I am a 44-year-old male. I have left hip pain for two and half months. Left hip pain started gradually two and a half months back, while doing repetitive hip hyper flexing exercises, jogging, and stretching exercises. Initially, the pain is present on the back of the hip, while doing exercises and along with leg cramps. After some time, leg cramps disappeared, and pain is localized to hip (C-shaped area around hip) and when severe radiating to lateral aspect of thigh up to knee. Pain is initially cramping and lately throbbing poking in nature and less than 5/10 and intermittent. Recently pain has increased sometimes reaches to 8/10 especially at night. Pain is partially relieved with pillow support under thigh and analgesics. From four to five days it is not relieved by any support and not able to find the position of ease, supine position on bed. It awakes me from sleep sometimes. I am getting a lot of pain in my hip while getting in and out of the car and wearing my pants. Pain is also felt while working in sitting position in front of the computer desk. One week back my right ankle was swollen suddenly, without injury and unable to bear weight on that leg. The swelling and pain of right ankle decreased in three to four days with analgesics.
Past history: No pain in the hip before. Mild hypercholesterolemia (Lipitor 10mg). No DM, not a known hypertensive. Endoscopic sinus surgery for sinusitis. For occupation INH testing positive, IGRA positive. Used INR for two months and stopped on the advice of primary care provider for muscle cramps. Later started on B6 vitamin.
Medications: Ibuprofen 200 mg for a few days followed by Naproxen for one week, Cyclobenzaprine for few days. Stopped because of sedation and local analgesic ointment. Only gave partial relief gave one intramuscular steroid shot and Toradol shot.
Personal history: not a smoker, not an alcoholic.
Family history: Mother has OA of knee, psoriasis on finger joints (flare ups sometimes), no DM, no HTN. Father: OA, HTN, DM+.
Physical Examination: No restriction of hip joint movements, but pain on flexion, adduction and internal rotations and flexion abduction and external rotation. Mild tenderness at the left trochanteric area and hip joint. Power :5/5 in all groups of muscles. No distal neurovascular deficit.
Labs: primary care provider at university hospital did CMP for muscle cramps. Basic arthritis profile and CBC with differential.
Imaging: MRI hip without contrast.
Welcome to icliniq.com.
There seems to be arthritis going on. The MRI report shows (attachment removed to protect patient identity) an effusion of the hip joint, and as you explain, the ankle also swelled up once.
The blood reports seem normal, except for mildly elevated WBC (white blood cells) counts. In light of the above information, I would correlate this with your psoriasis. Sometimes people with psoriasis can develop arthritis with the involvement of joints with pain and swelling.
I would also suggest that you get yourself tested for HLA B27 by the PCR method. This may sometimes be positive in people with psoriatic arthritis.
In such a scenario, disease-modifying drugs like Sulfasalazine or biological medication like anti-TNF are sometimes prescribed.
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Thank you doctor,
I am skeptical about psoriatic arthritis as I do not have any silvery scales or rash on my fingers or scalp. Only my mother has a mild psoriatic rash on hands, which is present sometimes on her fingers cracks. When we took her to a dermatologist, he diagnosed it as psoriasis. Recently, I came to know that my sister had elbow pain her doctor attributed it to psoriasis. Do you think it is related to psoriasis?
One of the primary care physicians mentioned that my uric acid levels are in the high range and could be related to gout and asked me to repeat the uric acid. He also mentioned that psoriatic arthritis of the hip joint is very rare, and he never saw in his 15 years service. Is psoriasis ruling out disease? I heard that there is no diagnostic test for it. I am suffering from this hip pain a lot. Before the onset of this pain, I used to run for one to five miles every day. Now I am housebound and could walk for little distance and could not bend my hip and put any strain on it. At night time, I have to keep my leg in a supine position only with a pillow beneath my knee (mild flexion of the hip). The pain is not letting me rotate in any direction.
I am looking forward to hearing from you soon.
Welcome to icliniq.com.
I agree with you that hip effusion may be a rare manifestation. However, psoriasis can affect any joint. Arthritis may not always correlate with the intensity of skin psoriasis. There are no antibodies in this disease.
The other ways to further investigate are to check genes like HLA- B27. Uric acid is commonly elevated in gout as also in psoriasis. Other modalities available to further characterize the disease are to aspirate the hip joint and analyze the fluid to check whether this is inflammatory fluid, the presence of crystals, etc.
The MRI that you have got done has only scanned the hip joint. Ideally, the sacroiliac joints should also be scanned to check for any silent sacroiliitis, which further helps with the diagnosis. We try to give the most probable diagnosis however, a differential diagnosis may always be there.
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