Osteoarthritis At age 22?

Thank you for your response.

At what age were you diagnosed with OA? 

I did look through "Problems diagnosed as Osteoarthritis CAN be cured in some cases" but i could not find a person younger than 25 with this problem. 

Thank you

Hi,

I am 42. I was diagnosed with hip OA and a mild case of dysplasia, which means that my hip sockets are shallow. It is a result of degenerative joint development before birth. I've been a runner, mountain biker, rock climber during my adult life which I am suer helped me to keep my joints healthy. I found the cause of my current symptoms in the sources I recommended. 

I am sure that it is not a question of age, it is the duration of the intensive use of the joint in misalignment.

A good physiotherapist can analyze your muscle situation but also refer you to a specialist in case it's necessary.

" if not OA, and any form of inflammatory arthritis has been ruled out, then could be muscle imbalance;"

Hi,what I found is that muscle imbalance can cause OA or any form of inflammatory arthritis. 

Besides dealing with the pain and the arthritis you need to address the muscle imbalance to solve the primary cause of your symptoms.

A good PT can help a lot. 

Thank you for your response. 

I'm actually in New York. I have seen an orthopedist and he told me that he is not sure about what this could be but that my cartilage seem thin.

What other doctors do you recommend me seeing ? 

Hi

Step 1: do you know your blood results / have they done thorough blood tests. Are these all negative for inflammatory arthritis of any type?

Step 2: if yes to above have you seen an immunologist who does more extensive blood tests?

I truly think it's very unlikely indeed to be OA but need more information to help you. Some of the best stuff is coming out of John Hopkins on this subject. Have you had any significant childhood illnesses? Where exactly does it hurt?

Thank for your reply.

Yes my blood tests came out negative. I have not seen a immunologist but I will do. I did not have any significant childhood illness. This is beasically the first major problem that has happened to my health.

Theres a strong pain in the front of my hip when i stand up. Its right in front. I feel it inside. When im sitting, theres coming and going mild pain when im sitting and this started recently like 3 weeks ago.

Thank you for your help.

Ok this sounds even less like OA. Typically OA hip is on the inside in groin. Typically but not always but if you run, more likely to be tendonitis / inflammation. This needs specific treatment normally ice rest NSAIDs physical therapy. This is more likely given your MRI gave them the idea you'd get better.

Next step is to get another MRI. You need to correct this as you will now unwittingly be walking differently and that might well stress the joint and give you OA. Sounds like the original othopaedic guy was correct but that the treatment was not good enough or that you were overusing it or not committed enough - tendonitis things take ages to get better and generally need more rest and ice than people want to give them. .... Go back to the orthopod and ask to compare the two Mri'd and get a better physio and don't overuse until healed as you'd be doing more damage. Sounds like flexor tendon damaged to me which is then causing other issues with surrounding muscle and maybe joint. Fairly sure you have not got a correct diagnosis here so you need a better opinion...MRI will tell you if tendon issue.

I did get two mri including an arthogram. The second one (January 2016) showed that it got worse than the first one (July 2015). The second doctor also said that it may be tendonitis but in the prescription for the teraphy he described it as OA.

I want to see if im understanding you. What youre saying is that i should stop the exercises ?

He did give me diclofenac sod. I taked them for 3 weeks but after i stopped the pain came back.

Thank you. I will actually see the rheumatologist next Thursday to ask him exactly why he thinks it OA.

I forgot to mention that i also have sometimes lower back pains, i don't know if it has anything to do with it. You also mention pain in the groin, and i just touched that area and i felt pain right at the bone. I will take your advise and put ice three times a day.

Do you have knowledge looking at MRIs? I can actually send you mind if you could take a look at it.

Somethings like these shows on the report:

Bone marrow adema of the interior aspect of the left acetabular roof which appears increased compared to the last mri.

There is thinning of the articular cartilage bilaterally and osteophytes of the femoral heads and superlateral acetabulum.

The previously seen bone marrow adema of the inferior aspect of the left femoral head is no longer seen.

No definite superior labral tear is seen.

Question of left anterior labral tear.

This is most of the information that is on the report.

Hi,

Ok...you have now given much more relevant information. Let us assume that a good radiologist wrote this report and it relates to you (worth checking). If this report is accurate you are in a space which is right at the leading edge of medical knowledge and is not fully understood. Odema can be related to the bone or to the bone marrow. It is basically fluid in the bone, I. E some form of inflammation. It is important to distinguish if it's marrow or bone. This is typically seen in the knee after an all tear and the reason why is not understood properly. Also seen in hip and pelvis. Only discovered 30years ago. Most often in athletes. Now there are theories on this -all Unknown- that it is a precursor to bone necrosis (death of bone due to poor blood supply to it), or OA or something called bmes (bone marrow oedema syndrome) or to do with injury and micro fractures that don't show up on X-rays. Numerous things could be diagnosed at this stage. 80%of odemas self heal within a year. It is slightly different to primary arthritis as typically it is a bone issue.

However osteophytes have grown on critical surfaces which indicate it is not self resolving. This is generally bad news.

Now here's the thing... You are young and assuming this is on one side they will want to rule out a few things here as it is quite rare if you have provided all correct facts. They will need to treat you and this depends on finding out why you have this issue. If it is related to sport e.g. More common in marathon runners and no underlying systemic issue you will probably be referred back to an orthopod - John Hopkins is absolutely a global leader in this field. Ask them. Write to them. Treatment varies depending on what else is going on but might include arthroscopy, stem cells or strong drugs to control underlying infection. You have only mentioned one side so I think they will now do more tests.

Don't accept a simple OA diagnosis. The rheumatologist said this due to osteophytes but in this case more going on. You need to work out the cause of the persistent odema. This really is at the very forefront of medical research and lots of clinical trials. Ask to be referred to John Hopkins due to your age.

This is quite serious so don't ignore but make sure you get an absolutely expert orthopaedic surgeon on your case.

They may give you calcium - another thing which presents with this is transient ostropotosis - which goes in time, you really need to insist they get to the bottom of what's causing the odema. If the rheumatologist says it is a bi product of OA, simply state that the medical journals in the last 12months don't suggest this is the case. You need to get to a Rheims and orthopod in s major teaching hospital for this as they will be much more knowledgeable about research being done now. Most rheumatologist a are clinicians not operating at the forefront of medical research. Ask to be put in touch with an orthopod in a major teaching hospital who also has experience of stem cell treatments. Preferably John Hopkins or the top place in New York. They will be interested in you due to your age and will help you.

This all sounds a bit scary but don't be scared but you do now need to turn your fear into determination to get top notch treatment as quite rare so really need the best.

The other thing is that diet is likely to be a treatment. Go anti inflammatory asap. Make sure you eat tons of fruit and veg - I mean lots e.g. 7 or 8 a day inc green ones to get right bits and minerals to help the underlying root issue here. They may recommend calcium sups also.

Don't give up ...action and determination to get ok again are crucial now at this stage. Knowledge is important now as right at edge of a normal rheumatologist a knowledge and they will probably just spout guidelines at you. Ask them to help you find the latest, say you are happy to be a Guinea pig, ask them to refer you due to your age to the best teaching research hospital near you or to John Hopkins. The rheumatologist will do so if you are nice and are prepared to really be determined about it. Forget the depression... Easier said than done I know... But determination to get to the right guy who can treat you and who will treat you is required here.

There are numerous treatments but these all depend on the diagnosis of the underlying condition and that is not standard primary OA. Your bone odema and age says something else is happening but it is not common so next step is to get to a guy working at forefront of new treatments in major top teaching hospital as rheumatologist can only treat your symptoms. You need an expert -really expert - orthopod to tell you your options . If it was me I'd also be volunteering for new stuff as long as it was in s top 10 hospital as a log of treatments for this are not yet mainstream or widely available.

Remember: determination and don't give up - that will make the difference to you. You will beat this but you are going to have to have your mind in the place that says I'm gonna find the best guy in the best place and it will be ok.

I hope this helps. If you want to research it go to google scholar and type in things like hip odema but only bother to look at papers in last 5 years. See which hospitals in New York are writing the research papers and get to one of them is a good bet.

I do think i had an injury while doing a squat at the gym probably two years ago. I don't remember exactly how but i do remember one day not doing it correctly. I probably put too much weight and didn't do it correctly.

Im sorry to put you in a doctors position, but right now what do you think i should do? Should i rest and keep taking inflammatories or keep doing hip exercises ?

I will write to and asked to be referred to John Hopkins but that will probably take sometime.

I bought over the counter a numbered of vitamin including calcium, omega 3, vitamin E, vitamine D.

You are really helping me on this problem and i really appreciate that. I try to keep myself positive and not be depressed by this but it is hard knowing i might have OA. Would having Edema might mean a better news than having OA? Or do i already have both? I read a few times your reply. I apologize if I misunderstood anything.

Thank you again for your help.

