Undiagnosed Hip Knee Pain only when Stationary

[jointpain1967]

I am a 41yo Female with severe dibilitating pain in my hips and knees and now my toes. I have seen 5 doctors and all they do is give me pain killers.

The only thing that sticks out in my mind as a possible clue is that the severe pain comes only after I have been in one position for an extended period of time. Then when I start moving around, the pain is released. I also have pain in my muscles between these areas which could be a separate issue. I will sometimes get a throbbing pulsating sensation in my toe joints.

The pain will wake me up at night so I have to move to relieve the pain but it is unbearable and returns after a few minutes in one position. The other clue is that in the morning when I first get out of bed, I can barely walk. I look like an 80 year old, then after a few minutes I am fine. Also the level of pain is getting increasingly worse and I am worried I might end up in a wheelchair.

I am told that it is just arthritis and fibromyalgia but these symptoms are strange and the pain is worse than anyone I know with arthritis.

[Tom Plamondon PA-C]

Hello,
Thank you for writing in to Doctors Lounge.

You have reported hip, knee and ankle/foot pain which is worse in the morning and after stationary positions. Activity improves the pain. Also, the muscles between the joints hurt. You are taking morphine for pain and have been diagnosed with arthritis. You are wondering if the pain can be from something else. History also includes osteopenia.

From what you have described, it sure sounds like arthritis. Different types of arthritis include osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis, gout, arthritis assoc with inflammatory bowel disease, infectious arthritis (usually only one joint).

OA affects the knees, hips, back and hands whereas RA affects smaller joints of the hands and feet. Because the treatment for RA and OA are different, it would be important to screen for RA. Labs would includes CBC, rheumatoid factor, anti-CCP, sed rate, CRP and xray of painfull joints (feet).
Xray's of the hips and knees would also help define osteoarthritis.

A referral to the rheumatologist may help as he may differentiate the type of arthritis and consider other treatment options (disease modifying anti-rheumatic drugs aka DMARDS ...for RA; NSAIDS or acetaminophen; exercise).

Keep us posted and take care.