SI joint Pain

[Holly]

Hello,

I have a 39 yo female patient who come in complaining of severe SI joint pain that began during a trip to New Zealand. Her rheumatologist had given her a tentative Dx of AK (positive HLA B27). She has had 2 x-ray series and 2 MRI series done – the radiologists reports are ‘unremarkable’.

I ran Genova’s Comp Stool Panel in order to rule in/out klebsiella. The stool panel came back negative for any infections, but did show a lack of variety in gut bacteria, specifically oxalate degrading bacteria. I had her keep a diet log and saw that her flare ups usually corresponded to eating spinach the day before.

I had her discontinue spinach and other high oxalate foods and the pain that she had been dealing with for over 8 months subsided almost immediately. Unfortunately her relief was short lived. After 3-4 weeks the pain has come back.

I’m unsure how to proceed. I have been reading about crystal arthropathy and wonder if this is an avenue to explore further for her given our short tern success with a low oxalate diet.

I welcome any guidance you can give me on this case.

She is currently taking a variety of supplements: probiotic, prebiotic, calcium, K2, D, fish oil, b complex and some others.

Thank you,

Holly

[DrWoeller]

Holly,
Great call on the oxalate link with spinach elimination, etc.

She could dumping more oxalates as they don’t come out all at one time. It can take years in some patients. Also, if heavy candida is present it too can create oxalates. I would run an OAT on her.

The Crystal Arthropathy is an interesting angle. There may be more going on than just oxalates. It sounds like she could benefit from some urine and blood testing for different crystallization problems. I am not an expert in this area, but the Rheumatologist would certainly know what specific labs to order.

Dr. Woeller

[Holly]

Hello Dr Woeller,

I had my patient run the OATs test and have attaached the results below.

Yeast is slightly high, though I’m not sure that this can cause severe SI pain.

The high 3-hydroxyglucaric acid marker is also high. She does not have a history of any severe illness, nor was she eating a ketogenic diet when this test was run. I’m not sure what to make of this.

Any feedback would be helpful,

thank you,

Holly

[DrWoeller]

Holly,
I doubt anything from this test would explain severe SI pain. Her neurotransmitters look under produced though. However, what is the history of SI pain?
Dr. Woeller

[Holly]

She does have a history of mood issues. here is her history:

04/28/15: Newly diagnosed auto-immune disease: Started noticing back pain during trip to New Zealand in November 2014 – parts of body would falls sleep or pain in back at night during travel. Started having sciatic pain in December 2014 after lots of sitting during yoga training. Pain changes all the time – currently lots of pressure at tailbone. Notices a big difference when gets stressed. MD Dx sacroiliitis. Dx slight scoliosis. In August 2014 prior to this travel experienced upper back pain. recently has had numerous imaging studies and in-depth blood work by rheumatologist.

Other:
Sleep: 2 weeks of every month doesn’t sleep well, correlated with period – starts the week before. Was put on Paxil in October 2014 – seems to help. Never been a good sleeper – tied to childhood trauma. Had sleep disturbances for 20 years. Nightguard. History of waking at night to urinate, 3-5x per night.
Moods: History of depression. Had severe case in 2012: suicidal, binge eating. Did CBT work, was put on Paxil again. Stress *should* be better – overscheduled, worries, obsesses. Dx with severe depressive disorder, PTSD without psychotic symptoms.
Digestion: Leans towards constipation. Does juice cleanses regularly. Back to constipated now, which corresponds with sleeping issues. Dx with SIBO several years ago- was put on antibiotics. Got hives the second week (sulfa). Used to have really distended abdomen after eating. Doesn’t happen much anymore. Can have flatulence.
Raynaud’s: Raynaud’s runs in family. Tends to have cold hands and feet.
Hypoglycemia: Notices low blood sugar if has too much sugar. Hasn’t experienced hypoglycemic issues in a couple years. Asthma symptoms resolved now that hypoglycemia is under control.
Weight: Ideal weight 107. 110 now, at peak 120 in 2013. Height 5 1/2 .
Memory: Has alway seems to have memory issues – seems like getting worse. Forgets words.
History: History of ear infections, constipation. Pneumonitis. Tried to get off the pill in 2013 (has been on it since age 16).
Family history: Father had psychiatric issues. Mother has osteopenia, grandmother has heart issues. MGF also psychiatric issues.

Clinical Findings & Initial Recommendations:
Blood Test Findings*
Functionally low blood sugar, lab high ALT (liver enzymes)
Functionally low iron, lab high TIBC
Lab low T3
Creatine Kinase high
HLA-B27 positive

[DrWoeller]

Holly,
She is hypothyroid for one thing. The low iron could play a role overall with health too.

If you ran an amino acid panel you would likely find that some or most are low too. I would suggest some digestive enzymes to assist with gut function.

Also, with the autoimmune disease perform a food sensitivity panel as such as the Food IgG test from Great Plains.

Have you ever looked into Low Dose Naltrexone? http://www.lowdosenaltrexone.org.

Dr. Woeller

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