The 20 Years Mystery!

A 50 years old lady comes to the clinic with history of chronic pain all over her body, but her most pressing issue was severe left shoulder pain that began 5 months ago. She was told her labs were normal and that she had a local shoulder problem and was given a local steroid injection that didn’t help. She then had an MRI of the shoulder and was advised surgery that was done 3 months before presentation to our clinic but her symptoms got worse after the surgery. She then did another MRI that showed more inflammation not less, and said she has been having aches all over her body for nearly 20 years especially in the lower back, butts, legs, but also all over joints, and had done lots of labs but nothing came up.

The lower back pain has been there for more than 20 years, every day, worse at night and in the morning, with long lasting morning stiffness. We did labs and they were almost normal, but her back x-rays showed severe chronic inflammatory changes of spondyloarthritis of the pelvis. In spondyloarthritis labs can be normal in up to half the patients even when they have active disease.

She almost cried when we told her that the x-rays showed she suffered for many years because for a very long time she was told there is nothing wrong and to just take some painkillers and sometimes was even dismissed as another “whiner”. We started her on treatment and she began improving gradually and she said that within few weeks of treatment she had some of her best night sleep in more than 15 years.