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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can intense pain in the back and hip be due to a relapse of rheumatoid arthritis?

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Dr. Saddiq Ulabidin

General & Family Physician

Practicing since :2011

Answered : 1929 Questions

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Posted on Tue, 31 Jul 2018 in Lupus
Question: I have RA which has been in remission. The usual symptoms of RA are hand, wrist, knee and foot pain. I do not have these. 5 nights ago I awoke with intense pain centralized to my right hip. Since then it has progressed into pain in my right back as well as my hip with radiant nerve pain in my right arm, occasionally. The pain seems to be intensifying in back at the hip area. I have been taking 2 Advil every 5 to 6 hours which wears off by hour 4 or so. Last night I took the methotrexate and Humira, thinking that this may be RA related. However, have had a terrible night in pain with Advil not helping. My fear is that this may be referrent pain to something else, like an ovarian cyst or appendix, although when I push down on my belly, I just feel discomfort in my back and hip.
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Answered by Dr. Saddiq Ulabidin 2 hours later
Brief Answer:
May need fresh anticcp levels and Xray hip and lumbar spine

Detailed Answer:
Hi! Welcome to Healthcaremagic. Thanks for sharing your concerns with us. We will try to help you in best way possible. First of all it's sad to know what you had been going through lately.

Based on the history you have shared, it can be a relapse or flare of RA as it can involve sacroiliac joint and may present the way you have been experiencing though since using immunosuppressive treatment for RA may increase chances of underlying infection so possibility of underlying soft tissue infections like psoas abcess should also be ruled out.

X-ray Hip joint as well as lumbar spine should be done to start with and if needed CT scan of pelvis and lumbar spine may also be needed.

For RA control, fresh anticcp levels should be repeated to monitor disease activity and repeat follow up with rheumatologist should be sought for optimization of disease modifying anti rheumatoid drugs. Meanwhile OTC analgesics like acetaminophen or Ibuprofen as you already on should be continued.

For more severe pains potent analgesics like tramadol, or gabapentin may also be needed. CT will rule out other possibilities like related to pelvic viscera as you suspected to be among possibilities.

Supplements for calcium, D3 and bisphonates should be continued alongwith anti rheumatoid drugs.

Wishing you a speedy recovery. Hope this has answered your query. If you have any questions please feel free to ask. Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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