Arthritis - testing/diagnosis?

My GP diagnosed me with mild arthritis in my right hip earlier this year - he diagnosed me from an x-ray. I saw my GI last week and we discussed my arthritis. My GI is concerned because my GP never diagnosed specifically what type of arthritis and whether or not it's related to my (still technically undiagnosed, but GI said it's IBD) gut illness. So I'm going back to my GP tomorrow to discuss my options.

For those who have gotten your arthritis specifically diagnosed as to what type of arthritis it is and whether or not it's related to your IBD, how did you go about doing it? My GI said CT or MRI would be a good place to start. I wanted to get others' opinions on this who have been there & done that. What do you guys think? Should I ask for a referral to a specialist or should I just request that my GP order an imaging test? Any other ideas on how to diagnose what type of arthritis I've got?

Hey Cat, good to see you again. I had a bone density test done, way less invasive and was diagnosed with moderate arthritis, but I have knee problems since grade school and that can increase arthritis. Not sure if it is crohns related, but blood work also confirmed it. Not sure if this is your avenue. Hugs

I was diagnosed first with Enteropathic Arthritis and then later AS. Oddly enough the arthritis flares on my left side worse than my right, and the Crohn's is on the left side of my colon, too. I also have tendon damage where the Crohn's attacks right at the base of the joint, in my hips and knees.

I would get a referral to a Rheumatologist-when Crohn's arthritis is involved, it gets out of the G.I.'s league.

There are many other medications that Rheumatologists use to control it and they also look for different things in the bone density scans, x-rays and blood tests. You definitely want a specialist; otherwise the G.I. will just pour prednisone into you, when there are much more effective options.

Arthritis

I suffer from Crohn's and after suffering for nigh on 30 years with joint pain of all descriptions I saw a rheumatologist. As soon as I told her my history and that I had Crohn's she diagnosed me with Ankylosing Spondylitis, a type of arthritis which affects the soft tissue of the spine, as well as other major joints, the sacroileac being the main ones. With the correct medication, exercise and chiropractic I am a hundred times better. AS and Crohn's are connected; they are both auto immune diseases. See a good rheumatologist; the first one I saw gave me a cortisone injection in my foot and said "come back if it's no better". He was useless. The longer you have to wait to get in to see the rheumy, in my opinion, the better, as it means they are in demand and, therefore, good at what they do. I had to wait two months, but it was well worth it. Good luck.

Thanks all! It sounds like asking for a specialist is in order. I go to see my GP in a few hours so I'll ask him at my appointment if he could give me a referral. I'm also going to have to do some reading up on Ankylosing Spondylitis (sp?) because I don't know much about it but it sounds like it's pretty common with IBD and could be the cause of my hip pain.

Pen, glad to see you around the forum again! Hugs to you too!

Jeannette, that's interesting about the attacks being on the left side for you. I haven't been fully diagnosed yet, but the majority of my abdominal pain is in the lower-right, and it's my right hip that has the arthritis. So I'm fitting that pattern too of same-sided abdo and joint pain.

Linda, welcome to the forum and thanks for your response!

Just got back from my GP appointment, and it was interesting. He didn't refer me to a rheumatologist nor book me for any imaging tests. What he did do was refer me to an orthopedic surgeon. Apparently the surgeon will be more knowledgeable about arthritis than a rheumy would. So I've got an appointment for late October to see that surgeon and we'll go from there.

Arthritis

I would be going to another GP!

:ywow: That's jumping the gun quite a bit Cat. The Rheumatologist would know more because they specialize in the autoimmune diseases that attack the joints, such as Rheumatoid, Enteropathic, Plaque and Psoriatic Arthritises. The orthopedic surgeon won't know what's going on; they need a Rheumatologist to have all the tests done and a diagnosis; their job is to correct damage, not prevent it.

Sorry the Medical Transcriptionist in me just came out lol. I don't want to discourage you, just trying to help you get to the right place is all.:thumleft:

Arthritis

I'm with you Mountaingem. It appears the GP is just looking at the sore hip, whereas a rheumatologist will look at the whole picture, and then, refer to an orthopaedic surgeon if considered necessary. The surgeon will only look at the joint in isolation.

Let me share my experience-
My GI sent me to an Orthopedic Surgeon about my hip and knees. The OS was ready to schedule a hip and knee replacement surgeries. He recommended I consult a Rheumatologist first. When I saw her, she took a look at the same test results as my GI and OS, but saw something different. She also checked my ESR rate and WBC count as well; she didn't just rely on the imaging tests.

