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Rheumatoid Arthritis

In rheumatoid arthritis, the synovium thickens, swells, and produces chemical substances that attack and destroy the articular cartilage covering the bone. Rheumatoid arthritis often involves the same joint on both sides of the body, so both hips may be affected.

Ankylosing Spondylitis

Ankylosing spondylitis causes inflammation of the spine and large joints, including the hips, resulting in stiffness and pain. it can cause erosion of the sacroiliac joint and fusion of the spine (bamboo spine).

Psoriatic Arthritis

Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a skin disease that causes red patches with scaling.

• Joints in psoriatic arthritis can be red, swollen, and warm.
• Sausage-like swelling can occur in fingers and toes.
• Changes in nails, like pitting, can be seen.
• Some patients have pain in the tailbone (coccyx).

Physical Examination

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

X-rays

X-rays are imaging tests that create detailed pictures of dense structures, like bone. X-rays of an arthritic hip will show whether there is any thinning or erosion in the bones, any loss of joint space, or any excess fluid in the joint.

(Left) This X-ray shows a normal hip. (Right) This X-ray shows inflammatory arthritis with decreased joint space.

Reproduced with permission from JF Sarwak, ed: Essentials of Musculoskeletal Care, ed. 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

 

Blood Tests

Blood tests like sedimentation rate (ESR) and C-reactive protein (CRP) are indicators of inflammatory arthritis. Antibodies like rheumatoid factor, antinuclear antibody, and anti-citrullinated peptide can be useful in the diagnosis of inflammatory arthritis.  

Nonsurgical Treatment

The treatment plan for managing your symptoms will depend upon your inflammatory disease. Advances in the treatment of inflammatory arthritis have made a dramatic difference in the lives of people with these diseases. Inflammatory arthritis can often be well controlled using medications, and it can go into remission when treated early in the course of the disease. 

Non-steroidal anti-inflammatory drugs (NSAIDs). Drugs like naproxen and ibuprofen may relieve pain and help reduce inflammation. NSAIDs are available in both over-the-counter and prescription forms.

Corticosteroids. Medications like prednisone are potent anti-inflammatories and can suppress the immune system. They can be taken by mouth or by injection.

Injections in the hip, such as corticosteroid, hyaluronic acid, or platelet-rich plasma (PRP), can also help control pain. 

Disease-modifying antirheumatic drugs (DMARDs). These drugs act on the immune system to help slow the progression of disease. Methotrexate is a commonly prescribed DMARD.

There are several newer medications on the market known as biologics, genetically engineered proteins which target specific parts of the immune system that trigger inflammation. These drugs can be very effective for patients with rheumatoid arthritis, psoriatic arthritis, and other forms of autoimmune inflammatory arthritis.

Physical therapy. Specific exercises may help increase the range of motion in your hip and strengthen the muscles that support the joint.

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

Assistive devices. Using a cane, walker, long-handled shoehorn, or reacher may make it easier for you to perform the tasks of daily living.

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
• Which disease is causing your inflammatory arthritis
• Progression of the disease

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

Total hip replacement. Your doctor will remove the damaged cartilage and bone, then position new metal or plastic joint surfaces to restore the function of your hip. 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 socket are replaced with an artificial device.

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

Your doctor will discuss the various surgical options with you. Do not hesitate to ask why a specific procedure is being recommended and what outcome 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 the possible complications with you before your surgery.

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