From the reports, please let me know the disease I am suffering from.

Hello,

Welcome to icliniq.com.

You are very young and should not be having the kind of hip pains that you have described. I have also gone through your reports (attachment removed to protect patient identity), which you have sent and there are some points that we have to concentrate on and discuss with you. First of all, I need to see your MRI images, which you have not sent as only the report is attached. Secondly, your ESR and CRP levels (erythrocyte sedimentation rate and C-reactive protein, respectively) are high along with HLA-B27 being positive. Also, your Mantoux test is also positive. As far as I am concerned, this tilts the discussion more in favor of ankylosing spondylitis (AS), which is an inflammatory pathology rather than tuberculosis. Because, both hips are involved, which is unlikely to be a clinical picture of TB. Also, your MRI has been reported to be having a likely infective pathology. So in my opinion, you should get your MRI looked up by some other radiologist. Also, please tell me the answers to a few questions, and on the basis of which I will be able to understand your issue better. Do you feel stiff when you get up in the morning? Apart from hips, do you also feel lower back involvement with a progressive decrease in spine movements, etc? Is there any associated difficulty in breathing, etc? Since you had an intermittent period in which you felt better with anti-inflammatory medications and intensive physical therapy, this again goes in favor of it being an inflammatory issue. Looking at your clinical picture and test reports attached, it looks like early onset of AS although I would like to personally examine you clinically before making a conclusive statement. If it is ankylosing spondylitis, then there is definitely a genetic predisposition to it. So, there is no permanent cure. But, intensive physical therapy along with medications will help you in maintaining mobility and avoiding progressively increasing stiffness. So, all inflammatory diseases have painful periods followed by periods in which the patient does not have any pain, which is a natural course of the disease. To make you understand everything better, I need to see your MRI images and doctor's prescription. Also, let me know about the management done to date and any associated history of fever, night sweating, weight loss, loss of appetite, etc.

Hello,

Welcome back to icliniq.com.

I have gone through your reports (attachment removed to protect patient identity) and there is definitely some effusion in both your hip joints indicative of some inflammatory process going on. Also, the two different blood test reports are quite contrasting. So, I will advise you for ESR, CRP, and HLA-B27 levels and if you want can get a TB Quantiferon test. But, please get it from a good laboratory, which we can rely upon and preferably get them done on an empty stomach. Your present joint pains may not be related to your profession as we are contemplating an inflammatory etiology for the same, although your activity levels and mobility may keep you fit. Not all genetic conditions have to manifest from birth. I have said that there is a genetic predisposition for AS, which we test by getting HLA-B27 levels done. But normally, AS starts to manifest in young boys from about this age group only. Lastly, as I had clearly written, if you are having AS, then there will be periods of intense pain and stiffness and other times pain-free intervals. It is a characteristic of most inflammatory joint diseases. You cannot do much of that in terms of modification of any particular activity, but intensive physical therapy, adequate calcium and vitamin D intake, and anti-inflammatory medication on an SOS basis are the management of choice. Other medications including a group called DMARDs (disease-modifying antirheumatic drugs) and biological therapy can be given after consultation with a rheumatologist as they require close monitoring. Again, I feel strongly that this should be an inflammatory and not an infective process, but your blood reports should confirm it. If there is a doubt, then a synovial biopsy can be taken from the more painful hip.