That is a tricky question. The edema is not good news but in young sportsmen normally resolves. But yours has not. The edema could be caused by a number of factors some not so serious, others more serious. So it is essential to have a detailed discussion with your rheumatologist on the causes of the edema.  No-one on this board will be able to help you on that one because detailed knowledge is needed across the blood tests, xray and mri.  Could be numerous conditions so you definitely need to go back to rheumatologist on that one as soon as possible.   My gut feel and it is only gut feel not knowledge is that whatever caused the edema has caused the joint to be stressed and has damaged it. For this you need at your age to be referred to the best possible surgeon for an opinion as they may be able to treat you with the latest stem cell stuff  - which is still in its infancy but could save your joint entirely or with joint compression or similar, depending on how much cartilege is lost. However, lot of crooks out there so hence the advice to go to a top teaching hospital which is doing research.   However, a top orthopedic surgeon has a range of options if the joint is damaged depending on e.g. if the joint has micro fractures not visible of x-ray, whether there is a further underlying condition causing the edema or if the edema is temporary and will heal.  Any good surgeon woudl only operate as a last resort but they may have a view on e.g. if you have a tendon tear, if there is debris in the joint etc etc, if there is underlying issue etc etc. 

Look, no point in worrying as you now need to know MUCH more from a) the rheumatologist - it is simply not good enough he has told you OA - there is an underlying issue here with the edema and b) a really good surgeon for an opinion.  I think its quite important you see someone quickly as some conditions have a window of opportunity for treatment that is then lost.  This may all sound scary but its not life threatening; but could get more painful so you do need to get action and be determined.

​Clearly the joint is currently inflamed. Therefore, i would try and control the inflammation by a) diet b) ask the rheumy exactly what supplements you need a.s.a.p.  You cannot go wrong eating tons of fruit and veg and fish - which shoudl negate the need for supplements but they may give you calcium depending on certain underlying conditions.  I personally would only do pilates type non stressful exercises to keep the joint mobile until you have a better handle on what is causing the edema and why it is not clearing and why the joint is so stressed. 

The squat could have caused a ligament or tendon issue which then unbalanced the joint which has then worn on one side. IF this is the case, fundamental at your age to ask to be referred to a top orthopaedic surgeon in a teaching hospital who may consider you for stem cell treatment to repair it / or some other orthopaedic procedure.  This is quite important as all of this stuff is really new but if the cartilege wears away completely you are not in a good place. So be determined, take action, take control, ask lots more questions of the rheumatologist and dont be satisfied with simply 'OA', take pain killers.   This may soound a bit scary but things to ask your rheumy are things like

​"what is causing the edema.. do i have necrosis of the hip?" "Do i have transient osteoporosis?" " Can i be referred as a trial, given my age, to JH, as i understand they are doing stem cell transplants on hips"... i suggest this so he takes you seriously and that you are going to be a pain in neck to him and thus he will want to refer you on to a teaching hospital. Say stuff like " I know this is at the forefront of medical knowledge and i am scared. But i dont want the standard guidelines of NSAIDs at my age. i know the top teaching hospitals are running clinical trials and they may save my hip joint.. can you get me referred..."

​It truly depends on what is the underlying issue... if hip necrosis then the blood supply to the hip joint is an issue and e.g. JH might treat this with decompression but you need to get action quite quickly before it gets too damaged. But it might not be necrosis. How bad it is depends on the edema and what is causing it.

My gut feel from what you have said is that an injury damaged the bone which in turn damaged the joint rather than the other way round. Neither are great news but it is likely to be this one joint - you just need to get to the bottom of the edema and then get the best possible teaching hospital on the case. I think if you nag or write they will be interested in you due to your age.   Most doctors get bored with seeing e.g. 60 year old women all with the same issue. You are interesting to them and slightly unusual thus nag your rheumy to refer you on ASAP, as you will be of interest and i think they will want to see you as you will increase their learning curve. A good teaching hospital will be able to treat you to delay further treatment for many years if you act quickly.   i.e. your results are serious due to your age but not life threatening but try and get non-standard treatment at forefront of current practice rather than standard guideline stuff.  Simply not good enough the rheumatologist has said OA. Does not sound like primary OA to me - the edema is significant in this regard.  Something is damaging the bone and it is not resolving.

​Suggest you google John Hopkins Hip Stem Cells - a load of papers will come up. Write to JH ASAP. It is no 1 globally but you are interesting to them. They are running a trial at the moment. Ask them for help due to your age. Dont despair but you DO need to get into action mode.  You do need a teaching hospital so ask your rheumy to refer you onwards. If in NY, also dont depair as every top rheumy is following what JH are doing. Get on the JH mailing list - from their web sites - as this will enable you to see their clinical trials and you can write to be on one. i get their stuff sent every week.

