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Dr. Andrew Rynne

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Exp 50 years

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What does this MRI report regarding arthritis diagnosis indicate?

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Dr. Alokkalyani

Rheumatologist

Practicing since :1999

Answered : 517 Questions

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Posted on Mon, 11 Aug 2014 in Lupus
Question: I have received the following report. I am a 29 year old male. My doctor (primary care physician) says that I have arthritis and that it cannot be cured. She further recommends 60 pills of 375mg prednisone (which I really don't want to take after reading the associated side effects) I wanted to hear an expert opinion from you. Where should I go from now?

EXAM:

The right forefoot MRI date 05/14/2014
clinical history: Right big toe pain, redness that grows with time, and swelling with difficulty walking

TECHNIQUE:

Multiplanar multisequence MRI of the right forefoot is performed with and without gadolinium. A total of 14 mL of Magnevist were administered intravenously for this exam.

FINDINGS:

Small first metatarsophalangeal and first interphalangeal joint effusions. No evidence of tenosynovitis or significant degenerative change. The visualized flexor and extensor are intact. No fluid collection or bone marrow edema. Small intertarsial joint effusions are partially seen. No abnormal enhancement.

IMPRESSION:

Small first metatarsophalangeal and first interphalangeal joint effusions. No evidence of tenosynovitis, fluid collection or bone marrow edema.

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doctor
Answered by Dr. Alokkalyani 1 hour later
Brief Answer:
DOES NOT SEEM Serious

Detailed Answer:
Hi and thanks for the query

I am Dr. Alok and very pleased to be assisting you with your health questions today.

With the history you provide and MRI report, it is difficult to reach any conclusion. Only on the basis of joint effusion, it is not possible to make diagnosis.
And you didnot mention, what type of arthritis it is?
can you further elaborate, full history and further blood test if done, so that I can assist you further?

I wish you good health, take care
--Dr. Alok


Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Alokkalyani 58 minutes later
The possibility of gout has been ruled out by a uric acid test. I have been given many blood thinners including pentoxifylline which gave allergic reactions like unbearable headaches and rashes and therefore had to be stopped. Earlier posting of this condition with pictures (I had not taken an MRI at that time) suggested that I should produce an MRI for better remarks which is why I produced the MRI. I have attached the picture of my toe again. Earlier posts suggest vascular malfunctions but my primary care physician says it is not that although I don't know based on what she says that. Osteomyelitis has been ruled out based on a three phase bone scan with 26.5mCi technetium-99m MDP.

About my accident; I was hit by a car on the same foot which damaged my ligaments and has decreased the mobility of my ankle a bit. I don't whether that immobility puts more pressure on the big toe. I am not going to take the prescribed medicine (the huge dose of prednisone) at the moment. I need some advice as to what to do about this.
doctor
Answered by Dr. Alokkalyani 4 hours later
Brief Answer:
gout may be

Detailed Answer:
Hi,

At this point, I would have to say "Gout can only be ruled out after joint fluid exam". If joint fluid examination wasn't done, your doctors still needs to consider Gout in their differentials. I would suggest to test uric acid level from the blood while you have toe pain and swelling as an alternative tests. Dual CT of thumb is also another tests that I suggest.

In this context, I advice you to see a rheumatologist for proper diagnosis.

Hope this helped.

Take care


Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Alokkalyani 6 hours later
Based on the MRI report, bone scan (which was negative for osteomyelitis) the picture of my toe I have uploaded and my clinical history, what condition do you think best describes what is wrong with my toe? Would it be arthritis etc...
doctor
Answered by Dr. Alokkalyani 2 hours later
Brief Answer:
gout or trauma related

Detailed Answer:
Hi
My first differential is gout - now only confirmed by dual Ct scan of toe
Second is osteomyelitis- but as MRI is not suggestive- chance is virtually none
Third is trauma related inflammation
But to reach any final conclusion, need to see patient and examine
Hope this will helpful

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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