I've been suffering with unexplained right hip pain since July 2010. It started in 2009 but only lasted no more than a day. Then one morning in july, I woke up with this pain and it got so bad I couldn't walk, sit, stand etc.

I went into Accident & Emergancy and I got Referred to the orthopaedic outpatients clinic. I've had ultrasounds, X - Rays, God knows how many blood tests, 4 MRI scans (2 with a special dye).

My Blood tests how a rise and fall in my CRP Markers (which indicate inflammation but doesn't pin point where). No doctor at my local hospital has managed to find a cause for this and I am now being sent to a speicalist in London to have a small operation to insert a camera into my hip and have a look around and take a biopsy of the hip fluid.

I have been taking Tramadol for the pain and my doctor also prescribed me Meloxicam (an anti inflammation drug). I am always in pain and it's getting to the point where the Tramadol isn't as effective as it was when I first started taking it.

I use crutches to get around everywhere, but manage to hobble around in my home because it's such a small house everything is close at hand. I used to be active with my husband (walking cycling etc) but these activities cause me even more pain.

Has any one got any idea what would cause my inflammation markers to rise and fall so much and what could be causing this pain.

It's starting to get my husband and me very down because we can't do the things we used to be able to do. Sometimes I am in that much pain I have to take 400mg Tramadol over one day and I find that I have to stay in bed and not move as any movement causes more pain.

Please help me.
Thanks in advance
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replied May 29th, 2011
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Amy,

There are several of the rheumatological disorders that have intermittent inflammation. Rheumatoid arthritis and the crystal arthropathies often present this way. unfortunately, there are so many inflammatory diseases and new ones are being added all the time.

So, it sounds like you intermittently develop inflammation, and as such, your C-reactive protein (CRP) goes up. As you stated, this is a very sensitive test, but not specific. It is better than the erythrocyte sedimentation rate (ESR), because the CRP goes up quickly and goes down as the inflammation goes down. The ESR tends to stay elevated for a long time after the inflammation has subsided.

Unfortunately, there are actually very few of these disorders that have any test specifically for them. Hopefully, the biopsy will help to delineate your problem. Just don't get discouraged if the biopsy comes back with only acute and chronic inflammatory changes. With the hip arthroscopy, they will also be able to look directly at the condition of the articular cartilage and how the labral rim is doing.

Many times, an inflammatory disorder has to be treated symptomatically, until it progresses to a point of being able to tell exactly what it is. But, even with a diagnosis, often the treatment is still the same: antiinflammatories. Remember, the Mobic (meloxicam) is to reduce the inflammation, so it takes time to work. But, as the inflammation goes down, then the discomfort should also. It is actually treating the problem, as opposed to the opioid pain medicine, which just masks the symptoms.

Tramadol is a semi-synthetic opioid pain medicine. As such, patients become tolerant to it with extended use, requiring increasingly larger and larger amounts to help with the same amount of pain. Patients will also have withdrawl symptoms if the medicine is stopped suddenly, after being on it for several months.


If you have not seen a rheumatologist, that would probably be your best physician to see for the inflammatory problem. Hope the biopsy from the arthroscopy shows something definitive. But, either way, stay as active as possible. The worst thing you can do is decondition, as that will make your problem just that more problematic. Water activities are very helpful for patients with lower extremity problems. It provides warmth and takes the weight off the lower extremities. Also, maintain your range of motion, weight, and cardiovascular status.

Good luck.
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replied June 1st, 2011
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Gaelic thanks for your reply.

One of the consultants I saw was from rhumatology and he couldn't find anything either.

When I had blood tests done they checked for the Rhumatiod factor which wasn't present in my blood.

So I just don't know. I only take the Tramadol when I need to mainly just before I go to bed. I also take it if I'm going to be doing activites that are going to cause a lot of pain and discomfort.

It's making me a little depressed because no one seems to have any answers.
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replied June 1st, 2011
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Amy,

Hang in there. Hopefully the biopsy of the synovial tissue will yield some results.

