SI joint pain, X-rays and MRI

How many of you have had negative SI joint X-rays, but have persistent pain and stiffness to be followed by an MRI that was positive for activity due to PSA? I have been having major pain/stiffness and my Rheumy is not wanting to treat (maybe cortisone injection/prednisone)it without positive MRI findings. Does this make sense? If I have to have joint damage to get treated, it seems pretty backwards.

An MRI is looking for joint damage. He is looking for inflammation or possibly stenosis. MOST back pain 's cause is unknown. You can only have a limited number of injections before they cause serious damage. I'm sure he wants a reason first. He is not likley to treat you for PsA without periperal evidence, or at least Sacroiliitis at least grade 2 bilaterally or grade 3 or 4 unilaterally. He then would want at least one of these three:

  • Low back pain and stiffness for more than 3 months that improves with exercise but is not relieved by rest.

  • Limitation of motion of the lumbar spine in both the sagittal and frontal planes.

  • Limitation of chest expansion relative to normal values correlated for age and sex.

IF you have periperal involvement then you need to have established inflammatory articular disease with at least 3 points from the following features:

  • Current psoriasis (assigned a score of 2)
  • A history of psoriasis (in the absence of current psoriasis; assigned a score of 1)
  • A family history of psoriasis (in the absence of current psoriasis and history of psoriasis; assigned a score of 1)
  • Dactylitis (assigned a score of 1)
  • Juxta-articular new-bone formation (assigned a score of 1)
  • RF negativity (assigned a score of 1)
  • Nail dystrophy (assigned a score of 1)

Treatment with prednisone is becoming more and more infrequent. and most facilities/practices have established some pretty strict protocol to follow before prescribing prednisone. It used to be used for diagnoses of inflammation. Those days are over. Once you meet the Modifies New York Criteria for Ankylosing Spondylitis (or Undifferentiated SpA) or CASPAR criteria for PsA, treatment becomes easier to come by.

So No I don't think he is going backwards. Serious treatment costs in excess of $40,000.00. Insurance companies are awfully particular. Good luck and I hope you get some relief soon.

Thank you for this information. I fit the criteria, unfortunately and I despise taking oral Prednisone. I am just getting frustrated, impatient and desperate, I suppose. I have been dx’ed with PSA for 21 years. SI joint pain has become part of my life since Sept. I have been on Enbrel since then along with Mobic for a major flare, almost all over. Yesterday I had a c-spine positive for mild Degenerative joint disease and unfortunately, having another flare for the past three weeks. At my appt yesterday, she only wanted to change my NSAID. She said she wasn’t sure if I was developing an immunity to the Enbrel or not. I guess the MRI is next. Thank you, again.

I agree I was lost when I first got diagnosed. I thought well, if joint damage is what you are looking for, let me come back in 10 years so you can see it on an X-ray. My rheumy refused to do an MRI on top of it all. She did an x-ray and saw no joint damage so said she wasn't going to treat the arthritis. Needless to say I didin't go back to her. I went to a derm and showed them how severe my skin was and got on Enbrel.