Do I need a biopsy for a chronic hip and leg pain diagnosis?

Question

Hi doctor,

I am a 49-year-old female who has had chronic health problems for a while. Originally, I was told I had lupus, but now I am beginning to think it is something else. Nine months back, I consulted an orthopedic surgeon due to suspected necrosis in my left hip. After an arthrogram was done, it revealed I had severe bone marrow inflammation in my SI joint and was referred for a diagnosis of ankylosing spondylitis, which brings me to now. I have severe hip and leg pain, it aches constantly, severe fatigue and itching, bad headaches, and migraines.

I just feel like crap, and I am not getting any better. I am on Plaquenil 200 mg daily, Duloxetine 60 mg, Dexamethasone as needed, usually three days a month, Oxycodone 30 mg as needed, and Imitrex as needed. Not sure how to post a copy of my lab, but my RBC is 5.3 million cells/mcL, my MCH is low 26.9 pg/cell, and my hematocrit is 44.2 %. My hs-CRP is high at 6.6 mg/L, and calcium and protein are both borderline high. My ALT and bilirubin are also high. My UA shows high for ketones, WBC, leukocyte, esters, and hyaline cast.

I tested negative on the HLA-B27 DNA test. My sed rate was borderline high at 19 mm/hr, and I was negative for Sjogren's antibody as well as Sm and Sm/RNP antibodies. At this point, I am not sure what is going on. Should I push for a bone marrow biopsy to rule out a possible MPN? I desperately want answers as to why I am in such pain and ill health.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have checked your blood tests (attachment removed to protect patient identity) and read your complaints about your health. Apparently, you have rheumatic disease. It does not seem to be lupus or rheumatoid arthritis at first sight, according to the laboratory reports. In the MRI (magnetic resonance imaging of the hip, it actually seems to be better than the last time. I saw that you may have a urinary tract infection, according to the urinalysis values you provided. Do you have a burning sensation during urination?

You should follow up with a rheumatologist to further characterize your pain. Regarding pruritus, there are some tests that should be done. A sonogram of your liver and some laboratory reports as well to rule out hepatic disease, blood disorders, parasitic infections in your bowels, etc. You should also get an MRI of your brain and cervical spine for a better understanding of your headache.

Revert in case of queries or doubts.

Regards.