What Causes Bilateral Hip Pain Along With Pain In Neck And Lower Back?

Posted on Wed, 15 Apr 2015

Question: Hi,

I had an ANA test done almost a year and a half ago which showed homogeneous pattern 1:640 and speckled 1:160 - anti DNA, ENA and all other associated tests negative, however, It was also discovered at this time that i had tested positive to both thyroid antibodies anti-Tg and anti-TPO, however all my TFT's were in range, therefore i wasn't commenced on medication or any other treatment.

I was referred to a rheumatologist who could not make a diagnosis of lupus, it was assumed that the ANA may be elevated due to hashimotos, and my other symptoms were from other causes and not an AI disease.

My symptoms at the time, which continue today include bilateral hip pain, lower back pain, neck pain, frequent headaches, usually always present on waking, feeling "foggy" in the head, constant fatigue, hair loss, weight gain and now difficulty losing weight despite strict diet and intensive exercise (i have always been sporty so i train quite hard).

I have recently had blood work done that now shows an ANA of 1:1280 (homogeneous) and 1:320 (speckled) anti-DNA, ENA's remain normal and negative. My thyroid antibodies remain elevated but all TFT's remain in range.

My symptoms remain, i have noticed recently my pain is worse but i had put that down to starting a new job. I am now waiting to see a rheumatologist again.

I guess my question is what is my most likely scenario? Could this be all thyroid related or could it be more than that?
Also, is an ANA level dangerous? should i be treated for this, even if my rheumatologist cannot make a definitive diagnosis?

Answered by Dr. Shafi Ullah Khan (2 hours later)

Brief Answer:
Lupus with endocrinological manifestation

Detailed Answer:
Thank you for asking

I read your question and i understand your concern. Your presentation is basically the combination of Lupus and Hashimoto. The reason for euthyroid status is because hashimotos primarily dont come hypo in start but with passage of time it goes in to hypo. Increased uptake means its in the start. It needs to be managed.

you qualify the ACR criteria. Hair loss, rheumatological manifestations. positive ANA and anti DS DNA 1:160 titre is considered positive with speckled ANA.

So you need to be managed for Lupus and hashimoto together. Which is corticosteroids, DMARD both biological and non biological ones and low dose hydroxychloroquine. Your uptake increase is a good sign as it indicates a hot nodule and thus innocuous and less likely to be malignant. Regular follow up of the thyroid hormones assays is advised.

It could be just lupus with endocrinological manifestation as thyroid antibodies also come positive with lupus.

Weight loss inability is likely attributed to hormonal reduction. You being hypothyroid but still showing euthyroid due to released thyroid from dying cells due to antibodies attack. It can be a challenge to lose weight with this but right now we have bigger issues to concern about.

Nut shell, Your ANA levels is enough for me to treat you for Lupus. had you been my patient i would have put you on SLE protocol .

I hope it helps. Take good care of yourself and dont forget to close the discussion please.

Regards
Khan

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