OA?

Posted , 6 users are following.

Hello all,

I'm 39 and I've had worsening hip pain for over 5 months now. Blood tests showed high ESR, which has now settled. I have a raised rhematic marker and also the rhematic anti body. The pain is all around my hips, groin and lower back. It's worse if I walk or move a lot and at night - I can no longer sleep on my back for example. The pain varies from dull/burning to sharp, which sometimes travels down my legs. It's on both sides.

My grandmother had severe RA.

The next stage in my assessment is an ultra-sound of my hips.

I have some questions if I may. Does my story sound like anyone else's? I know it's a fairly short time to present OA does this likely rule it out? Has anyone been diagnosed via ultrasound?

Thank you so much for any advice or help.

Warm wishes,

K

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  • Posted

    Hello I have had osteoarthritis for 20 years, I have only been diagnosed by x-ray, I had my ESR raised a little while ago, I have it low back left hip groin right wrist thumb joint, left shoulder and forearm, at the moment I have it really painfull and when I lay on my back it feels like I have a growth on left side flank, but they say it's all to do with the nerves being affected. My lower back is off the scale at moment and it affects my lower abdomen. I hope you are getting some pain relief..

    lyn

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  • Posted

    How long have you had the pain?  At this stage, due to your family history and to the raised rheumatic markers + your age, i would be asking your rheumatologist why they believe you shoudl not be on DMARDS or Biologics.  I state this not to firghten you but becuase there is a window of opportunity in RA where the disease can be put into remission early on.   Thus time is of the essence in ruling out RA. Your symptoms are more akin to RA than OA, as described. Do not delay in getting a rheumatologist to see you quickly.  TYpically ultrasound is not used to determine or diagnose OA.  Can i ask are you female and has the pain started after a child was born?

     

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    • Posted

      Hi Sparkle. Thanks for replying to me. I've had the pain since December. I was very ill - my GP believes I had proper flu. I didn't get better in general and also the hip pain began from there. The first and second lot of blood tests showed climbing ESR and on the third lot of bloods (late March) he included the rhematic screening, which flagged up. At that point he referred me to a rheumatologist via BUPA. Via the rheumatologist I've had more extensive blood tests (again showing the rhematic marker and also the rhematic antibody). The consultant thinks the chances of RA are low because I'm not presenting with hand/feet. I believe he's suggested the ultrasound to check the joints but also the soft tissue etc.

      I do indeed have children but not recently. Both pregnancies, births and post-births were fine and I had no hip issues nor indeed any other issues (for which I am very grateful).

      The pain some days can be near debilitating and I can find it hard to walk at all, especially on the days where we have been out or very active with the children. I work four days a week and they are the easiest as I sit at a desk and therefore not physically active much at all. On Saturdays and Sunday's however I'm in pain all day and it gets worse as the day goes on. Sleeping is hard and a couple of times I've got up in the morning unable to pop my socks on (which I always do first thing). I've always been fit and well and I'm finding this all very hard to deal with. I don't smoke or drink and I used to exercise often before the children and I had no spare time. The rheumatologist did try a cortisone injection but only in to the soft tissue and it had no effect.

      Thank you for any kind advice x

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    • Posted

      Hi, I am going to be a little bit blunt here, but purely to help you...

      ​1. If it was just OA of the hip, it would show on an x-ray which you have alrady had. In addition your rheumatoid factor would not show up and your ESR would likely be normal also.  Most OA also starts on one side and your age plus these other indicators makes OA unlikely.  2. If RA, your rheumatoid factor would be positive, which it is and the first flare woudl have a raised ESR, which you do have. I cant see the results of your other blood tests so difficult to see but if this was me, knowing what i do, i would quite urgently ask for a 2nd opinion from a rheumy in a teaching hospital. Where do you live?  The reason i state this is that if it is RA, there is a window of opportunity of about 20 weeks where early interventaion can reverse the disease completely. This needs strong drugs to do so. After this window of opportunity is missed, then you would have life-long. However, it will not be like your grandma. In the last 5 years biologic drugs have revolutionised the treatment of RA. However if this was me, i woudl do EVERYTHING POSSIBLE NOW to make sure - if i did have RA you are still in the window of opportunity where these drugs NOW might heal it or put it into remission. This window of opportunity is only a few weeks so you need to take action on the chance it really is RA. Personally, i would get an urgent 2nd opinion from a rheumatologist from a teaching hospital. Where do you live?  At least you would then have done everything you could.  3) As you are on BUPA, I'd forget the ultrasound and ask to be referred for an MRI urgently.  This will tell the consultant way more than the ultrasound - unless there is some contra-indicator that means you cannot have one.  Nothing is as good as an mri.  4) Eileen is right in that it might be reactive arthritis following flu, where the joints are being attacked but again early intervention woudl help this. But more difficult to diagnose - but your rheumatoid factor being positive is not a normal clinical sign of this. It is very unlikely to be Polymyalgia Rheumatica as you do not have the clinical signs of this and your rheumy would have easily been able to diagnose this.

      ​I am sorry to be so bunt bu ttruly i mean to help you - time for action - you need to see a consultant rheumatologist in a teaching hospital urgently as it might make a huge difference to your life going forwards IF you do have RA. Early treatment is vital. You are still in that window of opportunity. You will be out of it shortly. Rule it out absolutely.   The fact your rheumatoid factor was raised and your ESR was raised are key signs. If you are on BUPA no reason you cannot have an ultrasound or MRI within a week privately.  I would urge you to do so.   If you feel uncomfy doing this, go back to your rheumatologist or email him and ask why he believes you do not have RA given your Rheumatoid is positive and your esr was raised. POint out you know about this wondow of opportunity where early use of biologics put he disease into permanent remission or cure. Ask why he woudl not be doing this.  If he whitters on about he wants to be sure or whatever, ask why you cant have an MRI this week.  A really good rheumy finds it relatively easy to diagnose RA and take action urgently.  Your signs are not those of OA so unless there are other tests etc which we dont know about, that indicate otherwise, then i woudl assume the worst and absolutely ensure you are utterly satisifed you do not have RA, given this window of opportunity. I would urge you to not delay in finding out as at the moment it may be curable.

       

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    • Posted

      Can I just mention that being rheumatoid factor positive or negative is only one bit of a jigsaw. You can be positive and perfectly healthy and be negative and still have what is called sero-negative RA.

      And many people with PMR present with just hip and lower back symptoms at first - it is atypical but possible. Though there being no response to a steroid shot in soft tissue does make it unlikely.

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    • Posted

      Hi,

      ​I am amazed that you have been given a steroid shot at this stage which does not endear me to the rheumy. Also, he has clearly not given you detail you need to understand your results.  I would not be so strong about you getting a 2nd opinion urgently were it not for the fact that this window of opportunity exists. IF it is RA, then you truly woudl want to know and be on treatment now as the first few weeks make huge difference.  So you really MUST rule that out due to this window of time. Action called for urgently to make sure it isnt RA. The signs are not currently good - Rheumatoid antibodies, raised ESR, bilateral, your age, your grandma. For all of these reasons, it looks like RA and lets hope it is not. But IF it is, then you need to know urgently as you may stop it in the first few weeks. Ignroe the fear and find out.  If it isn't then you will have a while to work out what it is and what to do as less critical. For RA, timing is everything.  You have nothing to lose and everythign to gain from getting another opinion - ask to see someone specifically. To find out who, look for your nearest teaching hospital and then find the consultant in RA.  If it isnt RA, he will then refer you to another colleague.  You have absolutely nothing to lose in doing this. I would do it ASAP.  If you need help finding someone, tell us where you live and we will see if we can help further.  Eileen may be right - but truly, get a 2nd opinion from a RA specialist urgently as might make a huge difference to your life. Step 1 is to rule out RA absolutely within the critical time frame.  So feel the fear, ignore it and take action.  You can be relieved if it is NOT that way. If it IS, then you are lucky and will have caught early enough to treat and probably cure or send to long remission. Once ruled out, i am sure Eileen and other will help you and offer support - these boards are great - but dont delay on this issue as time is of the essence in this particular case

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  • Posted

    Although you are rather on the young side - if your rheumy doesn't think this is RA and doesn't find good evidence for that, I would suggest there might be a possibility of something called polymyalgia rheumatica (PMR). In about 80% of cases there is a raised ESR - which is actually quite uncommon in OA and the symptoms also match - the rheumatoid antibodies are not significant because there is no item that distinguishes between them. However, although it isn't true, many rheumies think it only happens in over-50s. Another possibility may be myofascial pain syndrome or hip bursitis - both common alongside PMR.

    Another option could be something called reactive arthritis - you develop it in response to an infection which does fit with your history of a "virus" and the symptoms starting.

    However - the ultrasound of the hips should show up any inflammation there and, I think, other lower spinal problems because it does sound as if your sciatic nerves are being irritated for some reason or another. You have my sympathy - it HURTS!

    Good luck.

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  • Posted

    Thanks both for your advice and insight. I appreciate it very much.

    Sparkle - I haven't had any X-rays yet or MRI. The ultrasound will be the first scan, so to speak.

    I will certainly look into what you are highlighting re the window of opportunity for early intervention. The ultrasound is only a few days away so I'll get that done and then see what it shows. I'll also look more into RA than OA and PMR. Eileen - my rhemy dismissed PMR exactly because of my age but I'm open minded and keeping it in mind.

    Thank you again for all your help.

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