I had osteoporosis in my hips with hairline fractures from5 years of constant prednisone. She prescribed medication (Zomeda) that was given in an infusion and made the bones heal. Then she examined my knees and could tell the joint was fine (no replacement needed) but the tendons going into the joint had been damaged by Crohn's. She also found the AS in my upper back; no one else bothered to check me for it because being a women it's less common. She gave me Methotrexate injections to start.

I didn't respond as well as she liked, so I decided I was ready for the Remicade. I'm so grateful she had treatment options for me besides surgery.

So there it is, hopefully this is helpful!

Since my teens I had had neck pain and awful headaches. After the birth of my first child at 25 I couldn't walk without excruciating pain in my right hip. My GP said it was a 'touch of arthritis'. Throughout the rest of my 20s my neck stiffened, I had headaches almost every day and my lower back and legs ached. I lived on codeine. Turned 30 started with diahroea and cramps. 13 years later diagnosed with ulcerative colitis, which has since been changed to Crohn's because of the result of a biopsy. Turned 40 and my left shoulder froze and took 18 months of chiropractic and gentle exercise to heal; once it healed my right shoulder did the same thing, another 12 to 18 months. Then I got plantar fasciitis (pain in the foot) as well as neck and hip pain, and decided it was time to see a rheumatologist who gave me a cortisone injection in my foot, which didn't work at all. I then decided to see another rheumatologist, waited 2 months to see her but it was well worth the wait. Once I told her my history of aches and pains and then said the magic word, Crohn's, she had me diagnosed, which she followed up with blood tests. Because of the Crohn's I can't take anti-inflams - tried them and they caused stomach bleeding, so I take Plaquenil and Arava, paracetamol, do lots of walking and swimming and have chiropractic three times a week. That all seems to keep me mobile and usually in relatively little pain. I take Pentasa for the Crohn's which has been in remission for the past 8 years. As I turned 50 I feel better than I have felt since my teens. So there's always hope. You just have to not give up and keep looking for a better answer.

Thanks Jeannette and Linda. I think that I will go see the ortho surgeon and see what he says. If he wants to do surgery or anything like that, I'll immediately go back to my GP and tell him what happened and ask for a referral to a rheumy. My GP is a good doctor, his reasoning for sending me to an ortho was because none of my blood work currently shows anything out of whack. My IBD is in remission so my CRP, ESR, white blood cells etc are all in the normal range. So my GP couldn't see anything in my blood work to tie in to any auto-immune type of arthritis. GP thinks that ortho surgeon will probably just order imaging tests (GP didn't want to do that himself, he wanted someone with more expertise to do it). If the ortho surgeon wants to do surgery, I will definitely walk right on out of there and not look back! All I'm really after is an MRI or possibly a CT scan of my hip. If the ortho surgeon can order that, great - if not, I'll go back to GP and try to get to a rheumy.

My arthritis is mild so I highly doubt the surgeon will try to talk me into surgery of any kind. And like I said, my IBD is in remission, so I doubt that they'd put me on something like remicade or humira either. If I wasn't in remission, then I could see going on one of the biologics to get both things under control, but really my issue now is mild ocassional joint pain (it had been worse, but physical therapy really helped). I think it'll be okay - and if not, I'll get a referral to a rheumy.

My right hip is hurting right now, too. I was told 8 years ago, during my first flare, that I had arthritis in it, probably related to the Crohn's. Once the Crohn's was in remission, the hip pain went away. It's flaring back up now and the hip pain is back. I've never seen a specialist about it. It was diagnosed via an xray, ordered by my GI. I figure if I can get the Crohn's back into remission, the hip pain will go away.

If it's only mild and your responding to physio then the surgeon will prob do nothing but it's worth having his opinion. In the Uk they tend not to do surgery unless the hip's giving way or causing you pain at night, apart from surgery he might offer you a cortizone injection but again if it's only mild it might not be worth it. It would be interesting to hear his opinion about the relationship with IBD so keep us posted on his thoughts.

I am seronegative which means that nothing shows up in my bloodwork either, but I still have AS.

I have a question. So, if they can't diagnose you with Arthritis of any kind. How do you manage the pain in the mean time?

