Ankylosis Spondylitis, Seronegative Arthritis Dismissed In Face of Old Hip Arthritis and Back Pain
Hip Pain and Arthritis, AS and Seronegative Arthropathies
When you have chronic hip pain and back pain, especially degenerative hip arthritis, new similar types of pain complaints may be ignored. Even when it is not in the hip.
Other less common disorders such as seronegative arthritis, are not entertained. Patients often become convinced by the health care system nothing else is wrong. It must be all the same old problem, or worse begin to feel it is all in their heads.
This is because they have become conditioned to follow the path of taking the same old medicine or treatment. Time constraints limiting available time to speak to the doctor is a problem.
This affects quality interaction time necessary to properly diagnosis new problems. Some less than typical degenerative arthritis but still seen often enough conditions are missed.
This includes ankylosising spondyitis (AS), and even psoriatic arthritis. These arthritis conditions, can be missed as the commonly tested for rheumatologic arthritis conditions, like Rheumatoid arthritis or Lupus do not show up on these laboratory tests. This is why they are often referred to as seronegative arthritis or more recently Spondyloarthropathies.
All of this is bad for patients. The current managed health care system is not always easy to navigate or patient friendly. Even doctors going to other doctors have problems, believe it or not.
Hip Pain, Low Back Pain, and Knee Pain
A frequently missed problem is radiating pain. Radiating pain is referred pain to other areas. The hip certainly can radiate or be confusing. Often patients with hip degenerative arthritis, also have degenerative arthritis of the spine. Low back pain is second to the common cold in frequency of complaints. Doctors often just ignore back pain, because it is so common.
More serious back pain may involve nerve root or spinal compression, resulting in radiating or radicular numbness, tingling or pain in nerve root distributions. However, the hip can also radiate down the leg, to the groin, or buttocks often confused as low back pain.
Hip pain can even refer to the knee. Complicating matters is hip and knee degenerative arthritis can be present at the same time. What if however, another problem exists, in addition to degenerative arthritis? This may be totally overlooked. This has been the case with ankylosing spondylitis or psoriatic arthritis without skin lesions. Atypical complaints may be just chalked up to degenerative arthritis, when in fact something else is wrong.
New Hand Pain
New hand symptoms should not be confused with hip pain or back pain, ever. Someone needs to listen to your complaints always. Sometimes you do need to get another opinion. Sometimes even a third opinion. Research is often needed to get you more educated on the medical terms and conditions to better understand what is going on. Being more educated can lead to making truly informed decisions. A doctor telling you what to do is not an informed decision.
When there is new hand pain, a diagnostic work up is needed. Blood work and x-rays are standard. Rheumatologic conditions can be confusing. Not everything is degenerative arthritis, and not every rheumatologic condition is Rheumatoid Arthritis. A family history of ankylosing spondylitis, or AS, is very important. AS is often thought of as just spinal or sacroiliac joint involvement. More recent understanding, has similarities to psoriatic arthritis. Meaning it can be axial or skeletal, and peripheral. Peripheral means in the distal joints, like the hands or feet.
Failure to understand this leads to importer diagnosis. Women often have more peripheral involvement, but men have are frequently seen with both.
What is in addition to old sports injuries or degenerative arthritis, something else is going on? Seronegative arthritis is often overlooked initially because the laboratory blood work can be normal. This is why it is called seronegative, no positive serologic tests. The hallmark for Rheumatologic disorders is positive blood work. The Rheumatoid Factor (RF), ANA or anti-nuclear antibodies, and a host of other lab tests reveal the disorder. Sometimes with seronegative arthritis non-specific labs are elevated and clues to something is amiss.
These may be the sedimentation rate or ESR, the C-reactive protein (CRP) all nonspecific. These two labs can be elevated in infections, or even bad diet and lead to cardiac disease.
Abnormal ESR, CRP and X-rays
Distal hand erosive changes can be seen in seronegative arthritis. Nail changes can also be subtle, and overlooked. When x-ray changes, subtle lab findings like elevated ESR and CRP look closer at the patient. Often the physical examination will reveal other tell tale signs. Asking more questions often leads to further problems. If you don’t look or ask you won’t find it, is very appropriate. This goes back to spending quality time with the patient, and the limitations of managed care. X-rays of the spine, pelvis and hip may reveal further findings of spondylitic changes of the spine, or subtle changes in the pelvis or hip.
Seronegative Arthritis May Propel Degenerative Arthritis
Lastly, seronegative arthritis such as AS, can lead to inflammatory escalation of breakdown of previous degenerative arthritis joints. Quite literally it will attack old sports injuries, trauma sites, or already worn joints. A very important reason to pay close attention.
This is called personalized medicine. Dennis M. Lox, M.D. practices individualized personalized medicine. There is no cookie cutter, one-size-fits-all approach. Everyone deserves this because they are unique individuals.
Dr. Lox believes this is the best way to ensure the best results in quality care.
About Dennis M. Lox, M.D.
Whether you are a professional athlete, weekend warrior, or have arthritis from aging, Dr. Lox can help.
Dennis M. Lox, M.D. is an internationally renown Sports and Regenerative Medicine specialist. Dr. Lox incorporates Regenerative Medicine techniques such as cell science applications, Platelet Rich Plasma (PRP), and Tissue Engineering aspects, to help patients from around the world with a vast array of problems. Dr. Lox is board certified in Physical Medicine and Rehabilitation. Dr. Lox lectures extensively and has edited two PM&R textbooks, the prestigious A State of the Art Review (Star) on Low Back Pain, and Soft Tissue Injuries: Diagnosis and Treatment.
Dennis M. Lox, M.D. maintains an active practice in the Tampa Bay, Florida area, and in Beverly Hills, California.