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Why do I have sacroilitis, if all tests are negative?

Q: I am a 26 years old unmarried male. I weigh 47 kg and I am 5 feet 4 inches tall. I am suffering from low back pain which radiates along the leg from the past three years. The pain originates from sacroiliac joint, when there is a sudden stress or jerk on the joint (like during playing or catching a bus). There is also a shooting pain when I sneeze or cough. Three years back I had a small accident on my pelvis. I had no pain or injury at the time of the accident. But a week later I had pain. I consulted several doctors, who gave pain killers and did the following investigations, but no one was able to diagnose the disease. MRI of pelvis: The irregular T1 hypo and T2 hyperintensities in sacrum and iliac bone adjacent to right sacroiliac joint. SKELETAL SCINTIGRAPHY (Tc 99m MDP): 3 phase scan showing increased uptake in both SI joints with associated increased blood pool is suggestive of sacroilitis. X-ray (AP, PA & Lat view): Both SI joints show sclerosis in the lower two third suggestive of sacroilitis. I also took the following tests, whose values are normal and negative. CBP & ESR (repeated every six months), HLA B27, Mantoux test, molecular analysis of M. tuberculosis, ANA profile (Euroline), RA factor, Serum calcium, phosphorus, uric acid, C-reactive protein, Serum proteins A/G ratio, Alkaline phosphatase, Serum creatinine and Alanine Aminotransferase (SGPT), Colonoscopy (a small fissure in ano). Please advise.

A:The tests that have been performed were done to find out the cause of sacroilitis. More frequently it is associated with other spondyloarthropathy, and the associations can be with inflammatory bowel disease, some remote infection like TB, psoriasis etc. If all tests are negative, it can be seronegative spondyloarthropathy, i.e. negative blood tests. First line of treatment is NSAIDS - like voveran, that you are taking. This can be changed if its not effective. Second line of treatment is sulfasalazine or methotrexate medication. Newer medications include etanercept (enbrel) and infliximab (remicade). The early trials of these medications have been encouraging. Lastly, surgical intervention may be required. A rheumatologist would be able to help you better. The medications have to be tried to see which suits you the best. Sometimes 5 to 7 days courses of oral steroids are prescribed to get control over the disease.

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