Diagnosis is based on more than blood work. History played a large part in my diagnosis along with the Crohn's. My rheumatologist asked me if I had ever had erythema nodosum which is painful inflamed fatty tissue on the lower parts of one's legs. I remember those painful lumps all too well from when I was a teenager, but the GP then (ie, 30+ years ago) didn't seem to know what they were. My rheumatologist also looked at my finger nails; she also measured the bend in my spine. The artrhrits symptoms began in early to mid twenties which in usually when AS manifests itself. Everything points to AS. She treats me with AS medication, although because of the Crohn's I can't take any anti-inflammatories. For immediate relief of bad pain I take paracetamol with codeine.

Yes, I agree Linda-I too test negative for everything in blood work-except for an elevated white cell count.

My joints become red, hot to the touch, swollen, stiff and extremely painful. My doctor says she can see the arthritis, so I guess it's fortunate that it manifests itself in a way that can be diagnosed.

My doctor prescribes Vicodin and Tramadol, not to be used together, of course! I also take Diclofinac (sp?) which makes me very nauseated, so I take Zofran with it.

My arthritis doesn't manifest itself in redness or swelling and generally not even painful to the touch, with the exception of my right hip which often gives me pain on walking. I get a general ache and stiffness, feel exhausted and I get the chills (ie, mild fever). I just feel like I have influenza, no energy, can't be bothered doing anything. Since I started on an imunosuppressant I have felt a lot better, but if I go off it for any reason (ie, a cold or cough as I need my immune system working to capacity then) then I start to go downhill with the arthritis symptoms. Because of the Crohn's I can't take Diclofenac. I have tried ibuprofen but ended up with the start of a Crohn's flare. I took Celebrex but had stomach bleeding, so am off anti-inflammatories forever.

OK, that helps. I have been hurting hard since June. I started tracking the symptoms because I couldn't ignore it anymore. Every joint hurts, even to breath my chest hurts, My blood work only shows some kind of infection, I don't have a history and there was no sign of swelling or redness. Until just the last three or for days. I did take a picture of my wrists for the record. It seams that when I do finally get in to see the doctor it goes into hiding. I am on Remicade since January, Toradol takes knocks the top of the pain of. Make sure I take it with food, so far no gut pain. I have added Tylenol Arthritis on top of that. I can at least walk, although I am wearing Croc's, can't wear any of my regular flat shoes, forget any heal. Winter is going to be more difficult with the ice on the ground. It is wearing me down and I am constantly medicating myself to keep going. Sounds like from your experiences and pain control methods, that what I am doing is pretty much all that can be done by me. Thanks.

I should also say that apart from medication I also walk for an hour three times a week, swim 20 x 25m laps once or twice a week and I visit my chiropractor three times a week. It's the big picture that keeps me going. I have tried cutting out, or down, on each one and it ends in disaster. I am by no means a fitness freak and I do struggle by the end of my walk but I know that if I don't do the exercise I become a wreck. I find winter hard, but also very hot summer days (high 30Cs to low 40Cs). In the heat my feet seem to just burn. All in all, though, with my regime I am a hundred times better than I was in my undiagnosed 20s.

That gives me hope. I need to clarify that I am on Ketorolac 10 mg, which is half of Toradol, that way I can bump up the Tylenol. The Tylenol 3 (Canadian and US version of paracetamol with codine) didn't touch my pain. That aside, I need to stop being afraid of the pain relievers and use them to get active again. I use to walk a lot, garden a lot, golf, practice Tia Chi. I don't want this to stop me from cross country skiing, snowmobiling I want to go ice fishing, (brrr now I know I am crazy) and I want to start Yoga.

Keeping active is the main ingredient!

I went to the orthopedic surgeon today, and it went better than I expected. He did new x-rays of my hip, and he doesn't feel that I've even got arthritis! Based on where my pain is (it's more to the outside of the hip rather than down in the joint) and both the old and new x-rays, he thinks I've got bursitis instead. My right hip is very slightly different from the left on the x-rays, but he said that could just be natural, that the human body isn't perfectly symmetrical. If I do have arthritis, it's incredibly mild. He said he certainly wasn't going to recommend surgery nor a cortisone shot, which was a relief. He thinks I should do a bit more physical therapy - I had been to PT, but they focused on strengthening the hip and the muscles around it. Ortho thinks I should do more stretching type exercises which should help the bursitis. I'm going to try doing some yoga & stretching on my own as my physical therapist is on maternity leave, and if I'm not doing any better by January when she's back, then I'll go back to her (Ortho doc said he'd be happy to write me a new referral to physical therapy and I should just give him a call if I decide to go back to PT). So, that's that! I'm pretty pleased, glad I probably don't have arthritis and I like the game plan of stretching, that sounds much better than surgery or injections.