OpenHealth Q&A

Exploring Potential Diagnoses: My Experience with Joint Pain and MRI Insights

At 24 years old, weighing 89kg and standing at 176cm, I come from the Arabian Gulf region. Over the years, I have endured persistent discomfort in my lower back, spine, and various joints. I also have a history of hypothyroidism, managed with a 50mcg dosage of levothyroxine. I do not smoke, drink alcohol, or engage in illicit drug use. I have a significant family background of autoimmune ailments: my father has psoriatic arthritis (PsA) and psoriasis (PsO), while my mother suffers from autoimmune hepatitis and Hashimoto's disease. My maternal lineage is heavily affected, with all eight of my aunts affected by Hashimoto's thyroiditis. My battle with lower back pain began in 2017, initially localized on the left side. Since then, it has progressively worsened, and by 2020, I began experiencing pain in my right lower back as well as my left knee, elbows, and wrists. Over these five years, more joints have become affected, particularly the smaller joints in my hands and feet. I've also experienced tenderness in my left ribs, and overall joint pain has become a significant issue. My posture has deteriorated notably, exhibiting classic signs of inflammatory arthritis, such as relief with movement and morning stiffness. While I have not experienced dactylitis or notable swelling in my joints, the pain and stiffness are markedly severe. My lower back pain is particularly crippling, accompanied by extreme fatigue that isn't psychological in nature; on some days, I struggle to perform simple tasks such as shaving. Starting in 2023, I developed diarrhea (which persists), alongside episodic symptoms like a burning feeling in my left eye, itchiness, light sensitivity, and pain behind my eye. This condition marked my first encounter with headaches occurring primarily in my left eye, and occasionally alternating to the right. Additionally, I am grappling with plantar fasciitis in both feet and pain in my left Achilles tendon, alongside a general malaise resembling flu-like symptoms. Interestingly, my joint pain mirrors that of my father, though our symptoms differ; he predominantly reports discomfort in his ribs and neck, whereas my complaints involve my lower back and various peripheral joints. My symptoms suggest a broader joint involvement, which I find noteworthy. After ruling out inflammatory bowel disease through endoscopic procedures, my tests, including RF and Anti-CCP, returned negative. Furthermore, I tested negative for HLA-B27. To my surprise, I found remarkable relief using Celecoxib 200mg twice daily, which alleviated most symptoms in just 24 hours, potentially obscuring the inflammation seen in my sacroiliac joint (SIJ) MRI—this was under evaluation prior to treatment, so many symptoms abated except for the persistent diarrhea and worsening plantar fasciitis. My rheumatologist has clinically diagnosed me with undifferentiated spondyloarthritis (SpA) until further assessment. However, my MRIs indicated no signs of inflammatory back pain according to radiologist evaluations. My doctor chooses to disregard this radiological assessment, leaving me feeling uncertain, as my clinical signs and family history are my only supporting evidence—my inflammatory markers are also within normal ranges, with the sole exception of a positive ANA at a 1:640 titer, while all other connective tissue disease tests returned negative. What perplexes me is that both radiologists produced succinct reports that do not reflect anomalies I feel exist. Although I lack radiological training, I am convinced there are notable changes. In summary, the radiologists concluded that the SIJ scan appeared normal without chronic alterations, while the full spine MRI revealed degenerative disc disease, mild scoliosis, multiple herniated discs, and annular tears. Though the lumbar pain is minimal, I experience bilateral SIJ and buttock pain radiating to my thigh, coupled with cervical and thoracic discomfort, and tenderness in one rib near my left nipple. It’s worth mentioning that I have mild scoliosis, which, in my opinion, doesn’t account for the excruciating pain I endure—this condition emerged after my symptoms began. I've numbered the MRI slices for easy reference if needed.

Answers (1)

3/28/2025, 1:10:46 AM

OpenHealth AI

Your experience with persistent joint pain and related symptoms is complex and understandably troubling. Given your family history of autoimmune diseases, your clinical diagnosis of undifferentiated spondyloarthritis (SpA), and your symptoms, it's essential to address your concerns thoughtfully. Here’s a structured way to evaluate and manage your situation:

Main Points

1. You exhibit symptoms consistent with inflammatory arthritis related to spondyloarthritis.
2. Your family history indicates a potential autoimmune component, which may play a role in your symptoms.
3. MRI findings show degenerative changes, while clinical signs persist despite radiological reports indicating no inflammatory activity.

Explanation

It seems that your situation involves a mix of chronic pain due to joint and possibly musculoskeletal issues, along with a potential inflammatory component. The presence of joint pain, fatigue, and your family background all suggest that monitoring and management are key, even in the absence of definitive MRI proof of inflammation.

Your response to Celecoxib indicates an inflammatory process might be present, even if it isn’t fully captured in your imaging. The connection between your symptoms, family history, and the diagnosed condition suggests that ongoing evaluation is important, especially considering the progressive nature of your symptoms and the painful experiences you've described, such as the plantarfascitis and other musculoskeletal complaints.

Actionable Next Steps

1. Symptom Diary: Start keeping a detailed record of your symptoms—note when they occur, their severity, and any patterns related to activity, diet, or medication. This diary can be very helpful in discussions with your healthcare provider.

2. Regular Follow-Up: Schedule regular follow-ups with your rheumatologist to monitor your symptoms and response to treatment. Be open about your concerns regarding the discrepancy between clinical findings and radiological assessments.

3. Consider Additional Specialists: Since you also experience eye-related symptoms and gastrointestinal dysfunction, consulting with an ophthalmologist for the eye discomfort and a gastroenterologist for the ongoing diarrhea may provide further insights and relief.

4. Physical Therapy: Inquire about a tailored physical therapy program to address your back pain, improve posture, and manage the symptoms related to plantar fasciitis. Exercises that focus on strengthening core muscles and maintaining flexibility can help alleviate some pain.

5. Manage Pain and Monitor: While you’ve found relief with Celecoxib, ensure you’re also incorporating non-medication strategies such as heat therapy, gentle stretching, and appropriate rest to manage your pain.

6. Consider Lifestyle Adjustments: Focus on a balanced diet, maintaining a healthy weight, and low-impact exercises (like swimming or cycling) to help manage symptoms systematically without exacerbating joint pain.

7. Research Support Groups: Connecting with individuals who experience similar symptoms can provide emotional support and practical coping strategies.

Conclusion

Your condition requires attentive management and collaboration with healthcare providers. The combination of persistent symptoms, family history, and initial medications all indicate an ongoing process of evaluation and adaptation. Keeping track of your symptoms and health changes will empower you in your discussions with your healthcare team. You are not alone in navigating this journey; many resources and strategies can assist you in finding relief and understanding your condition better. If you have further questions or wish to discuss specific aspects of your treatment, feel free to ask.