What is this pain from?

[Lizbethann]

Hi,  I have had Adult onset Stills Disease for 15 years.  For the last 6 months or so my lower back/hip areas have been hurting quite bad.  

The main symptoms on most days are pain/stiffness in bottom of buttock, side of buttock/hip area.  Gradually this lessens during the first few hours of my day and I am left with a mild pain and stiffness in the area.  At night if I have sat down or laid down for a while the area is very very stiff and some pain.

At its worst it was a huge pain and problem to lean forward or go up stairs although that is getting better.  At it's worst the very upper back and side part of my thighs hurt tremendously as well.  

If I up my anti-inflammatories for a week (my Dr. says it is okay to do sometimes) the pain gets much more bearable and easy to deal with for about 2 weeks and then gradually comes back.

Any help is greatly appreciated.

[Kevin Pho, MD]

I would consider some imaging studies to further evaluate for a musculoskeletal cause of the discomfort - a lower back and hip MRI would be reasonable at this time.  

Anti-inflammatories are reasonable.  Other options would include trigger point injections into the lower back musculature as well as steroid injections in the hip and sacroiliac joints.  Of course, this would depend on what is found on the MRI results.

Another option would be physical therapy.  

These options should be discussed with your personal physician, or in conjunction with an orthopedic referral.  

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.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Lizbethann]

Thank you for the response,  I do wonder one thing though,  with the pattern of being worse in the morning,getting better with movement and responding to anti-flammatories-  does this sound arthritic?

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[Parsec]

Hi lizbethan12:

Pain in morning that relents can be due to ankylosing spondylitis (AS).  The most effective treatment for this disease is antibiotics plus total starch exclusion ("The New IBS Low-Starch Diet by Carol Sinclair with foreword by Professor Alan Ebringer; amazon UK).

The antigen test would be useful (HLA B27), and a nuclear bone scan is best to show inflammation (X-rays of SIJs are the gold standard for AS, but fusion takes much longer in women than men), and mris do not image inflammation very well in cases of sacroiliitis.  Many have elevated sed rate (ESR).

If you take NSAIDs, AS can worsen because it is caused by one of the most common bowel germs (Klebsiella pneumoniae) and NSAIDs increase intestinal permeability.  In fact anything which attacks the intestinal tract can cause or exacerbate AS:  Ross River virus, candidiasis, shigellosis, giardiasis (which also has its own arthritogenic factors), salmonellosis, hep B vaccination, chlamydia (Reiter's is usually caused by this, but this evolves into AS within two years), and E. coli (Delhi belly), candidiasis, etc.  Another possible connection is with LECTINS or allergy-induced permeability (gluten/casein) in cases of sprue (celiac disease); a common cause of psoriatic arthritis that is excluded as AS.

Good luck to You,
John

[Purple Passion]

I am 46 years old.  I was diagnosed with fibromyalgia and chronic fatigue syndrone six years ago.  I have a pineal cyst on my brain, mitral valve prolaspe, irritable bowel syndrome.  The last six months I have been having more mobility problems than ever.  I have extreme muscle/joint pain, I cry myself to sleep many nights from the pain.  Is there something other than what I have listed that may be causing this pain?  My quality of life is almost null at this point.  Please help shed some light on this.