Inflammatory hip arthritis

There are more than 100 different forms of arthritis, a disease that can hinder everyday activities due to pain and stiffness in the joints. Inflammatory arthritis occurs when the body’s immune system becomes overactive and attacks healthy tissues. It can affect several joints throughout the body at the same time, as well as many organs, such as the skin, eyes and heart.

There are three types of inflammatory arthritis that most often cause symptoms in the hip joint:

  • Rheumatoid arthritis;
  • Ankylosing spondylitis; Y
  • Systemic lupus erythematosus.

Although there is no cure for inflammatory arthritis, there have been many advances in treatment, particularly in the development of new medications. Early diagnosis and treatment can help patients maintain mobility and function by preventing serious damage to the joint.

Anatomy

The hip is a spherical joint. The cavity is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thigh bone).

A slippery tissue called articular cartilage covers the surface of the ball and the cavity. Creates a smooth, low friction surface that helps bones slide easily from each other. The surface of the joint is covered by a thin lining called synovium. In a healthy hip, the synovial membrane produces a small amount of fluid that lubricates the cartilage and helps movement.

normal hip anatomy

The anatomy of the hip.

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TREATMENT

Total hip replacement

DISEASES AND CONDITIONS

Rheumatoid arthritis

Description

The most common form of arthritis in the hip is osteoarthritis, the “wear and tear” arthritis that damages cartilage over time, causing painful symptoms in people after reaching middle age. Unlike osteoarthritis, inflammatory arthritis affects people of all ages, often showing signs in early adulthood.

Rheumatoid arthritis

In rheumatoid arthritis, the synovial membrane thickens, swells and produces chemicals that attack and destroy the articular cartilage that covers the bone. Rheumatoid arthritis often involves the same joint on both sides of the body, so both hips can be affected.

Ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammation of the spine that most often causes stiffness and low back pain. It can also affect other joints, including the hip.

Systemic lupus erythematosus

Systemic lupus erythematosus can cause inflammation in any part of the body and most often affects the joints, skin and nervous system. The disease occurs in young adult women in most cases.

People with systemic lupus erythematosus have a higher incidence of osteonecrosis of the hip, a disease that causes bone cells to die, weakens the bone structure and leads to disabling arthritis.

Why

The exact cause of inflammatory arthritis is unknown, although there is evidence that genetics play a role in the development of some forms of the disease.

symptom

Inflammatory arthritis can cause general symptoms throughout the body, such as fever, loss of appetite and fatigue. A hip affected by inflammatory arthritis will feel painful and stiff. There are also other symptoms:

  • Dull and aching pain in the groin, the outside of the thigh, the knee or the buttocks.
  • Pain that worsens in the morning or after sitting or resting for a while, but decreases with activity.
  • Increased pain and stiffness with vigorous activity.
  • Joint pain severe enough to cause lameness or difficulty walking.

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Medical exam

Your doctor will ask about your medical history and symptoms, then perform a physical exam and order diagnostic tests.

Physical exam

During the physical exam, your doctor will evaluate the range of motion in your hip. Increased pain during some movements may be a sign of inflammatory arthritis. He or she will also look for a limp or other problems with your walking (the way you walk) due to the stiffness of the hip.

X-rays

Radiographs are tests of images that create detailed images of dense structures, such as bones. X-rays of an arthritic hip will show if there is thinning or erosion in the bones, loss of joint space or excess fluid in the joint.

normal hip and hip with inflammatory arthritis

(Left)   This radiograph shows a normal hip. (Right)   This radiograph shows inflammatory arthritis with decreased joint space. Reprinted with permission from JF Sarwak, ed: Essentials of Musculoskeletal Care, ed. 4. Rosemont, IL, American Academy of Orthopedic Surgeons, 2010.

Blood test

Blood tests can reveal if there is a rheumatoid factor, or any other antibody indicative of inflammatory arthritis.

Treatment

Although there is no cure for inflammatory arthritis, there are several treatment options that can help prevent joint destruction. Inflammatory arthritis is often treated by a team of health professionals, including rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists and orthopedic surgeons.

Non-surgical treatment

The treatment plan to control your symptoms will depend on your inflammatory disease. Most people find that some combination of treatment methods works best.

Nonsteroidal anti-inflammatory drugs (NSAIDs).  Drugs such as naproxen and ibuprofen can relieve pain and help reduce inflammation. NSAIDs are available in the form of over-the-counter and prescription.

Corticosteroids   Medications such as prednisone are potent anti-inflammatories. They can be taken orally, by injection or as creams that are applied directly to the skin.

Disease-modifying anti-rheumatic drugs (DMARDs).  These medications act on the immune system to help slow the progression of the disease. Methotrexate and sulfasalazine are commonly prescribed DMARDs.

Physical therapy.  Specific exercises can help increase the range of movement in the hip and strengthen the muscles that support the joint.

In addition, regular and moderate exercise can decrease stiffness and improve endurance. Swimming is a preferred exercise for people with ankylosing spondylitis because spinal movement can be limited.

Help devices  The use of a cane, a walker, a long-handled shoehorn or a reamer can make it easier for you to perform the tasks of daily life.

Surgical treatment

If nonsurgical treatments do not sufficiently relieve your pain, your doctor may recommend surgery. The type of surgery performed depends on several factors, including:

  • Your age
  • Condition of the hip joint.
  • What disease is causing your inflammatory arthritis?
  • Disease progression.

The most common surgical procedures performed for inflammatory hip arthritis include total hip replacement and synovectomy.

Total hip replacement.  Your doctor will remove the damaged cartilage and bone, and then place new articular metal or plastic surfaces to restore your hip function. Total hip replacement is often recommended for patients with rheumatoid arthritis or ankylosing spondylitis to relieve pain and improve range of motion.

In total hip replacement, both the head of the femur and the cavity are replaced with an artificial device.

Synovectomy  Synovectomy is performed to remove part or all of the joint (synovial) lining. It can be effective if the disease is limited to the joint lining and has not affected the articular cartilage that covers the bones. In general, the procedure is used to treat only the early stages of inflammatory arthritis.

Your doctor will discuss the different surgical options with you. Feel free to ask why a specific procedure is recommended and what results you can expect.

Complications   Although complications are possible in any surgery, your doctor will take steps to minimize the risks. The most common complications of surgery include:

  • Infection
  • Excessive bleeding
  • Blood clots
  • Damage to blood vessels or arteries
  • Dislocation (in total hip replacement)
  • Limb length inequality (in total hip replacement)

Your doctor will discuss all possible complications with you before your surgery.

Recovery.  The time it takes to recover and resume your daily activities will depend on several factors, including your general state of health and the type of surgical procedure you have. Initially, you may need a cane, walker or walking crutches. Your doctor may recommend physical therapy to help you regain strength in your hip and restore range of motion.

Results

Inflammatory hip arthritis can cause a wide range of disabling symptoms. Today, new medications can prevent disease progression and joint destruction. Early treatment can help preserve the hip joint.

In cases that progress to severe joint damage, surgery can relieve your pain, increase movement and help you enjoy daily activities again. Total hip replacement is one of the most successful operations in all medicine.

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