Costochondritis and Sacroiliac joint pain

[Zelda5]

I've finally got a name for the pain in my ribs that has plagued me for at least 20 yrs. I've been through lots of tests ct scan of the appendix, upper GI, 2 Hida scans, ultrasounds of liver and gallbladder etc. I was initially diagnosed with GERD and initially had high hopes that the med's would alleviate the pain, but nope didn't do a thing and my GI Dr. tried different and more expensive acid reducers and even an anti spasmodic that left me feeling like I swallowed a brick. Earlier this year, diagnosed with a fatty liver, but wasnt totally convinced that was the cause of my pain, because felt they would've figured that out sooner after all those other tests. Anyway, after I was told by a new Dr. after losing my primary Dr. (new Dr. referred to me by my Gastro) he finally diagnosed me with Costochondritis after the most painful attack that I've ever had, and after all these years it made the most sense to me than anything else and I'm disgusted it took so long. The pain Dr. had mentioned to me a few months ago that he thought the hip and sacroiliac joint paint were connected and at the time I was skeptical because I was still thinking my pain was because of the fatty liver. Now it all makes sense with the high C-RP and it beginning short time after my back injury that left me in a body cast for 8wks. The cast was applied by residents that contoured the right side around the ribs just a little too much and my ribs (at least you could see them back then), afterwards what had looked different on the right side. I guess this is going to be a lifelong problem. Anybody else have this and how did you alleviate the pain during an attack or flare or whatever it is and did you have an injury that preceded this. Could this be Ankylosing Spondylitis, the new Dr. says that's a disease of males, but it seemed like what I read online is the ratio of male to female is 3:1? Also, they did an xray of my lower back and sacrum and it was normal, not sure where to go from here. Any advice on med's or treatments etc and how far should I push this, just wanting to get some pain relief. Thanks in advance!

[Boozybird]

Hi Jean, what a frustrating experience as well as all the pain! As this new doc came up with this diagnosis has he/she got a treatment plan? I read in the papers recently about a woman with desperate pain who was thought to have breast cancer and referred to an oncologist who diagnosed rib pain due to yoga! Apparently holding the plank for 15 sweaty mins gave her referred pain from ribs! So, my point is they are obviously tricky problems.... If your Crp rate was elevated maybe an inflammatory problem but any smaller joints affected? Maybe a good sports therapist or physio can mobilise the problem rib joint back to health? I guess you're on a new path now - hopefully leaving all the trauma of the past behind... Keep us posted eh? Best wishes

[Zelda5 in reply to Boozybird]

Hi Boozybird,

Don't have any small joint problems, but had plantar fasciitis a couple of times. Other than that, no other joints or other pains that have afflicted me for very long. The only thing new Dr. advised thus far was that if it bothered me again to go ahead and take Mobic for pain which is the exact opposite of what he told me to do the week before when he prescribed the Tramadol, because he said with my stomach issues Mobic would aggravate that more, but Tramadol didn't touch the pain at all, maybe took a slight edge off for a couple of hours at best. the hip pain is worse when I sit too long such as long car rides, but gets better when I'm moving around as long as Im not stooping which makes the whole lower back hurt like a burning pain. Your right it has been a rather tricky problem to get at and I guess in a strange way it's been for a reason, as they have found those other things that probably would have worsened if I hadn't been trying to find this one pain. I will check with Dr. and see if therapy would help. Thank-you!

[brad7]

bilateral sacroiliac joint pain is prime indicator of ankylosing spondylitis , Have you had hlb 27 marker gene to confirm this. This would surely make the pain you seem to indicate,

[earthwitch in reply to brad7]

the only problem with getting an HLAB27 done by GP or primary care is that if it turns out negative, then they may well refuse to refer to rheumatology. I think thats a test best left to the rheumatologist to do as it isn't specific for A.S. (loads of people have it but don't have AS and up to 10 percent of people with AS and a much higher percentage of people with Psoriatic Arthritis don't have it).

[Zelda5 in reply to brad7]

Hi brad7,

It's mostly in the right SI joint, but on occasion I've felt pain in both, not sure though if it wasn't referred pain, because I've felt pain in my groin too. When I'm doing chores around the house when stooping for very long the pain radiates across my lower back like a burning sensation.

[earthwitch]

Yes it definitely could be ankylosing spondylitis, and that would need ruling out. Your doctor is in the dark ages if he thinks it is only a disease of males (as even though males get it more often, there are still an awful lot of us females with it).

Insist on being referred to a rheumatologist for a full assessment, as it is only a rheumatologist who can really diagnose A.S., and its a rheumatologist who will know how to treat it. I would have thought that having your ribs in a cast would have been the worst thing out for costochondritis caused by A.S. as you really need to keep all joints moving to stop them from fusing.

Lower back and SI joint xrays can be normal for a long time with A.S. and again, its only a rheumatologist who can really assess. If you aren't showing damage in the SI joints, they can still give a diagnosis of undifferentiated spondyloarthropathy if they think that is what it is, and still treat you and stop damage from occuring so quickly. A rheumatologist might also request an MRI that may show up the early signs.

The other possibility, that doesn't always show up as much damage on xrays, is one of the other forms of spondyloarthritis like psoriatic arthritis (where you only have to have very minimal psoriasis or psoriatic nail changes to meet criteria for diagnosis), but again, you need to be seeing a rheumatologist. Your high CRP and costochondritis should be enough to argue for a rheumatology referral.

[Zelda5 in reply to earthwitch]

Hi Earthwitch,

You've provided me with lots of good info there. I will push for a Rheumatologist referral again. I asked the previous Dr. to refer me, but he didn't get it done before he parted ways with the Hospital who he had sold his practice to a few years ago. Bet he regrets that now! Anyway, the Drs. that moved into his old practice were signing off on those things that were left and they sent some records to a Rheumy Dr that I had picked, but it was the wrong things and they refused me. Apparently, they sent him records of my thyroid not anything else, and my Doc also had referred me to an Endocrine, which was done before he left, so maybe that's where the lines got crossed. He left two days after my last appointment. I don't think I had Costochondritis before I had the cast, but I think it led to it, although it may have been just a coincidence. All I know, was that I was very miserable that last few weeks especially, due to the fact I gained just a few pds, but it was enough to even restrict my breathing a little, unless I was laying on my back or I was constantly adjusting the cast by pulling it up from the bottom to make more room and it was always rubbing against my rt rib side. It was a couple of years later though when I was in my last trimester of pregnancy when it really started giving me pain and it subsided some after birth, but the pain has remained with me to varying degrees since. I guess Ill just need to convince the new Doc to refer me. Thank-you for the great advice, much appreciated!

[Zelda5]

Hi Reallyfedup,

I wouldn't have put that to being hypo, but now that you mentioned it they finally started me on thyroid med's 50 mcg a day and this is my second day of taking it. My blood pressure is up today it actually woke me up, so I figured it's either that or the med for overactive bladder. I followed up with the surgeon who took out my parathyroid adenoma and he was the one who ordered it, but he started me on 100 mcg a day and this new Dr. cut it down to 50. He said he usually didn't prescribe it until it's over 10, but I asked him if that was the case for someone with Hashi's and he seemed to be more appeased by that. The first time I took the thyroid med. my BP was up that day too., but I didn't think it would kick in that fast. My last TSH was 6 something. Thanks!

[Sandwaves23]

Sounds like you may have psoriatic arthritis/enthesitis. I have the exact same issues plus more, but the main one is si joint/hip/rib area/feet pain. Also have hashimoto's/hypothyroidism and low vitamin D.