Remember that about 15% of patients with rheumatoid arthritis will be seronegative (negative RA factor). And, there are so many inflammatory arthropathies out there. Most have no serological tests to confirm them.

In most cases, as time goes on, enough symptoms finally show up, that a diagnosis can be made. Now days, patients are presenting to the medical community at much earlier stages than in the past. There are now tests to find inflammation (CRP, ESR, etc) before clinical signs manifest. So, it seems like it takes longer to find out what is going on, and in a way it does, because of the earlier presentation.

Even without a firm diagnosis, a lot of patients are treated symptomatically, quite successfully. However, as you probably know, there are no cures for most of the inflammatory arthropathies. Most are just managed.


Again, hang in there. If you are feeling really down, you might consider joining a support group of some type, just to get together with others in your same situation. Also, get out of the house. Isolation and depression can make pain much worse. Light physical activity is a must to keep the joints moving. The RA Foundation recommends that all joints should go through a full ROM, once a day. That is all that is required to maintain normal ROM. Pool activities are great.

Good luck on your upcoming surgery.
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replied June 6th, 2011
Extremely eHealthy
Thanks Gaelic.

I'll let you know how it does (although it'll probably be a while) lol.

Thanks for your input and support. Smile
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replied January 24th, 2012
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So, I had an operation called a hip arthoscopy on the 19th jan 12 and it turns out I had a labral tear which my consaltant shaved and repaired. However on talking to him a few hours after the operation, he does not think that the tear is the cause of the pain.

I have to go back to see him in 4 weeks time and hopefully I'll know some more then. My husband and I are hoping that this was the reason and I can now get on with leading a normal life again without crutches.

Because the hip was dislocated, I will need to have some physio to get the muscles up the strength again...

So If this isn't the cause then I'm really out of ideas as no one seems to have any idea either....
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replied January 24th, 2012
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Amy,

Did the surgeon give you ANY idea of what he thought might be going on? Did he do a synovial biopsy while he was in there? Was there any other findings, other than the labral tear? Was the articular cartilage in good condition?

Without knowing this type of information, you are correct, who knows what is going on. Hopefully, when you speak with the surgeon, he can give you more information on what he found in and around the hip.

Work on your therapy, especially in getting the range of motion back (within the allowed limits). Who knows, maybe debriding the labral tear will help with some of your pain. Hang in there. Good luck.
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replied January 14th, 2013
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He didn't mention anything like that. A year after my op I'm still no better. I'm still using crutches and have since had hydrothearpy but was given only 4 sessions and was told I couldn't have anymore.

I thought about EDS, but my rhumatologist doesn't think it's that, he's convinced it's monoarthritis. I saw my rhumatologist in october who ran a load of blood tests. My CRP was <5 which is where it should be but i think this is more down to taking at the time meloxicam (have been switched to arcoxia 90 since), and I have RNP antibody in my blood but at a very low level. I also had a repeat of my x ray which apparently came back normal.

My bloods are being repearted soon to see if the RNP antibody appears again and to what extent as the rhumatologist thinks it's a red herring whatever that is. Why can't people speak english and explain things to patients that they actually understand?
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replied January 17th, 2013
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AmyA,

The RPR (Rapid Plasma Reagin) test is an effective screening test for syphilis, as it is very good at detecting people without symptoms who have been exposed. However the test may suggest that a patient has syphilis, but who in reality does not (i.e., it may produce false positives). False positives can be seen in viral infections (Epstein-Barr, hepatitis, varicella (chiken pox), measles), lymphoma, tuberculosis, malaria, endocarditis, connective tissue disease, pregnancy, autoimmune diseases, intravenous drug abuse, or it can be from a contamination. For patients who are at high risk for actually having syphilis, the VDRL test is performed (Venereal Disease Research Laboratory).

