straight: I’ve been offline for several weeks now, and I’m so behind I think I’m ahead.

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Seenie, do you meant this literally as well as metaphorically?

My little (well quite big) b*^%ers burn and tingle, especially at night. To me that suggests inflammation, yet as you know all I hear is OAy OAy OAy all the way these days. So should the heat be flagged up?

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Yeah, literally, inside. No redness on the skin. And they tingled, like kind of teeny electric pulses, which made my GP order nerve conduction testing. (Nerves were fine.)

After I was diagnosed, my orthopedic surgeon was so alarmed by what seemed to be happening to my feet, that he referred me to his colleague, an orthopedic foot surgeon who I knew of, from people I’d known had gone to him, as brilliant and who has a five year long waiting list. (Yes, you read that right.)

I saw him in a matter of months, but maybe that was only because he owed my Ortho guy one. He looked at the x-rays and said that the number of joint surfaces involved would make fusion (that is, pain relief and restoration of function) impossible. But at one point during the consult he was talking to me with his hands around my midfoot. (A bit weird: I wanted to say “what are you doing?”) And then he said “You’ve still got inflammation in there, I can feel it.” I was so impressed that a doc with his kind of reputation and skill would do something that was so low-tech and simple. But maybe that’s why he has the reputation he does.

OA? Maybe it is. But how the h*ll would they know? A safer assumption (for you, anyway) is that it’s PsA. I don’t know what diagnostic modality would shed light on that, though: ultrasound maybe? Didn’t you have that before?

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Thank you so much, hopefully of interest to others - not trying to hijack.

I had an ultrasound that showed little inflammation but lots of damage, described to me as OA. But more recently the phrase ‘no significant erosions’ has also been used & that can be read in two ways, either ‘no erosions’ or ‘only little erosions’. Little erosions become big ones I would think.

I think an expert would feel the vibrations when my feet tingle, it is as if something in there is trying to get out!

Appointment time soon and this is going to get an airing for sure.

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I’ve read you guys posts a couple time and I still can’t wrap my head around what you’re saying the cause is of the tingling/vibrating thing? I feel like my whole body does that… I don’t think I’ve mentioned it to any doctor before… should I?

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Hi there Seenie :smile: Thanks so much for taking the time to respond to this just now!!! I’m pleased to hear you are on holiday, and not away due to being unwell :smile: I do hope you are having a blast on your holiday!!!

Never underestimate the value of experience, in anything, most especially with this darned disease, as much as it sucks having to go through that experience!!!

My understanding with the MRI was to help deciding where to go with further meds… although I do wonder if it was really gathering some solid evidence to convince Pharmac (they are the body that need to approve funding for meds here). Although I nearly meet all of the Pharmac requirements to qualify for funding my CRP would need to be over 15, or ESR over 25, or I would have needed to be on Prednisone (greater that 5mg) for 3 months… this is the last hurdle for funding, unfortunately my CRP and ESR never get that high (mostly well within “normal” levels), so short of 3 months worth of Prednisone I think the rheumy might have been hoping to find sufficient evidence to push Pharmac so I can get started on one of the biologics. She gave me the choice of areas to get scanned, although she wanted to do one hand, I suggested a foot and ankle… as that’s where the pain and stiffness have been consistent for the last 2 years, my feet/ankles are pretty much a matching pair as far as symptoms go but I chose the left foot as apart from the bone spur under heal there is an odd one on the side of my left foot (the radiologist did comment on the planter spur, but no mention of the one on the side of the foot, which is what one of the things that made me suspicious she had not reported on the whole foot)… The rheumies had already felt inflammatory arthritis, and seem to suspect PsA, although the more experienced one did say that the tenosynovitis he felt in my hand ONLY comes from inflammatory arthritis, most usually RA.