​I am a researcher and collate as much as possible from round the world for 3 top guys in the field over here so they can access easily. A top guy in NY would know what the top guys in JH are doing and be following it.

the only other tip i can give you is "​Dont have conversations with your brain. dont talk to it. SImply have one conversation with the chatter box in your brain and that is " shut up, its going to be ok, i am on the case to get the right and best treatment now and thats that. i'm gonna write down a plan of action and then im going to get 8 hours sleep, wake up eat lots of fruit fish and veg and get on the case of getting a referral to the right guy. in the meantime, i just have to get through today and as i got through yesterday, i expect i can get through today. So whilst i am concerned i am not going to worry as that will only release more cortisol to make it worse. I am now on the case, so brain stop worrying me. "  

​hope this helps. Part of the action plan should be to go and buy some good veggie cook books so you dont get bored eating all those vitamins + writing to JH for advice + getting their stuff sent to you + seeing your rheumy ASAP + getting some sleep + getting some pilates / low stress non-weight bearing exercises which keep your hip mobile whilst not stressing it at all. Go for it! Action requried!

the other thing from your MRI is that it stated te inferior aspect of the left femoral head is no longer seen... i.e. the bone has healed here.But it has not healed on the lect acetabular roof (google to see where this is).  They are questioning a tear in the labrum. This protects the joint and normally if torn, the surgeon will repair this and remove the osteophytes at the same time in a young athletic male. This is quite a 'good' procedure. So a good orthopod surgeon would review the mri and try and work out the cause of the edema and woudl attempt to ascertain if he should intervene on a labral tear  - it this is torn, it will ultiamtely damage the joint, so they tend to repair them.   Hence, why you need to get to the bottom of it quickly. 

http://health.ucsd.edu/specialties/surgery/ortho/areas-expertise/sports-medicine/conditions/hip/Pages/labral-tears.aspx

will give you an idea IF this is what the issue is.  You need a good orthopod ASAP.  

hi the other thing would be if you have a labral tear - i have sent you web address and its waiting to be moderated... if you have a labral tear  then the orthopaedic surgeon is likely to mend it at your age with minimally invasive surgery and remove the osteophytes to stop the joint becoming arthritic.  The radiologist was looking for this and was uncertain on the MRI.   Some of the edema had in fact healed but the bit round the pelvis had not so again the orthpod would look at what was causing this and try and get it to heal.  The one glimmer of hope - which i guess is what you are looking for is that one of the edema locations had healed since last time but the other had got worse so dont sit and hope for the best...

​you need a good orthopod ASAP who will check in more detail to find a labral tear.  You can look them up on google in young sportsmen.  The edema is the thing you need to get to the bottom of ....

 

I will ask my rheumatologist for information this Thursday when i see him. I was reading about stem cells on the john Hopkins hospital website. It says they are staring test on mice later this year. I will write them a letter to make myself as a volunteer but, do you think the edema could grow even more by the time i get to have the stem cells injected? or even if i get them injected. I will see if i can find an orthopedic surgeon in a bigger hospital in New York.

About the window of opportunity, i don't want to be negative, but it's been two years since I started feeling it. It started as a really small pain and a year later it's when it started bigger that I had to get checked. I hope i have not missed that window of opportunity yet. I do feel after my two physical therapies that it has gotten way worse now. I will take your advice and rest for now since I do not know exactly what is going on. The therapist told me that the exercises is for strengthening the muscles. But I really don't see it getting better.

Right now I’m coping this with hope that it might get better. It is hard to imagine myself on this position. This has shocked me. I totally did not think it was that serious until I searched it like three weeks ago. I was also thinking that I’m still 22, and technically men stop growing at the age of 25 so basically I can three more years to grow cartilage. I'm not sure if it works that way. Just a thought.

With regards to the labral tear, it says on the report "No definite superior labral tear is seen. On the sagittal images, there is a question of an anterior labral tear with contrast extending between the anterior labrum and the tip of the labrum."

Let me also write what's left on the report that I probably did not write before.

There is a mild scoliosis of the mid lumbar spine convex to the left.

On this examination, there is no definite bony protuberance of the anterior aspect of the left femoral head neck junction to suggest the CAM type femoral acetabular impingement.

You have really given me the knowledge for my doctor's appointment this Thursday and I really thank you for that. I wish I would of known this a year ago when I was way better than now, but it's never too late. I hope.

