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Suggest Treatment For Recurring Shoulder And Hip Pain

Posted on Wed, 15 Feb 2017

Question: I am dealing with recurring shoulder pain and hip pain. Recently I am having knee pain and stiffness along with right wrist pain and right thumb pain. I am not having positive results for rheumatoid arthritis, but feel I must have inflammatory issues. I am positive for the gene HLA B27. I'd like to be seen at Mayo, but not sure where to start. Thanks.

Answered by Dr. Naval Mendiratta (3 hours later)

Brief Answer:
Is it arthritiS

Detailed Answer:
good evening

Thank you for writing ön health care magic

I have fine through your history and would like. to ask you a few more queries before guiding you further

1. When is the pain in the joints more, on walking OT at rest

2. do you feel. pain in the nights as well which disturbs your sleeo

3. How are the mornings when you wake up.. you feel better or is it worse

4.Any fatigue which has incresed

5. did you notice any swelling in the knees or wrists

Well. it doesn't look related to HLA b 27..we need to figure out if it is inflammation or degeneration

Do let me know these queries and souls guide got further

regards
Dr naval

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Naval Mendiratta (40 minutes later)

My pain and stiffness is definitely worst on waking up in the morning. It does also bother me while sleeping but I do take a sleep aid to help me sleep. My knees are swollen and I have had Bakers Cysts in them, so had a cortisone injection in them also. There is slight swelling in the wrist. The knees hurt when walking longer distances (4-6 blocks). My wrist and thumb hurt most when trying to open a jar. My should hurts most when moving it. Also I have developed pain in my left jaw, noticeble more when chewing. No fatigue, but I had had weight loss of 6-7 lbs.

I have not heard back from my reply of 13 hours ago. Waiting for a response please.

Answered by Dr. Naval Mendiratta (15 hours later)

Brief Answer:
Is it arthritis

Detailed Answer:
Good evening

Sorry for the late reply. Had a long duty today...Just managed to reach home

Well, your symptoms do point towards Generalized Osteoarthritis which has affected your knees, CMC joint( Thumb), shoulders and the back. For some reason, it has progressed early in your case.

Since most of the symptoms are present on activity, it goes against the inflammatory arthritis(Rheumatoid). HLA b 27 does not have typical arthritis distribution as in your case. Moreover it is milder in the ladies. 80 % people may have the gene without developing the disease. So I strongly favor against it

But having said that, examination of your joints is always superior than talking about it theoretically. As of your bloods, none of them favor the inflammation..

TO proceed further, I would like if you could perform the following tests which would help us further in the long run:

1. X Ray knees standing( If already done, kindly attach)
2. Ultrasound of your shoulders and thumb

They will point out what exactly may be wrong here and how we can proceed further

DO let me know for more queries

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (54 minutes later)

The xrays of the knees showed arthritis. An MRI of both shoulders showed no mechanical problems that would involve surgery, so I just received another cortisone injection. My thumb and wrist are recent so I have not seen my doctor about them yet. In addition to all of this, I should mention that I have had injections of cortisone in each of my "sit bones" bursa. I am getting worried that if this is not RA that there is no medication to relieve the pain that i have. I am on Gabapentin at present. Lyrica caused drowsiness even in very low doses. Will cortisone injections keep relieving the pain? I have hydrocodone/apap when I need it, but would rather not take it at all.

Based on above what is my next step? Should I pursue or treat as though inflammation is my problem and try diet and homeopathic remedy?

Answered by Dr. Naval Mendiratta (15 hours later)

Brief Answer:
Osteoarthritis

Detailed Answer:
Good evening

If you could attach a detailed report, it would be helpful as I want to see what sort of arthritis are they pointing at...

2. Cortisone injections are just for temproary relief. The problem will recur back if we dont eliminate the cause...You may benefit for a few months but then it will happen again. Moreoever more than 3 injections in a single joint in 1 year are not recommended...

3. Factors against rheumatoid are the negative markers and you have no relief from painkillers. Although, I would like to see the MRI reports and a clincal examination is a must since we can have Seronegative RA as well( Both RF and Anti CCP negative)

For now I would suggest we give you a trial of Anti inflammatory(Cox 2--> Celecoxib 200 mg twice daily) for few days...I dont want to start oral steroids as it may mask the findings when you visit your rheumatologist which may leave us in confused state. And consult a physiotherapist for regular exercises...

Hope the information was useful

do attach the reports when you get time

Regards
Dr naval

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar