OpenHealth Q&A

Enduring Three Years of Unexplained Knee and Hip Pain

I am a 27-year-old woman. My ordeal began in May 2020 when I first noticed pain in both of my knees, primarily triggered by more vigorous activities such as descending steep trails or running. By the conclusion of that month, my discomfort escalated to the point where mere walking became intensely painful, even when I was at rest. I was given Biofenac, but it proved ineffective. After approximately two weeks, the acute pain began to ease, yet my knees remained achy, accompanied by a sensation of tightness and occasional tearing, as well as cracking and popping noises while I walked. In August 2020, I started to feel pain in my left hip, characterized by a burning sensation that radiated toward the groin, particularly when my leg was drawn towards my chest or in a deeply bent position. I also had sporadic pain in my lower back, left ankle (especially noticeable in the mornings), and in the muscles of my legs; however, these additional symptoms vanished after about three months. # Ongoing Symptoms: **Knees**: I experience constant pain, cracking, popping, and intermittent tearing sensations. The discomfort intensifies when I rise from a seated position, sit down, squat, navigate stairs, kneel, or perform dynamic movements like running, jumping, or lunges. Keeping my legs bent for prolonged periods exacerbates the soreness. **Hip**: I feel pain while resting and during movement, which also radiates to my groin, buttock, and hip side. There are stabbing pangs in the groin that intensify when sitting, lying on my left side, or engaging in vigorous physical activities. # Previous Treatments and Evaluations: **Hyaluronic acid injections** in both knees provided temporary relief from the cracking sounds. **Manual therapy combined with physical exercises** focusing on glute strength, quadriceps, and hamstrings, along with foam rolling and stretching routines have been attempted. **Physical rehabilitation** involving electrotherapy, laser treatments, and cryotherapy were also utilized. **Rheumatology assessment** included a three-month trial of sulfasalazine for suspected seronegative PsA, but no improvements were noted, necessitating a halt in treatment. Notably, I have no family background of rheumatic disorders, nor do I present typical symptoms such as joint swelling, redness, or skin changes. **Stem cell injections derived from fat** into the hip and knees yielded no significant benefits. # Conducted Tests: 🔹 **MRI Findings:** * **Left knee:** Exhibits mild lateral patellar maltracking and early-stage chondromalacia graded at 1. * **Right knee:** Similar observations as the left knee. * **Left hip:** Displays mild degenerative changes related to overload in the labrum. 🔹 **Blood Work:** * All inflammatory markers (ESR, CRP, RF, ANA, CBC, Lyme disease, anti-CCP) were **normal**. * **HLA CW6 and HLA B27 tested positive**, although numerous rheumatologists have dismissed the possibility of inflammatory arthritis. # Central Inquiry – Is Isotretinoin to Blame? The onset of my symptoms coincided precisely with the completion of an eight-month course of isotretinoin (Accutane). Prior to this treatment, I had no joint or musculoskeletal problems, nor any history of injuries or fractures. I’m reaching out to see if anyone has dealt with anything similar. Could there be further tests I should pursue? Does anyone know a specialist who addresses cases like mine? Any guidance would be immensely appreciated!

Answers (1)

3/17/2025, 10:10:58 PM

OpenHealth AI

Main Points: Your persistent knee and hip pain may relate to various factors, including possible effects of isotretinoin, underlying musculoskeletal issues, or biomechanical changes. Although treatments tried thus far have not led to significant improvements, it’s essential to focus on managing symptoms and exploring further evaluations.

Explanation: You are experiencing widespread joint pain, particularly in your knees and hip, characterized by various sensations like cracking and occasional sharp pains. The timeline indicates the onset of symptoms coincides with your isotretinoin treatment, which has been associated with musculoskeletal side effects in some individuals, although the mechanism is not well understood. However, identifying whether the medication is directly responsible requires careful consideration and ideally, a medical professional's guidance.

The MRI findings indicate milder joint degeneration and patellar maltracking, which could contribute to your symptoms. As you've already undergone extensive testing and treatments, including medication, manual therapy, and various injections, it’s understandable to feel frustrated at the lack of resolution.

Next Steps:

1. Symptom Management:

   • Activity Modification: Continue to modify or limit activities that exacerbate your symptoms, such as high-impact exercises. Focus instead on low-impact activities like swimming or cycling.
   • Pain Relief Measures: You might consider using over-the-counter pain-relief options like ibuprofen or acetaminophen if safe and appropriate for you, to reduce discomfort while you explore further treatment options.

2. Further Evaluations:

   • Referral to a Specialist: Seek a consultation with an orthopedic specialist focused on joint issues or a pain management specialist. They may explore interventions like diagnostic injections to pinpoint pain sources or advanced imaging.
   • Physical Therapy Evaluation: A fresh evaluation by a specialized physical therapist can provide new insights. They might suggest targeted exercises tailored to your specific joint mechanics and pain patterns.

3. Explore Other Conditions:

   • Further Autoimmune Testing: Given your positive HLA markers, consider discussing with your physician the possibility of more specific autoimmune evaluations, even though initial tests were normal.
   • Consultation for Recovery from Isotretinoin: Research a dermatologist experienced with isotretinoin-related side effects, to determine if there are additional supportive strategies to mitigate musculoskeletal symptoms.

4. Keep a Symptom Diary: Document your pain levels, activities, and any changes you notice day-to-day. This can provide valuable information to healthcare providers and help identify patterns regarding your symptoms.

By focusing on manageable steps, symptom care, and further exploratory evaluations, there’s potential for identifying interventions that suit your situation better. Remember, reaching out for support and continuing to advocate for your health is crucial. If you have any more questions or require further assistance, feel free to ask!