So, to have a low level titer for the RPR test, in a patient who is not suspected of having syphilis, it is usually felt that the reason for the positive result is usually due to the patient having some other problem (or it was a contaminant). This is the reason for it to be repeated. If the test comes back negative the next time, it is assumed it was a contaminant. It is remains at a low level, then one of the above conditions is usually checked for (by history, exam, or testing). In some cases, it is never determined why a patient persists to have a low positive titer.


When a rheumatologist feels that a joint problem is a monoarthritis, it just means that it affects only one joint (mono - one, arthritis - affecting the joint). Usually, this means that he/she does not feel that the problem is rheumatologic in nature. Most of the time, an inflammatory arthropathy (a joint condition which is inflammatory in origin) affects more than one joint, it is usually systemic in nature (it affects the whole body).

Most of the time, a monoarticular problem is due to an injury or degeneration (such as OA - osteoarthritis or DJD - degenerative joint disease). It is very rare for a rheumatological problem to affect only one joint. One disorder that is primarily monoarticular is Lyme disease, as it tends to affect only one of the weight bearing joints, particularly the knee. But, Lyme disease has a very good serological test for it (blood test). And Lyme disease usually has more than one Stage (arthritis is just Stage III).


Thus, again, when a rheumatologist is looking for a rheumatological problem he/she is looking for many joints involved (polyarthritis), many systems involved (muscles, bone, joints, tendons, connective tissues, cardiac system, ophthalomological system, etc, etc, etc), or that the patient is systemically ill (feels ill overall).

The rheumatologist looks for specific symptoms in the affected joints, such as joint effusions (swelling inside of the joint, as opposed to edema which is in the soft tissues), the formation of a panus (overgrowth of the synovial lining inside a joint, called “bogginess” in a joint), warmth, redness, deformity of the bones around the joint, and again, the patient feeling malaise (feeling ill overall).



It is very concerning that you are still using crutches over a year after your surgery. I do hope that you find out what is going on in your hip very soon. The longer a patient stays on ambulatory aids, the weaker they become and the less and less chance that they will ever get off of them.

Continue to seek out the cause of your joint pain. Someone has to be able to figure out what is going on.

Good luck.
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replied August 21st, 2013
Extremely eHealthy
Hi Gaelic,

I have since been seen by my doctors in London and they gave me 2 options.

Option 1 - Inject a steroid into the iliopsoas tendon under a GA and waiting for a couple of months and seeing if that helps.

Option 2 - Under a GA conduct an iliopsoas tendon release surgery and at the same time do another arthroscopy

They decided there and then to go for option 2. I was told that the surgery could make it worse, do nothing at all or make it better.

My surgery is scheduled for this September with a recovery time of up to 12 months and this will involve a lot of physical therapy.

According to my doctor, there is a 5-10% of young girls in the population that have pain in their hip joints and there is nothing that can be done for them. It's controlled by pain management and they have to deal and live with the pain.

I am still using crutches, and on the advice of my doctors bought a bike machine to help keep the hip joint mobile and keep the strength there.

Kinda nervous about the operation and have just about everything I can cross crossed. This is the last 'mechanical' thing that the doctors can do so if the iliopsoas release surgery doesn't fix the issue then it's down pain management route.

They are doing the surgery because I have a loud snapping/ clicking sound coming from my right hip, I also have it in my left hip but it's not causing me any discomfort. I was told that the surgery will 90-95% cure the snapping/clicking in my hip but they cannot tell me whether its the snapping/clicking that is causing my pain.

There's only so much more a person can take without any answers and I believe I've reached my limit. My husband believes that it's too much of a risk to go ahead with the surgery considering they are guessing and don't actually know if this will help and it's a long recovery period as well. He also believes that because they a said it might sort out the issues that I'm going ahead because I'm hanging onto the 'it might work for you'.

I was being referred to pain management but my rheumatologist doesn't think it's worth seeing them until I've had my operation and we know how that went etc and I agree with him on that.
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