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Pain in hip joints, neck and back. Marrow edema in MRI. Blood report shows HLA B27 positive. Treatment?

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I am writing down my MRI report and Blood Test report. I have pain in hip joints and lower back bone and at neck region.

There ia moderate effusion in the left hip joint. Marrow edema is noted in the acetabulum, involving the roof, both anterior and posterior pillars and quadrilateral plate. Small geodes/subchondral erosions are noted in the roof. Mild hyperintensity on PD fat suppresses images is noted in the superior part of the femoral head, appearing hypointense on T1. Subtle edema is superior part of the femoral head and neck region.There is no change in the contour of the head. Mild joint effusion is noted. Also noted is mildly hyperintense intra-articular signal suggesting granulation tissue/synovial tissue. There is reduction in the superior joint space and thinning of articular cartlage. No particular soft tussue is detected. Acetabular labrum appears normal.
Mild effusion is also noted in right hip.
Partial anklylosis of the inferior parts of both SI joints is noted. Also noted are extensive fatty changes in the subarticular aspects of both iliac bones and sacrum. Visualised intrapelvic structures appears normal.

Impression : Imaging findings are suggestive of inflammatory disease process in both the hip joints. Small area of narrow signal abnormality in the subchondral superior left femoral head also probably represents marrow edema. However a close follow up is advised to exclude development of AVN.
Partial anklylosis of both SI joints with extensive fatty changes in the subarticular aspects of both iliac bones and sacrum.

Blood Report :
HLA B27 has come out to be positive.

NOTE: I also have pain in lower spinal cord and in neck areas as well. My age is 25 and my weight is 55 Kg and I work as a Software Engineer.

As far as I have come to know till today is that it is an auto-immune disease. I would like to know all the ways to prevent it. And the best way to prevent it among them. If medication is available for such disease then kindly suggest with the amount of dosage. If any kind of exercise would be useful please suggest.

Thanks and Regards

Dwaipayan XXXXXXX
Posted Fri, 13 Apr 2012 in Back Pain
Answered by Dr. Atul Wankhede 6 hours later

Thanks for posting your question.

Your impression is correct, it certainly is an autoimmune condition. The MRI is most suggestive of an inflammatory process or an early stage of Avascular necrosis of head of femur. It is controversial though because AVN requires a history of minor or major trauma to hip, long term steroid medication or some relevant history which you have not mentioned in your history.

In any case autoimmune diseases are not easy to manage. They need well monitoring and proper rehabilitation. In my opinion you should consult an immunologist and prepare for long term medication. The disease per se may not be cured but complications can be avoided and managed. Exercises may be done under the guidance of a Physiotherapist. Ankylosing spondylosis can be kept in check with exercises.

Hope this makes it clear for you. Feel free to ask more details, I'm available for follow up.

Good luck.
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