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Q. Steroid injections did not help shoulder arthritis. Why?

Answered by
Dr. Nagaraj Patil
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 17, 2020

Hello doctor,

I have recurrent inflammatory arthritis with significant pain, tenderness, and restricted ROM on my right shoulder. The ortho gave steroid injections with minimal response. MRI of R shoulder shows AC inflammatory joint arthritis. I also have a TMJ problem with severe headaches. Occipital nerve blocks and epidural injections were given by ortho and tried Mobic with ineffectiveness.

I have a history of gastritis and bowel issues, chronic low back pain when sitting for long hours, walking, and hip joint pains. Tried physiotherapy, but the problem is recurring. I also have upper back pain, severe neck pain, C5 C6 disk herniation, L4-L5 disc protrusion. I am diagnosed with one-fourth leg length indescripancy.

I always have pains and aches. One week of Prednisolone gave relief from severe headaches, condyle remodeling, and TMJ pain in joint and bone. I am feeling tired and fatigue. I tried physiotherapy for the neck and shoulders with minimal relief.

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Hello,

Welcome to icliniq.com.

Based on the information and history provided, you have inflammatory arthritis of multiple joints with neural involvement. I could see that you have the involvement of cartilages as well. Investigations suggest you have positive RF (rheumatic factor). There are a few conditions wherein RF may be elevated. Now, I want to know a few things from your end to suggest accordingly. I have a few conditions in mind but would like to know answers to the below queries before I suggest anything.

Since when do you have these symptoms? Did all symptoms start at once, or is there a pattern (ex, shoulder joint involved first, then lower back, etc.)? Do you experience any dryness in the eyes or mouth (do you have difficulty swallowing or burning eyes)? Do you have rashes anywhere on the body? Any particular patterned rash on the face? Do you have a continuous or intermittent fever (either now or in the past)? Is your urine flow normal? Do you see frothy urine?

Thank you doctor,

I have chronic low back pain and neck pain for the past one year and shoulder pain for the past six months. I used many Ibuprofen over the past years and started going to doctors this year. I tried Ayurvedic treatment and had some relief, but again my pains are back.

My pain started in the low back and neck first and then shoulders. I have severe TMD. No one checked for ESR, and other blood works used to be all good except for mild anemia

I do not experience any dryness in the eyes and mouth, but I have bowel evacuation issues (never constipated) recently and aggravated. I have a hairline rash on the face and neck but more on the right TMJ joint, which is painful. The scalp becomes itchy with rashes and whiteheads. I do not have a fever. My urine flow is normal but sometimes frothy, but I drink a lot of water.

#

Hello,

Welcome back to icliniq.com.

It looks like you have something called autoimmune disease. Most probably systemic lupus erythematosus (SLE) or mixed connective tissue disease (MCTD). They are more common in females of your age and are due to the production of antibodies against the body's own proteins. In these cases, the body's defense system fails to identify its own protein and develops antibodies to fight it, leading to symptoms. Usually, more than autoimmune conditions co-exists (for example, SLE or MCTD, one may have thyroid-related or diabetes-related issues). As these conditions affect the entire body, steroid injections into the joint are not the long term solutions. You may feel better for a few days, but the pain returns once the steroid effect is gone.

With this background, I would suggest you visit a Rheumatologist who specializes in autoimmune conditions. He/she will carry out a detailed physical examination of joints for their extent of involvement, deformity, if any, accumulation of fluid, etc. They will also examine the pattern of rashes you mentioned. Based on findings, he/she may order some investigations (in addition to routine blood checks) look for specific antibodies that give us a clue for the diagnosis. Also, rheumatologists may do an x-ray of the involved joint investigations to look for the liver and kidney's functioning. Once the diagnosis is confirmed based on the above investigations, treatment can be initiated. Note that with the advancement in medicine, we have better medicine nowadays to treat such conditions. Your rheumatologist will decide the one which suits you best. You also need to discuss family planning with him/her if you are married and planning in the near future. He/she will tailor the medications accordingly or suggest appropriately.

No need to be afraid of these fancy terms mentioned, but I thought I should brief you about the possibilities. I am sure your rheumatologist will help you with the best available treatment.

I hope this helps.


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