Don't know if I have arthritis. What should I expect from GP

hippy

My knees have been bothering me for years. Initially it was the right knee and I was in so much pain. I was given an Xray that showed nothing. From this, my GP said I had a meniscal tear. It took many months to get better but it didn't ever get completely better. My GP at the time said it was my age(I was 40)
Anyway, I resigned myself to intermittent pain.
Now, fast forward 5 years, both my knees are giving me gyp but mostly my left. My exercise became extremely limited and I couldn't do anything high impact. Swimming was out as I have a phobia. Combined with this, my ankles and lower back began to get painful every evening. Through the night, my knees are in agony and when I get up in the morning, every single part of me hurts, even my fingers and toes! It wears off but I am left with the pain in my knees.
I went to GP who sent me for physio. I have done the exercises faithfully, every single day. It has absolutely made my legs stronger and my knees less painful. I can go for a decent walk now (although my knees will be in agony later on)
My physio says I am too young to be worrying about wear and tear and my GP says I am not getting any younger! I just want to know why I am still in so much pain post exercise, evenings and mornings. Is that unreasonable? I was hoping for an mri scan that would hopefully give me some answers but GP doesn't seem to see the need? It is like I just have to accept that this is the way things are for me now and no treatment is offered.
Sorry this was so long. I know only a Doctor can diagnose but I was just hoping for some thoughts?
Hippy :-)

stickywicket

Hello Hippy I'm really not sure what you can expect from your GP other than more of the same. I'm usually a champion of physios as they've done me a lot of good over the years. Indeed, it sounds as if yours has been good for you too but the idea of being too young for wear and tear is just plain wrong.

I think all you can do is tell your GP what you've told us. He / she will probably attribute the new aches and pains to greater exercise using unaccustomed muscles and that may well be the case though arthritis can and does spread.

Basically, with OA (I have both RA and OA) it mostly boils down to self-management and you can read all about it here https://www.arthritiscare.org.uk/living-with-arthritis . The GP can prescribe pain relief and / or anti-inflammatories to go with the physio but mostly the rest is up to us until surgery becomes a necessary option.

Some of your pain might be due to using joints and muscles differently and awkwardly and more exercises (for different bits) might help. Can you cycle? That's usually good.

If you're hoping for 'pain-free' your doc's only real option is to prescribe meds and they will only work in a limited way for a limited time. Doing all you can to help yourself will probably help more but, unfortunately, arthritis is that awful guest that just moves in uninvited and makes itself at home. You are not too young but you're doing the right things. I suggest you just ask your GP if there's anything more you can do. If not, keep on taking the tablets. It's not all bad - just different :roll:

hippy

Hi :-)

Thank you for reply. I am kinda hoping that GP can confirm arthritis, or rule it out. I am on medication for another health complaint, that has an uncommon side effect of joint pain. My consultant plays down this side effect but I know of others who have experienced this. It would be helpful for me to know for definite, what is causing the pain.
I am going to stick with the physio though and yes, I do have a bike. I was going to ask my physio what he thinks, the next time I see him. He has advised me not to do too much just now as apparently my left leg is very weak. I do have a stand that can make my bike into a stationery exercise bike. That would be good if I can only do a few minutes at a time.

bubbles

Hi there Hippy.
I can only endorse SW and their sound advice. Maybe your GP or your Physio can ask for a series of x rays, even the most basic of ones, knees, hips, lower back, will show if there is a degeneration of the joints. As SW says, pain relief is more pain dulling. You are obviously doing well with the physio and as much exercise as is comfortable.
I would ask for some supporting evidence, ie x rays, to help in a diagnosis.
Take care - Aidan

hippy

Thanks,

I think I have probably underestimated the effect that my physio could be having on joints/muscles, other than my knees. I have gradually become more and more immobile until I realised it was a problem. I put pain down to lack of exercise. It was only when I decided to walk more that I realised just how hard I was finding it. Now my physio has me working all the muscles from my toes up to my butt and a little bit of lower back. The lower back is really tough. However, I am doing well (I think!) as I have gone from 3xdaily exercises, 5 repetitions of 5 seconds. Now I am doing 8xdaily exercises, 10 x repetitions of 10 seconds. I know it doesn't sound much but I am afraid to overdo it and put myself right back.

stickywicket

It does sound 'much'. It's amazing how exercises eat into the day especially when they can't all be done in one fell swoop. I think you're doing very well but should listen to the physio if he / she says it might be too much.

Clearly everything is complicated by your other condition and what is good for one might be bad for the other. On the other hand you might happilt find that all your exercises are beneficial all round provided you keep an eye on how they are affecting things, which you clearly are doing.

daffy2

It may not be possible to know for sure what is causing the pain. Even if Xrays show OA it doesn't necessarily follow that's causing any or all of the pain. It's one of those things that as humans we can confound the rational scientific medical world with!
As Sticky says what can and does cause pain problems is when bodies get out of kilter structurally and then make adjustments - muscles become unbalanced and pressure is put on other areas. You are fortunate to have a physio who is taking a broader view of your situation, which will help to address such problems. It can be a long process though, as muscles have to unlearn as well as learn, and when they object that can be very painful! Muscles do a good job of supporting the joints and so working on that, although it may not solve the pain problem, will be beneficial long term.
The age thing is a bit of a red herring frankly. Wear and tear isn't only related to age(injury and/or type of work can play a part for instance) and by the same token there is increasingly a view that 'ordinary' OA can be the result of inflammatory processes unrelated to something like RA, and independent of age.
Have you tried heat, or topical pain relief, which can be useful for targeting troublespots?

hippy

Thanks for all the advice, it is helpful :-)

Re pain relief. I use Voltarol gel, it is like an amazing tube of magic! It helps almost immediately but unfortunately it's effect wears off very quickly. I tried a heat patch and a hot water bottle but it made the pain worse. I take ibuprofen but not very regularly. When I first started going to the GP about this, I was on another medication which was not safe to take at the same time as anti inflammatories but I am not on that anymore so I will remind GP about this. I was prescribed co codamol but I didn't find it particularly helpful in the lower dose but the higher dose makes me itch dreadfully, even with an anti histamine.
I have been for two walks today and my knees are ok, so the physio is clearly helping!

daffy2

I have been for two walks today and my knees are ok, so the physio is clearly helping!

