Inflammatory Arthritis of the Hip

Arthritis literally means "inflammation of a joint." In some forms of arthritis, such as osteoarthritis, the inflammation arises because the smooth covering (articular cartilage) on the ends of bones wears away. In other forms of arthritis, such as rheumatoid arthritis, the joint lining becomes inflamed as part of a systemic disease. These diseases are considered the inflammatory arthritides.

The three most common types of inflammatory arthritis that affect the hip are:

Rheumatoid arthritis (RA): RA is a systemic disease of the immune system that usually affects multiple joints on both sides of the body at the same time.
Ankylosing spondylitis (AS): AS is a chronic inflammation of the spine and the sacroiliac joint (the point where the spine meets the pelvic bone) that can also cause inflammation in other joints.
Systemic lupus erythematosus (SLE or lupus): SLE is an autoimmune disease in which the body harms its own healthy cells and tissues.

Signs and symptoms of inflammatory arthritis of the hip:

Joint pain
Dull, aching pain in the groin, outer thigh, or buttocks.
Pain is usually worse in the morning and lessens with activity; however, vigorous activity can result in increased pain and stiffness.
The pain may limit your movements or make walking difficult.

Diagnostic tests

Physical Examination by your orthopedic surgeon: your physician may ask you to move your hip in various ways to see which motions are restricted or painful.
During your exam, tell your physician if you walk with a limp, if one or both hips are painful, and if you experience pain in any other joints.
X-rays of the hip: this is to determine if there is any thinning or erosion in the bones, any loss of joint space or any excess fluid in the joint.
Laboratory studies (blood test) will show whether a rheumatoid factor or other antibodies are present.

Non-Surgical Treatment Options:

Anti-inflammatory medications, such as aspirin, ibuprofen, or naproxen may help reduce the inflammation. These can be prescribed by your physician.
Corticosteroids are potent anti-inflammatories, part of a drug category known as symptom-modifying antirheumatic drugs, or SMARDs. They can be taken by mouth, by injection, or in creams applied to the skin.
Anti-inflammatory creams are applied directly to the area of pain. These creams can be specially compounded by your physician or pharmacist, e.g. Ibuprofen cream, Ketoprofen 20% cream. Dr. Emmanuel has special cream formulations that he will dispense to you in his office if you cannot tolerated oral medications.
Methotrexate and sulfasalazine may be prescribed to slow down the progression of the disease. These medications are part of a drug category called DMARDs, or disease-modifying antirheumatic drugs. For example, tumor necrosis factor is one of the substances that seem to cause inflammation in people with arthritis. Newer drugs that work against this factor seem to have a positive effect on arthritis in some patients as well.
Physical therapy may help you increase the range of motion and strengthening exercises may help maintain muscle tone. Swimming is a preferred exercise for people with Ankylosing Spondylitis.
Assistive devices, such as a cane, walker, long shoehorn or reacher, may make it easier for you to do daily living activities.

If these treatments do not relieve the pain, surgery may be recommended. The type of surgery depends on several factors:

your age
the condition of the hip joint
the type of inflammatory arthritis you have
the progression of the disease

Your orthopaedic surgeon will discuss the various options with you. Do not hesitate to ask why a specific procedure is being recommended and what outcome you can expect. Although complications are possible in any surgery, your orthopaedic surgeon will take steps to minimize the risks.

The most common surgical procedures performed for inflammatory arthritis of the hip include:

Total hip replacement is often recommended for patients with RA or AS because it provides pain relief and improves motion.
Bone grafts may help patients with SLE to build new bone cells to replace those affected by osteonecrosis. People with SLE have a higher incidence of this disease, which causes bone cells to die and weakens bone structure.
Another option for patients with SLE and osteonecrosis is core decompression, which reduces bone marrow pressure and encourages blood flow.
Synovectomy (removing part or all of the joint lining) may be effective if the disease is limited to the joint lining and has not affected the cartilage.
If you have an infection in the hip joint, it must be eliminated, either through the use of medications or through surgical draining.