In short… nothing shows on x-ray as yet, and the MRI shows no bony erosions (a good sign that this can still be stopped in it’s tracks) or ligament issues (interesting given that at 17 it was deemed I had ligamentous laxity, which was what I first assumed the ankle problems stemmed from, when they showed up in March 2016, other joint problems had been hanging around on and off for years but the ankles and feet were a new thing and I figured were just from a sudden increase in walking).

As for PsA diagnosis, my GP thought that was the most likely one, given that I do get bouts of mild psoriasis off and on… the rheumies seem to prefer an inflammatory arthritis diagnosis, possibly PsA. All a bit of a crap shoot I think :laughing:

Oh boy, do I understand the menopause/OCD/drug seeking category we so easily get thrown into… I am very fortunate to have a GP who understands that I don’t want/can’t take opiods… what I need is effective treatment so that I can function at a far better level than I do now, and hopefull will be able to do so for years to come. He’s a real sweetie :smile:

To date medication seems to have had “some” benefits, the titcotil some seem to reduce pain levels enough to say my body soon lets me know if I’ve missed one LOL, the Mtx does seem to have (mostly) helped my hands, but all the leflunomide seems to done is increase hair loss LOL… hmm… despite all those meds, I still have effusions, I guess that in itself should prove that current meds are not quite up to par :laughing:

Oh, boy, do I understand how important the feet/ankles are… they are definitely a handicap as they are, even though I can still walk on them (limited distances though)… since losing a chunk of my visual field, therefore not being able to drive anymore my feet and ankles have become even more of necessity :blush:

Phew… that’s a heap of explaining LOL In short, ankles/feet have been a problem for a little over two years now… the pain and stiffness in them was a new thing when it started in March 2016, and have been consistent ever since… the only time I got relief for my ankles was on 40mg of prednisone (given for lung problem), and that was only for 4 days.

I am doing my best to be proactive with “the powers that be”, and to that end once I saw the MRI report and realised I couldn’t make head nor tail of it I phoned the rheumy nurse (at the hospital) who explained that yes the effusions were inflammation, and agreed that seemed the radiologist had only reported on the ankle and hind foot… she is going to see if the MRI pics can go before the radiology panel meeting next week to get their take on the rest of the foot, and will get the rheumies to phone me when they get back from the overseas conference they are currently attending… my guess is I will hear from them sometime this coming week (hopefully tomorrow), so it could be an interesting week LOL

Thank you soo very much for taking time out of your busy holiday to respond here, it is MOST appreciated!!! But please do go and ENJOY what is left of break, have fun with your companions!! After all, that’s the whole idea of a holiday :smile:

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Oh, that “burning” thing… I definitely have had that going on (off and on) in what I have just discovered would be the syndesmosis joints (where the fibular meets the tibia, the bony bit on the outside sides of the ankles). Oh, and the tingly/electrical impulsey thing in the front of my feet, I had assumed that had come from my spine, now I think, maybe, it was probably the MTP’s (it was in that general area).

At least the MRI and xrays of ankles/feet don’t show anything that might be considered OA (or at least not that I can make out lol)… so that’s one thing they can rule out from my feet/ankles :smile: I do have mild OA in my hips and “may” have it in my knees too (interestingly all of those joints still have good joint spaces, that alone has me questioning OA as the cause)… but… maybe this is secondary to years of mild, underlying inflammatory arthritis of some ilk? I guess we’ll never know :roll_eyes:

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Heya @Sybil, no worries at all re: the hijack :smile: It is always interesting to hear others experiences/issues, and adds even more to think about… by the way… this a good thing!!! :smile:

Best of luck with upcoming appt. and yes, do try to get this issue in for that airing!!!

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I know ageing muddies the waters … but all this OA that I allegedly have is in parts of me that PsA has most definitely gone for and have only come on since my first big flare. Inflammation in joints causes various changes and secondary OA is one such change. When pressed, every rheumy I’ve seen agrees with that … but only after they’ve gone through the ‘oh we all have OA, I expect I have some, etc. etc. etc.’ routine which absolutely does my poor wee head in.

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