Nhs referral question

kazzab456

Hi

Ive had oa in my right hip for the last 6 years and I've been under the care of a hip consultant for about 3 years but I have stiffness and pain in my lower back. Before he referred me my GP mentioned in conversation that there are slight signs of oa where my hip joint touches the spine those were his exact words and he didnt elaborate and I didnt think too much about it at the time I just accepted it. Since then I've changed GPs as my old one wasnt very supportive of my arthritis and my new GP has been fantastic.

Anyway to cut a long story short Ive assumed that in my yearly appointnents with my hip consultant that because he xrays my hip and my spine shows on the xray he would mention to me if there were any problems with my spine.

I've had an mri scan on my neck today for non arthritis reasons but its gotten me thinking as to whether or not I should be asking for a referral to see a back specialist or should I just leave things as they are for now? I have OA in my ac joint and thumb so it something that I'm prone to having.

Sorry for the rambling message.

Karen

helpline_team

Hi Kazzab456,

I’m glad you hear that you now have a supportive GP to help you manage your arthritis and yearly appointments with a hip consultant. It sounds as if you’re in a good position for your arthritis to be consistently monitored and any changes in your condition noted and responded to.

You have asked about the possibility of an x-ray for your upper back (as your lower back is included in your hip x-ray). While only your doctors can give a definitive answer, I can say that x-rays are not always needed either to diagnose or treat arthritis. It is usually best to start from the symptoms you feel or observe. This is because some level of arthritic change is very common in the neck or upper back – for example, it affects approximately 85% people aged over 60 – but some of these people have no awareness of any problem, and others have only mild symptoms of pain or stiffness. Strangely, the level of arthritis detected on an x-ray does not always match the level of pain or stiffness a person feels. Individual differences in general health and fitness and in pain thresholds may be factors here.

I’m not sure, from your post, whether you have ever had physiotherapy for your arthritis, but if not, that would be worth exploring with your GP. Daily physiotherapy exercises are an important part of managing OA for most people. Exercises specifically for the back are also helpful for most people, especially in middle or later years, who want to maintain a strong and flexible back that promotes the health of their spine. These exercises from Arthritis Research UK are some examples: http://www.arthritisresearchuk.org/arthritis-information/exercises-to-manage-pain/back-pain-exercises.aspx.

I hope this response has been helpful. Do call the Helpline (9.30am – 5pm, Monday - Friday) if it would be good to talk things over.

Best wishes,

Rachael (Helplines Team)

daffy2

Hi Karen
I'm not one of the Helplines team, just a forum member but wanted to add a couple of comments as I have some experience of back issues. Something to bear in mind is that, particularly at the level of consultant referrals, the NHS tends not to see the whole person nor even the whole 'system' (such as hip/spine relationship)but just a specific problem - the reason for the referral in effect. If you see a consultant about your hip(s) that will be what is looked at so you can't necessarily assume that any spinal issues in the vicinity will also be assessed.
If you are not having problems with your back at present then I suspect you won't have much luck getting to see a back specialist, at least through the NHS. The presence of OA is not, of itself, reason to investigate, for the reasons Rachael mentions.
I have scoliosis(curvature of the spine, diagnosed nearly 50 years ago) and when, nearly 5 years ago I was diagnosed with severe lumbar osteoporosis, and then later with OA(widespread, including the spine) I thought that getting an assessment would be useful, as did my GP, to monitor changes and help future management. I did eventually manage to achieve this, but it took 18 months, 2 failed referral attempts and the help of the scoliosis charity - because I was viewed by the NHS as 3 separate issues, none of which individually was considered reason to refer to a specialist.
I would second Rachael's suggestion about exploring physiotherapy, or in discussion with your GP other forms of exercise such as yoga or pilates which can help to maintain strength and flexibility to support your spine.