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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29783
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a Lupus Diagnosis, but my CRP and ANA titer which were

Customer Question

I have a Lupus Diagnosis, but my CRP and ANA titer which were high 5 yrs ago are normal. I have had Rt Hip pain for 3 years which has gotten progressively worse over time. Where I could walk 300 yds before I would start limping and have hip pain it is now much worse and starting to hurt walking just a few feet. When the pain stops when I stop and then starts again when I start walking and now hurts not only into the hip like a nerve or bone has been pinched but now hurting down the back of my thigh. I have also been having problems with both legs going numb after I standup from sitting off and on over the course of a year or so, Spine doctor did MRI and said 2 herniated disc not bad enough to cause symptoms so he did a Nerve Conduction test which was normal. So he said maybe i have some sacral arthritis. I am 3500 bucks poorer and have NO answer. I am wondering if I have Avascular Necrosis or Bone cancer, strong family history of Ca. My pain is not mild pain it is now very severe when I walk, and I don't know where to go next! Should I go back to the Hip orthopedic doctor again and ask for a HIP MRI? I feel blown off. I need to move quickly because may not have health insur. after Dec this year. I AM a Registered Nurse for 37 yrs, worked in ER, ICU, CCU and never seen this particular problem. It is not associated with any arthritis in my hip per xray. Only a Doctor need answer my question. No offense nurses.
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 2 years ago.

Greetings Donna.

Was a colored doppler study to assess the arteries done?
What did you hip x-ray and MRI show?

Dr. Arun

Customer: replied 2 years ago.

5-6 years ago, before I was diagnosed with Lupus, and RA (but have no joint deformities?) I had begun having severe hip pain and pain into my thigh only at night when I lay down and never when I was walking. It was severe boring pain 9/10 scale, affected one hip and thigh then the opposite. Urgent Care gave a shot of decadron didnt help at all. Lastly the pain stuck with the right hip. The hip pain after many months finally ceased. I had also started having joint pains and swelling. It would come in one joint, lateral non radial aspect of wrist and in a few hours jump to another like the side of the thumb on the other side and had fluid in my elbows which had to be drained, culture neg but did not have gout crystals. CRP 13-18very high, ANA titer was 1300 RA titer high, Antiphospholipids and anti-cardiolypin titers high. After Prednisone courses,Plaquenil, Metho Trexate over 2 yrs, the only thing that helped was Colchine that helped relieved the symptoms. My rheumatologist moved so havent seen one in 2 yrs, but did an ANA titer and CRP at local FMP office and it was now normal last year.


 


Left knee old injury 40yrs ago to anterior cruixate ligament, use to shift laterally OUCh, ended my tennis, and never repaired. Couldnt be done back then. Left knee would swell twice size of right after working the 2nd 12 hr shift in the ER constantly moving. Left ER now have a job that I sit a lot. Pain began right after leaving ER. Saw a Chiropractor 2 visits last yr about the hip, i think he was (not very knowledgeble) said left leg was inch longer than the right. I tried a 1/4 inch orthotic in shoe, did NOT help my hip pain.



Hip Xray normal, no arthritic changes, MRI L2 and L5 hearniation but was not enough to cause my symptoms the Spinal Surgeon stated. Normal Nerve conduction test. He also stated maybe I had some SI joint arthritis and said he could schedule to do a nerve block under flouroscopy?...see if that helped the pain and if it did then burn the nerve. His office hasnt called me to schedule that yet and its been 3 weeks.


 


The hip problem progressively worse over 3 yrs shortening the distance I can walk. Does not hurt when I begin walking, but then starts quickly with a very tired pinching sensation in the hip laterally. then progresses to posterior to the femoral head area. It feels like the femoral head bone is going too deep into the socket and moves out laterally to impinge the muscle and nerves. I take only Vicoprofen twice daily and additional Ibuprofen 400 twice a day. I am not wackie, and put off and put off finding out what this is, but especially the progressive walking limitations, has made me determined now, to find out because I need to walk for exercise! I can't shop at the mall anymore without freq. stops and feel I need a cane.


 


I do smoke, taXXXXX XXXXXtix 4 different times :( Do get pleuritic chest pains and some fibrotic lung changes since I took the Methotrexate yrs ago. Muscle stiffness, more clumpsy that I used to be. Weight 180 and 5'6".


 


Good Suggestion- color dopplar study not done yet.


 


Should I return to the Hip Orthopedic Doctor since the spine was not the problem?


Both legs still go numb,tingly weird sensation at times after driving/sitting not every day, and sometimes several times in one day. The sensation is relieved by stretching and bending forward at the waist. Spine doctor said its not spinal stenosis.


 


Thank you so much for your time and thoughts here. Im sure in your busy day this is just a hobby for you.


 


Please list any other additional test that could be done in addition to a Color Dopplar Study. Does that test check my femoral artery blood flow, or is it specific to the blood flow to the right hip?

Expert:  Dr. Arun Phophalia replied 2 years ago.
Hello Donna,

The colored doppler study would see the blood supply for whole of the lower limb including the hip area (femoral and iliac arteries). Apart from it, an MRI arthrography of the hip would be advised. The other important investigation would be single-photon emission computed tomography (SPECT). I would be suspecting of following;

1) Peripheral arterial disease; causes claudication.
2) Spinal canal stenosis; causes neurological claudication.
3) Mild hip osteoarthritis.

As a medical professional we tend to think and look for a pure diagnosis. Your symptoms can be combination of all the above. Spinal stenosis may be reflected on single-photon emission computed tomography (SPECT) nuclear medicine images as areas of increased activity related to the vertebral body end plates, facet joints, and uncovertebral joints. You may go to your orthopedic surgeon again to discus the spinal issue and hip arthritis (this too may be combination of osteoarthritis, autoimmune arthritis and metabolic arthritis). So your problem is a quite complicated. But after the orthopedic surgeon you would need to seek an appointment with a vascular surgeon who may also consider angiography after the colored doppler study.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

 

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Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29783
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 2 other Health Specialists are ready to help you
Customer: replied 2 years ago.


Just to let you know. I checked my DP pulses in my feet. Usually they are strong and bounding but I had not checked them in a long time. After your comment suggesting it could be vascular I checked my pulses. The right one I was unable to palpate. I went to a Vascular Surgeon and asked for a Color Dopplar study. The tech immediately told me I had 80 percent occluded area near the junction of the aorta in my illiac artery. I had a stent placement the next week with wonderful results!!!! I can now walk, run around my house 5 times without stopping and without pain.


Thank you so much! I tried to leave a nice verbal feedback, but could not find the right link to do so. So this is a note to let you know you were right on target in your suggestion. Thanks again.

Expert:  Dr. Arun Phophalia replied 2 years ago.
Thanks Donna for your update and great feedback. I appreciate taking time for it. I am so happy for you.

Best wishes and kindest regards,

Dr. Arun

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