That's good to hear and must be encouraging for you.
Re medication - it's worth asking a pharmacist about what might be suitable as it's their job to know about drug interactions and alternatives etc, but yes a good idea to check that your GP is up to date with the situation!
Have you asked your physio about non-drug pain relief?

hileena111

Hi Hippy
Have you been to a pain clinic yet?
The advice I was given there.......a lot didn't help because he was changing meds but they clashed with meds I took for another complaint so there wasn't much he could do there.
He talked about self management and he suggested I go to a group. He said I could go and not go back if I didn't want to or I could go and then go back if I felt like it.
Its self management and is once a month and the person that takes it talks about other ways to ease pain. Like relaxation, distraction things like that. Lasts for 2 hours and I enjoy it. The group gels well together and I get a lot out of it
I would ask if there is anything similar in your area

Love
Hileena

hippy

Hi, no, I haven't seen anyone other than my GP and the physio. I think the GP was hoping that the phsio would be a cure. Unfortunately, while it has helped my knees enormously, I am still living with joint pain that seems to be getting worse. I do however see the GP on the 10th (if I can get an appointI would like it if I was to find out for definite if I do have arthritis or not....because if I don't, I think there is a strong chance the problem is my medication. (I have bipolar mood disorder) Problem there is, my consultant doesn't want to entertain the fact that this med could cause joint problems! I hate when doctors seem to insist that THEIR treatment is ok so the problem must lie elsewhere. For example, I am on a medication for a physical problem, Solfenacin. It stops me having to get up in the night to pee! (TMI sorry!). My consultant (who didn't prescribe this, the GP did) told me all about the negative side effects I might experience on this medication, yet he seems to try to deny any horrid side effects from HIS meds!
Ah well, I will just carry on with the exercises and this reminds me that I haven't done them today! (Although I did walk a good bit!) Better go do them now :-)

stickywicket

Unfortunately, there is no cure for arthritis. If you've got it, you've got it for life. Plus the only 'test' for OA is to check for damage on x-rays. I guess it would be easier for you if your pain was a side effect of other meds buT at least the physio should do no harm whatever the cause.

hippy

stickywicket wrote:

Unfortunately, there is no cure for arthritis. If you've got it, you've got it for life. Plus the only 'test' for OA is to check for damage on x-rays. I guess it would be easier for you if your pain was a side effect of other meds buT at least the physio should do no harm whatever the cause.

Yeah, I know :-( However, you can't fight something until you know what you are fighting. IF I was diagnosed with OA, I could then gear myself towards anything I could do that would help relieve the pain. If there is no indication of OA, then my consultant really needs to look at my medication and help me move to something else. It would be terribly unfair if all this pain was a side effect of meds, that COULD be cured by a simple change of meds. If it isn't that simple, it would just be good to know. I know I need my meds but there are others worth a try.
What is being shown just now though is that physio IS helping but I may need more for other parts of my body.

My GP said the X ray that I had about a year or two ago, showed nothing major but he said that an X ray wouldn't show damage to the cartilage? On the letter he sent to the physio, he wrote "Possible MRI?" From that I am assuming that an MRI was being suggested if physio didn't work.

daffy2

The query MRI might not be to do with whether the physio works or not,but whether the physiotherapist, having got to know more about your joints and muscles, thinks it would be worth doing.As your GP said an Xray can't show cartilage, but an MRI can show the non-bony parts of the body and so provide additional information to the Xray.

hippy

So, I am at least getting an x ray on my knees. I was in absolute agony through the night, last night. I spoke to the GP today and he said that my last xrays were two years ago, I don't even remember having these and apparently they showed up wear and tear (which I don't remember being told!) so it would be a good idea to get them updated. He also said that if my physio isn't satisfied with how things are going, he will ask for an orthopoedics appointment for me.

I have had ibuprofen all today and little difference.

hippy

Thank you,

I don't see GP for another month but I am getting the xray tomorrow. I was speaking to another health professional today and she was asking why I haven't had a blood test for rheumatoid arthritis. I think it is just because the GP is working his way through the possibilities.
I see the physio again on Monday so I will obviously be letting him know what the situation is.

stickywicket

There's not really a 'test for RA' though many people think there is. Here's what ARUK says about diagnosing RA.

“No single test can give a definite diagnosis of rheumatoid arthritis in the early stages of the condition. Doctors have to arrive at a diagnosis based on your symptoms, a physical examination and the results of x-rays, scans and blood tests.

About 4 out of 5 people with rheumatoid arthritis have positive tests for rheumatoid factor, but about 1 in 20 people without rheumatoid arthritis also have positive results. Only about half of all people with rheumatoid arthritis have a positive rheumatoid factor when the disease starts. “
http://www.arthritisresearchuk.org/arthritis-information/conditions/rheumatoid-arthritis/diagnosis.aspx

Complicated or what?