In Pain and Perplexed.

Hi.  I am a 38 year old female.  Have been having pretty consistant and at times intense pain in right hip for quite some time now.  The pain seems to be a deep aching/cramping type pain for the most part.  Sitting for any length of time is uncomfortable.  I find myself trying to "stretch" my hip out in hopes that it will ease the aching.  I am aware of the discomfort constantly.  At times my thigh muscle feels constricted and tight and my big toe on the same side will ache and throb also.  Not sure if there is a connection.  I do have lower back pain also.  I do occasionally have a day or two where the 'pain' is gone.  Also, at various times I have neck pain that is really uncomfortable.  Turning my neck or bending it is painful.  Usually located on the right side also.  This is not nearly as often as the pain in my hip.  Also infrequently I have excruciating pain in my right wrist.  I cannot bend it or put any kind of weight against it as the pain is too intense.  This usually lasts for several days and then goes away as if nothing were ever wrong.  My question...is this indicative of RA?  If not, any suggestions as to what could be causing the problem and where I should start doctorwise.

[Kevin Pho, MD]

RA is usually insidious, with the predominant symptoms being pain, stiffness, and swelling of many joints.  Morning stiffness is a common feature of those with active RA; it has been defined as the following: "slowness or difficulty moving the joints when getting out of bed or after staying in one position too long, which involves both sides of the body and gets better with movement".  

So the description may fit RA, but doesn't have a characterisic story.  I would first fully evaluate the right hip.  Possible causes include arthiritis, sciatica or bursitis.  An orthopedic evaluation and hip MRI would be a comprehensive evaluation to consider.

To test for RA, I would suggest testing for rheuamtoid factor and an ANA (anti-nuclear antibody) level which would be a start to screen for a rheumatological etiology.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Venables.  Clinical features of rheumatoid arthritis.  UptoDate, 2004.

[Pubabubba]

The part about having horrible pain in your wrist and having it last for a day or two sounds a lot like Palindromic Arthritis.  The pain is very intense but when it is gone it is gone and there is no change in the joint until the next episode of pain.