Hi

Edemas at your age do naturally get better and one has healed itself. This should give you a little hope that with the right treatment the other will. Jh have been doing stem cell stuff for a couple of years; in uk several 000 people now been treated too. The thing on mice is slightly different. The fact they cannot rule out a labral test is significant which is why you need an exceptional orthopod. You have a mild curvature of the spine to the left which is mild but could have caused the imbalance in your hip on that side..again you need a good orthopod. The deems is like a bone bruise which isn't healing well. The physio is trying to build muscle to take pressure off the joint but you have this edema bruise so if that's weight bearing might not be helping but you do need that muscle to be balanced hence Pilates or yoga builds the muscle without undue stress on the joint. The joint has responded by growing osteophytes as its under pressure.. These can cause labral tears which is what they are checking for. The scoliosis might be caused by eg one leg being longer than the other or a few other causes but as you have released more data to us then slightly less worrying than to start with! Does not sound so much like a necrosis now which is probably good. Truly an excellent orthopod will help you. In terms of exercise treat it as a bad bruise - say you had a really bad one on your arm you'd still use the arm but you wouldn't lie on it or pressure the bruise. Hence Pilates yoga are good options as they allow you to keep muscle mass whilst allowing healing. You will need some treatment though. They will or may try to correct a mild scoliosis at your age which is possibly the underlying cause of the hip joint being stressed. None of this is easy as it takes a while and concerted effort over a longer period of time to correct underlying biomechanics. Teaching hospital orthopod top notch is what you need. Don't give up till you find one-they will be able to help you.

Hi again I just googled top orthopaedic surgeons in New York and there is a site called backers that comes up. This has top 59 recommended by healthcare leaders. You now need to research each one of these people individually. What you are looking for is someone aged in their 40's (still learning but with lots of experience), expert on scoliosis and hips but more importantly has written a few papers on subject trying new stuff or analysing it as this means they are really into it, will analyse your individual situation and will likely help you and if they can't will know someone who can . See which you feel you like the look of and ask your they my to refer you to them

I feel more relieve than I was a few days again. Now I know that I might not have OA (yet). I have my appointment for the doctor this Thursday. I will ask all the appropriate questions as you have helped me. Depending on what he says I will look for a good orthopedic.

I see that my back is not completely straight when I’m sitting or walking.

I did a hip imbalance test by laying down and looking at my feet. I got unexpected results. My left leg (the bad one) is more to the left than the right one. Meaning that the right one (the good leg) is more congested or tighter than the left. I think that means since I have been doing more stretches on the left leg, it might have loosen up more than the right. I could be completely wrong however.

 I do have quite a bit of work since my finals are in two weeks, but after that I’ll write a proper letter to a top hospital or university in this field.

Again, thank you for your help. I will keep you informed on what happens this Thursday. 

Hi

Ask for a gait analysis

If a leg goes more in one direction than the other could be trendleberh which needs specific physical therapy to correct, sometimes an orthotic in shoe as well. Again an orthopod could see this - might be caused by the scoliosis turning it which has then stressed the joint too much

They normally make you walk or run on a treadmill with infra red buttons down your spine and legs and feet so they can see where you are putting pressure. Whatever u do don't use orthotics from anyone other than the orthopaedic surgeon as rest likely to harm you.

The osteophytes are a sign of OA but in your case may be treatable if you have an issue with your labrum

Nothing will happen in two weeks so concentrate on your finals then get into gear to sort the underlying issues of scoliosis and edema and what is the root cause. A delay of a couple of weeks won't harm

Give up alcohol and drink water as alcohol dehydrating to the cartilage. U need tons of antioxidants -greens fruit and veg

Good luck with the finals

Ok there is bad news.

On the mri my rheumatologist showed me that i have Osteoarthritis on both hips but that its worse on the left and thats the reason i only feel it on the left for now.

He said theres nothing he can do and that i should see an orthopedic. He also said that hes seen these cases on young people before. The mri says: Osteoarthritis changes of both hips. Somehow i did not see this before but its there on the mri report.

And i believe this is right. Ive been feeling something weird on my right hip. A really mild pain not working. Maybe the starting of it. I also feel sometimes pain in my lower back.

So now what?

My insurance (Fidelis NY) only limit me to an specific amount of Orthopedics. Its listed on their website so i basically cant choose whichever i want.

My rheumatologist said that he does not know about stem cell injections.

On the worst case scenario that i find another orthopedists and he says he cant do anything other than surgery, what should i do next?

I know i have the option of sending a letter to St Hopkins but that could take months.

I have the options of physical therapy but its not working.

I was reading through the post: "Problems diagnosed as Osteoarthritis CAN be cured in some cases" but i did not find something specific that helped her other than exercises.

This is really scary. The fear of not being able to walk in 5 or 10 years and be with this pain everyday.

Add another action point

​1. Research which hospitals in NY are running trials on stem cells. (wont need insurance).

​ByW you will be able to walk in 5 to 10 years and even in 20.