Back OA and inflammatory arthritis

Elmbow

Hi. I was diagnosed with psoriatic arthritis. I have had mid-back pain for many years that's triggered by certain activities. But in the last few years, since developing inflammatory arthritis and neurological symptoms, it's lumbar pain that has troubled me the most.
It acts like inflammatory pain; worse in the morning, stiff, tender over the joint, improves with exercise, helped by NSAIDs etc.
A rheumatologist finally requested an MRI of my whole spine in April and gave me a follow-up appointment for 6 months.
Well I'm not waiting in pain for 6 months to get some scan results so I requested a copy.
It showed some bulging discs in my neck, degenerative disc disease in my cervical and thoracic spine, an extruding disc in my thoracic spine that is impinging on the spinal cord, and minor multi-level facet, costovertebral and uncovertebral joint degeneration.
But no inflammation or anything significant in my lumbar spine.
I have a few questions:
1. At 40, I can expect some wear and tear. But could this in any way be related to having inflammatory arthritis? It just seems a bit of a coincidence.
2. Could I have inflammation in the lumbar spine that doesn't show up on an MRI?
3. Is it reasonable for a doctor to order an MRI, knowing I'm in pain every day, and make me wait 6 months to even discuss it with me? Without any communication, not even to tell my GP?

I feel I am going out of my mind.

stickywicket

Hello again, Elmbow. I'm sorry things are tough for you right now and I'm afraid my answers will be strictly those of an amateur but here goes:

1. I don't know if the back pain can be related to the PsA. I do know that both PsA and AS (Ankylosing Spondyitis) are sero-negative but it's also quite possible to have an autoimmune arthritis plus OA and although, in such cases, it's much more common for the OA to arrive because the inflammatory arthritis wasn't treated aggressively enough quickly enough, some unfortunate people do do it the other way round ie the OA arrives first and then later the inflammatory arthritis.
When you wrote “since developing inflammatory arthritis and neurological symptoms”, you probably didn't mean the two to seem connected. Just for the record, from what I've read on these forums, neurological pain seems to be connected to OA damage rather than auto-immune problems.

2. My belief is that an MRI would show up inflammation but I could very easily be wrong.

3. I think this is a loaded question and all depends on what you call 'reasonable'. Just to play devils' advocate – if the rheumatologist believes the back pain is due to OA, and so not in his / her area of expertise and, indeed, in the province of the GP or, possibly, a neurologist, I can see them believing there's no rush as there's not a great deal to be done other than pain relief and exercises. If it is neurological then a referral to a neurologist might be deemed necessary but – and here's the catch – many hospitals have stopped references from one department to another and, instead, refer the patient back to the GP to let the latter decide whether or not to refer. That way, the expense is footed by the GP's surgery not the hospital. The old way was clearly quicker but that was when the NHS wasn't itself in dire straits.

I've never yet seen a consultant and not had a report sent to my GP. However, such reports can take some time. If you yourself have a copy, though, you could take it to a GP appointment and ask the GP what he / she made of it. I'm sure they'd be better informed than me.

dreamdaisy

Hello, like Sticky I am not a doc, just a long-standing practitioner of arthritis. Nothing is reasonable about the disease and how little can be done or not done to deal with it and there is nothing reasonable about ten million people trying to cope with it in all its forms.

I began with an auto-immune arthritis in 1997 which was eventually diagnosed as PsA in 2006 which changed nothing. OA was diagnosed in 2011 but when that began I do not know because I suspect it was hiding behind the skirts of the other. I don't have OA where you do but yes, things are stiffer in the morning, they ease as the day goes on (no medication apart from pain relief) returning in the evening as a result of the day's activity. My rheumatologist ignores my OA and the GP my PsA: I do my best to ignore both but it isn't that easy as there is an undoubted impact on life, as one would expect.

We are individuals with a very common disease. We can recognise our doctors but could they pick us out of a line-up of their patients? I doubt it. In an ideal world your comparative youth should fast-track you to a quicker response but it cannot due to the huge pressure of numbers accessing the same services. If one can afford to pay for reasonable then it's achievable but for the majority of is a case of 'put-up-and-shut-up, your turn will come'. Eventually. DD