Osteoarthritis question

[Clarella]

Im 38 and have had terrible lower back pain for 2.5 years since my son was born. I was eventually diagnosed with spd, hms but things were worsened by c section and wobbling thyroid plus anaemia.

I'm slowly recovering from the symptoms of all of this which was in effect very poorly weak muscles and fatigue.

I've got a great physio and tbh could do more at the mo; I'm on a phased return which has been sucking my energy! But building stamina.

My issue is that I'm still getting bad flares in my lower back. Ovulation and pmt worsens it but it's often very tight and achy in the am, pops and clunks but also crunches a lot.

My ESR blood test was spot on apparently. Is OA still possible without a raised esr? The reason I'd like to know is to inform any future preg but also that my job is very physical.

Obv really the way to manage is through physio which I already have, and pilates which I now do. But I'm feeling that in this case info could be useful as I'm only 38.

TIA

I'm basically trying to work out whether to bother the gp (again)

Bump?

I have osteoarthritis in my back. It doesn't show in blood tests. My back also grinds with movement. Can you push for a scan to diagnose?

Sorry to hear that and thanks for reply. Does it show on scans?

Physio is playing it down and telling me to carry on with physio, but the pain is starting to change actually and get worse. It's affected by ovulation and menstruation too. I know there's nothing can be done other than physio but it could be helpful to know from works' pov as I work with SEN and it can be very physical.

Yes I've just had a scan and it showed dried out/bulging disc L4/L5, which has caused wear and tear on the facet joint, narrowing the space where the nerve comes through. Osteoarthritis.
Where do you get your pains?

Very much si joint, but can be sciatica or whole pelvis aching; sometimes I can't wear certain trousers or even leggings if they put too much pressure on my pelvis.

However - this afternoon it's virtually not there after period has stopped. Still crunchy and stiffen up if sit for too long. So then I question osteoarthritis and blame spd / hypermobility syndrome.

Physio says no disc issues thankfully.

But I guess hms/ spd can lead to arthritis :/

Do you agree with the diagnosis of spd? Physio said it wasn't a disc problem to me aswell!

My back clunks when I'm sitting or twisting slightly.

I thought mine could've been SI joint problems, as the pain is around there aswell, along with bum and leg pain.

I have no idea what to think! I can bend well and easily though area often stiff. But that's due to hms. I've seen a rheum too but other things were going on at the time. I might discuss with gp again; I've never had a scan but it wasn't seen as the primary issue for a long time -it's the one part that isn't recovering.

Does your pain come and go and is it worse at certain times of month?

I'm at risk due to hypothyroidism and hms

They'll never suggest a scan unless something is really wrong. After 8 years of pain, back and forth to the doctors and months of physio I pushed for it. And I'm glad I did as physio were wrong. They say they only scan if a nerve is compressed. But I knew something was wrong.
The pain used to come and go but it got to a point, over a year ago, where the pain was every day and in other areas so I knew it had got worse. All my reflex tests, bending they thought were fine.
Yes sometimes worse at time of the month.
How long have you had physio?

Do the physio say it's hms and spd?

Are you thinking of rheumatoid/inflammatory arthritis rather than osteo arthritis clarella that would affect, potentially, inflammatory markers, but OA doesn't as it's bone related rather than immunise system/inflammatory related. Although it doesn't always show up with RA as there are different types of RA.

It will show on MRI as advanced wear and tear for example on the facet joints on the particular area of the spine that it is affecting. If the pain is sacral area, it could be L5/S1, or it could be the sacroiliac joint itself.

I have arthritis in two levels of my lumbar spine. inflamed and degenerating facet joints, end plate damage, dehydrated discs (prolapsed, dealt with by surgery), inflammation of facet joints has caused stenosis - increased bone growth/osteophytes which narrow the nerve channels from/to the spinal cord exit/entrance - these show up in MRI very clearly.

Your physio is obviously very helpful, but cannot tell you it's not a disc. He can suggest possible other causes, based on your symptoms, but if there is sciatic pain the only way to rule out problematic discs or to investigate possible OA, you need an MRI. You can get one, but you need to hassle your GP relentlessly so they know it is something that needs investigating. What makes your physio so sure it's not a disc?

Thanks Pavlov - sorry to hear of your issues. I assume as inflsmatory markers absent it could only be OA if any. I think it could be the SI joint.

When I saw rheum there was a lot going on - I strangely lost a lot of muscle due to issues with iron and thyroxine plus repeated infections, lack of sleep, Pushing myself for too long and possibly a reaction to sertaline (don't know but lists muscle issues in side effects) I then was over replaced with thyroxine which weakened me more and had rls plus a trest for addisons - which I don't have but am sure didn't help! I was dx with hms plus the other things by rheum.

I had awful issues in all my rib joints and wrists but only tje SI joint crunches and it's the only area not healing / still flaring. They considered fibro but as I was getting better it was discounted. Now I'm not so sure about the SI joint or if mild fibro. A phased return seems to have triggered more issues but could also be as I haven't been as able to do physio.

I have 6 weeks hol (teacher) to hammer the physio and see if it makes a difference.

I guess I'm trying to work out if it's worth bothering the gp. Tbh I tend to struggle on but I'm not so sure it's a good idea - mainly as work would need to know the score. And me.

At times of month and during flares the pain is fibro like from SI joint. My brain is sluggish and my body stiff but eases the second half of day.

The only reason I think not fibro is actually I can feel better after exercise, aside any doms / aching healing muscles, but due to a martial arts background that doesn't really phase me.

If I didn't know about a lot of this I'd be tempted to really hammer the exercise! But praps should anyway! I think this is physios attitude; treating me from a hms pov. It just feels so bloody odd in my lower back these days.

Thanks for thoughts, I think I'll discuss with gp.

You can have inflammatory arthritis or some types of RA, without inflammatory markers showing up in normal bloods - did you have in-depth bloods taken by rheumy? Also markers can be low if not mid-flare or towards the end of a flare, so worth having them taken repeatedly when the flare starts, middle, end, although of course not always possible For example, ankylosing spondylitis can affect mostly the sacral area, but also affect to a lesser (sometimes not a lesser) extend other joints. It can also cause rib pain, and general feeling of unwellness.

You will undoubtedly feel worse at the time of the month, as your womb swells/can become inflamed, and so do other areas around there, so it will put pressure on your sacral area.

I think it's worth returning to your GP to ask for another rheumy referral to rule out AS or other RA type conditions. AS in particular is notorious for being difficult to diagnose, especially in women as the symptoms can be different than in men.

I'm not saying it's what you have, but you do have some of the symptoms, and it sounds like RA of any kind has not been investigated so worth ruling out (and if it is AS or similar, you can work on treatment plans more quickly).

AS website really useful guidance on symptoms and getting diagnosed/ruled out, exercise guidance etc.

and an MRI will help to diagnose or rule out RA as well as OA, in terms of degeneration/fusion of vertebrae in the sacroiliac area etc.

Thank you so much pavlov, I will reply when finished work