Lower back and hip pain and stiffness. Is this RA?

help. I have had lower back problems in the past but this time it feels very different. It is incredibly stiff and the pain and stiffness is sort of spread from the spine in both directions to the top of my hips. But I have been doing reading around and apparently lower back pain is unlikely to be RA? I am not sure why? What do you all think? Has anyone else experienced anything similar? Sally x

12 Replies

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  • Hello Sally,

    I am sorry you are struggling so much. I think I am right in thinking that RA tends not to affect the back or the hips (although other types of inflammatory arthritis can do). But I wonder if what you are experiencing could be referred pain? I know from my own experience that when I am walking badly, I do get a significant amount of referred pain in my hips and back. I have had RA for many years now but I do remember having pain in my hips in the early stages and worrying that the RA was affecting them. But the rheumatologist explained to me about referred pain caused by the fact that I was not walking well because of inflammation in my feet and knees. He was completely right, because once the inflammation was under better control, my hip pain disappeared completely and only comes back when I am not walking properly again. I do think it would be worth mentioning it to your rheumatology team though because they may well be able to refer you for physio to see if that helps any. I really hope it eases soon Sally.

    Tillyx

  • Hey Tilly,

    Great reply as always however you get RA in any joint and that most definitely includes hips

    Hope you are managing to have a comfortable day

    Katie

  • Thanks Katie and sorry for giving duff info lol.

    I wasn't really sure so before I replied I looked at info on the Arthritis Research UK website which shows a diagram of "frequently affected joints" which doesn't include either the spine or the hips. But when I looked again, just now, there is a comment saying that "less commonly affected are elbows, hips and the neck". And there I was thinking I knew all about RA after 18 years of the wretched disease lol.

    Sorry if I misled anyone.

    Tillyx

  • Hey Tilly,

    I get things wrong too and am sorry if I sounded sharp- truly did not mean to. None of us can know everything and that is why this site is so important because when we share experiences with RA suddenly you have a whole load of information at our finger tips, plus the added benefit of new friends

    Katie x

  • Hi Katie

    Thanks - and please don't apologise - I was just embarrassed for giving duff info cos I am always so careful to check before posting if I'm unsure about something. Hey ho. I agree completely though how important sites like this are - and I really wish sites like this had been around when I was in the early stages of RA many years ago.

    Thanks again though Katie.

    Tillyx

  • Lower back pain is far more likely to be spondyloarthritis, which is a different form of seronegative inflammatory arthritis. Its really important to get the right diagnosis, because the treatment pathway is slightly different for spondy than for RA, as the inflammation is in slightly different places (enthesitis rather than synovitis for example, where the entheses are the areas where tendon and muscle join onto bone).

    Here is a poster for ankylosing spondylitis (one of the main forms of spondyloarthritis, with Psoriatic arthritis and enteropathic arthritis being others) - nass.co.uk/campaigning/have...

    If you google "inflammatory back pain" you will get more information too.

    It does seem that rheumatologists in the UK are far more reluctant to diagnose spondyloarthritis than in other countries. Its quite important that it does get identified early, but its not anywhere near as easy to diagnose as RA as its seronegative (i.e. won't show up positive blood tests for disease markers), often doesn't even show positive blood inflammatory markers, and you only see it on xray when it has got to the point of damage after it has been left untreated for a number of years. A good rheumatologist will pick up the signs early, but it does take a spondyloarthritis specialist generally (which many rheumatologists aren't) to make a firm diagnosis before it gets to the damage point. Treatment really should be started before you get damage. A lot of folk do seem to get wrongly diagnosed initially as either fibromyalgia (as the fibro tender points are in very similar places to spondy enthesitis points) or as seronegative RA. If you have significant back pain that responds to NSAIDs or to steroids, or you fit the criteria for "inflammatory back pain" then you really should be asking your GP or rheumatologist whether they are considering spondyloarthritis, and if not, why not.

  • My hips and lower back sometimes give me more trouble these days than other parts more commonly associated with RA. I have been told by a physio and a rheumatologist that this is most likely to be degeneration / wear and tear/ osteoarthritis than anything inflammatory. Tilda

  • I o uffer hip an back pain,,this is due to arthritus in both hips and osteo-arthritis in spine,,have jus been diagnosed with RA in hands knees and feet,,oh lucky me, have been put on Sulfasalazine for he RA,and been stopped from taking the diclofenic tablets,,so RA has improved but hip and spine pain returned,,so no win win there

  • Thanks everyone. I think the best thing I can do is raise it when I next see rheumy. Lots to think about. Thank you all for answering. It does help having others to seek opinions from!

  • I had lots of flares in my hips before the drugs brought it under control. I continue to suffer with persistent stiffness and aching in them. The rheumatologist has never suggested that this is anything other than the RA, eg osteo. My spine is fine - I had physio and she did lots to correct my posture.

    Hope that helps,

    Dotty x

  • I forgot to say that I did observe, and have mentioned to rheumy that my hips have stiffened up considerably each time I've come off or lowered MTX which makes me think its inflammatory/ RA related. But how they decide its RA or OA without scanning or

    x-raying I don't really know. X

  • Usually having a good response to steroids or NSAIDs is an indication that pain is inflammatory rather than mechanical or degenerative. I say "usually" because some folk can get some relief from NSAIDs for osteoarthritis, but if its inflammatory pain, then you would expect a much more dramatic relief, especially from steroids. In spondyloarthritis one of the diagnostic criteria is that you get significant relief from full therapeutic doses of NSAIDs (or steroids) within 24-48 hours, and that the pain returns within 24-48 hours of stopping the NSAIDs.

    If you do think there is any suggestion that your pain is inflammatory when the doctor is saying its osteo or DDD, ask some really strong questions about how they would confirm that and make sure you tell them whether you get relief from NSAIDs or steroids (or any other anti-inflammatory treatment). If you do have inflammatory spinal pain (in addition to your RA), then its important that it gets identified properly, because if it is spondyloarthritis the treatment pathway and the exercise and physio recommendations are slightly different for it.

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