I was diagnosed with osteoarthritis in both shoulders after X-Rays were taken this past weekend. I'm new to this subject, and have been reading everything I can find since I got the news. I'm writing this for two reasons: (1) To share my experience with others -- an experience that carries 2 warnings!, and (2) to ask some simple questions.
I think the problem really started with high cholesterol. In the summer of 2005 my doctor prescribed a statin. In the summer of 2007 I experienced a lot of pain in my left shoulder, so my doctor gave me a steroid shot, which helped relieve the pain. This happened once more in the next year or so, but I periodically experienced shoulder pain thoughout this time. Except for the two times I received a steroid shot, most of the other times it went away on it's own.
At the start of 2008, after taking one statin brand for over 2 years, my doctor and I both agreed to switch brands (the one I was taking received some negative press suggesting it might be harmful). Since my "good" cholesterol was still too low, I was put on a combination of statin and niacin starting in the spring of 2008. By November of that same year, I was in the doctor's office with extreme pain in my right shoulder -- not the left this time. I received a steroid shot to alleviate the pain.
Toward the end of 2008, I had been taking statins for about 3 years. During the last year, I was experiencing one pain after another. So I complained to my doctor, and questioned the wisdom of continuing statin therapy. He agreed, but we kept up the niacin. Within weeks my quality of life improved dramatically, except for my upper arms. After the next blood test, we could see that the niacin had no affect on cholesterol levels, so that was discontinued as well.
We waited 3 months for pain in the arms to clear up. No luck. It persisted, with the right arm seriously more affected when compared to the left (notice the pattern?). It was then that my doctor recommended X-Rays. The X-Rays showed osteoarthritis of both shoulders.
WARNING! (http://www.johnshopkinshealthalerts.com/alerts/arthritis/JohnsHopkinsHealthAlertsArthritis_482-1.html): "Many older people who take statin drugs ... to lower their cholesterol levels have osteoarthritis or are at risk for developing it."
WARNING! (http://www.medicinenet.com/script/main/art.asp?articlekey=16431): "[W]hen [a statin] is used alone to lower cholesterol, muscle damage occurs on the average in one person out of about every 500. However, if [a statin] is used in combination with other drugs such as niacin, gemfibrozil ..., or fenofibrate ... to further reduce cholesterol levels, the risk of muscle injury skyrockets to one person out of every 20 to 100 who receive the combination. The risk of muscle damage is thus multiplied five- to 25-fold by using a combination of a statin and another cholesterol-lowering drug rather than by just using statin alone."
It's difficult to say whether or not the steroid injections had anything to do with it. The "pattern" I allude to above is that two injections were received in the left shoulder, while one was provided to the right. Now my left shoulder (2 injections) is much worse than the right (1 injection). It could just as easily be that the left shoulder was already worse compared to the right. If anyone is aware of a connection between steroid injections (in this context) and osteoarthritis, I'd appreciate hearing about it.
I have 4 questions. Maybe I shouldn't ask so much in one post.
YOUR EXPERIENCE? This refers to people with shoulder osteoarthritis. My question is why is all of the pain in the upper arms, and feels like it's in the muscle there? Everything I read refers to pain in front of the shoulder, behind the shoulder and/or at the shoulder. I have no problems with my shoulders. All of the pain is above the elbow and below the shoulder, mostly occurring on the front of the arm in that area. Is this normal for osteoarthritis of the shoulders?
UNDERLYING CAUSE? The fact that my pain symptoms don't match the norm makes me wonder if there's an underlying cause. The suspected cause (statin/niacin) of the condition lends some weight to that perspective. For example, if the statin/niacin combination caused muscle/tendon damage, perhaps that induced arthritis. Anyone have any experience like this? I know injury is the number 1 root cause in the case of shoulder osteoarthritis, but I haven't experienced any injury to that area (or near there) at all.
RHEUMATOLOGIST? Is it better to see a specialist, like a rheumatologist? Would they provide any better perspective compared to a general practitioner, like my doctor?
MRI? Are there any advantages to having an MRI done? Most articles I see on this subject suggest there are not. X-Rays are more definitive in diagnosing and measuring recuperative efforts. On the other hand, the MRI is better for detecting certain underlying causes, which I proposed as a possibility. Perhaps this answers my own question. Any thoughts?
Thanks for making your way through this lengthy post. I hope the medication information proves useful to someone. If you have a relative or friend about to embark on the same path, let them know the possible risks. If someone had done this for me, I think I would have denied the use of both cholesterol lowering medications -- especially at the same time.