I am in an autoimmune shadowland presently. Diagnosed with RA four years ago but now with mostly neurologic and neuropathic symptoms - nothing has yet shown up in my blood or by MRI, Lumbar Puncture, blood or nerve conduction so it is classed as idiopathic small fiber neuropathy. I also have TMJ and my face goes numb and I'm often dizzy - can't swing my eyes round without feeling I might keel over.

Is it possible, despite a clear brain MRI to still have MS?

Yes it is possible. MS lesions can be in the brain, or the spinal cord or both. It is 'usually' in the brain as if there's much that's usual with this disease, but can appear anywhere in the central nervous system. If you or or your neurologist believe you might have MS, often times a spinal tap will also be done despite a clear MRI to look for the presence of O-bands (oligoconal bands) in the spinal fluid. The o-bands are only found in about 80% of people with MS, so it also isn't a definitive test either.

All of that makes getting an MS diagnosis quite difficult, it really likes to hide well sometimes. However, my fingers are crossed for you that it's not what you have and if it is, that the doctors will discover it quickly, and that you find answers to whatever is going on soon.

Thanks very much. My spinal tap was contaminated by trauma (took 7 attempts) so not entirely reliable I was told but the neurologist seemed to think the O bands they examined made MS unlikely as they matched the blood taken. I have reached the stage where I would even be relieved by a diagnosis of MS to be honest.

Having a face and mouth that is often numb and tingling or very sore, long standing dizziness, longstanding and widespread peripheral nerve pain (small fiber) which makes my legs crawl with wet sensation or else burn at night -with RA symptoms which have disappeared - is making me feel as if I'm in the XFiles and it would just be a relief to know what it was.

I do have confirmed autoimmunity so I wonder if I might just have mild overlap with RA and MS rather than one disease badly perhaps? Seronegative lupus is another possibility as is Vasculitis or Scleroderma. None of it is great really but a name would help me psychologically I feel.

Thanks for your help. Mat

if you look up McDonald Criteria you'll see what the drs have to look for to make a dx of MS.

sometimes it takes a while for lesions to show up on an MRI.
the waiting and testing can be difficult if these don't show up right away.

keep a sx (symptom) journal to track dates and sx's. it may help the dr to see what is going on.

keep us posted.

Thanks very much. I will look these criteria up. I live in the place (a group of Scottish islands) with the highest MS rate in the world. I do therefore trust that my neurologist knows what to look for. But it's good to also know what the small minority of MS sufferers who don't fit the criteria show. I just got print outs of my test results from the neurology tests in January. The CSF results and all results are within normal range as far as I can see apart from the O band screen which has nothing beside it - presumably this was because of the contaminated fluid.

Album, glucose and protein levels were all within normal range and cryoglobulin was negative so not Lyme. He must still be concerned about my symptoms though because he said he was going to speak to my rheumatologist.

Having failed to tolerate (severe reaction) four immunosuppressant drugs for RA now - they will not want to start me on the newer biologic drugs if there's any possibility that I have MS because these can cause or make MS much worse I believe.

Again many thanks.
Mat

Results from January - MRI of brain shows signs of small vessel disease normal for my age 52 (bit depressing that! )

CSF; albumin level 229 (0-380)
CSF: glucose level 3.1 (1.7 -3.9)
CSF: protein level 362 (0-700)

Cerebrospinal fluid level IgG 34 (5-64)
CSF appearance Visible
CSF oligoclonal band screen - (blank space)?

My tap results were partially contaminated by trauma so not sure if this explains the blanks?

Serum cryoglobulin level - normal
EDTA blood -Treponema pallium - Negative
IgG level (blank space)?
Venous blood Borrelia burgdorferi IgG negative

Serum ACE level 37 (8-52)
Plasma glucose level 4.9 (3.7 -5.6)

The neurologist told me a few weeks ago that something in these had flagged up as probably autoimmune or infection but I can't see what this could be from these results. Any ideas anyone?

Presently my white blood cells and lymphocytes are a bit high and so are my liver enzymes but the anaesthetist said this is probably because of the Prednsilone and not a worryto him re my surgery