Inflammatory Arthritis of the Hip

Inflammatory arthritis is caused by an overactive immune response that attacks the joints. Unlike Osteoarthritis (OA), inflammatory arthritis affects people of all ages. More than 18 million people worldwide live with rheumatoid arthritis.1 There is no cure for arthritis, but there are conservative and surgical treatment options.

The hip is one of the largest ball-and-socket joints in the body and can move in multiple directions. The acetabulum of the pelvis forms the socket, while the femoral head (upper end of femur/thigh) creates the ball. Articular cartilage covers the femoral head and acetabulum to create a smooth surface for the bones to move together. The synovial lining covers the joint surface and provides lubrication to the cartilage. The breakdown of cartilage and bone leads to arthritis.

Causes

When a person’s immune system is compromised, the body may react as though there is an injury, causing inflammation in the joint. The chemicals produced by this inflammation damage healthy tissue. Common autoimmune disorders like rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis cause inflammatory arthritis of the hip. Other autoimmune diseases—lupus, reactive arthritis, inflammatory bowel disease, juvenile inflammatory arthritis (JIA), and sarcoidosis—can lead to arthritis of the hip as well. Some treatments, such as chemotherapy, can also affect the hip joint. Inflammatory arthritis not caused by an autoimmune disease includes gout, pseudogout, septic arthritis (caused by an infection), and arthritis caused by Lyme disease.

Symptoms

If you are experiencing hip pain, visiting a qualified orthopedic specialist early on is essential. Many conditions share the common symptoms of inflammatory hip arthritis. A proper diagnosis can ensure the right treatment plan going forward. The most common symptoms of inflammatory hip arthritis include:

Pain and stiffness to the hip joint causing a loss in range of motion.
Pain in the groin can radiate to the outer hip, buttocks, and even down into the knee.
Pain is usually worse first thing in the morning or after sitting still for a long time, which improves with activity.
Generalized symptoms include fever, loss of appetite, and fatigue.
When pain is severe enough, patients will have a noticeable limp and have difficulty walking.

Diagnosing

A rheumatologist often diagnoses and treats autoimmune diseases. The diagnostic process includes a physical examination, a complete medical history, and diagnostic tests. During the exam, your physician will test for tenderness and pain in the hip area and evaluate any radiating pain you may have. Range of motion, evaluation of your gait, and other basic tests are used to understand more about the function of the hip.

X-rays are the first and often definitive diagnostic imaging test we use to diagnose loss of joint space in the hip. X-rays will show changes in bone structure, cartilage health, and the development of bone spurs in the joint.

Diagnostic tests that are useful in the diagnosis of inflammatory diseases and arthritis include:

Sedimentation rate (ESR)
C-reactive protein (CRP)
Rheumatoid factor
Antinuclear antibody
Anti-citrullinated peptide

Treatments

Sadly, there is no cure for inflammatory arthritis, which is progressive and chronic. There are many options for slowing its progression and treating the symptoms. Visit a qualified orthopedic specialist if you experience prolonged or significant hip pain.

Conservative Treatment Options

Conservative treatment is often aimed at the autoimmune disease, focusing on the affected joint(s) as they become problematic. Inflammatory arthritis can go into remission if treated early with medications.

Oral or injectable medications can assist in reducing inflammation and suppressing the immune response to specific disease processes. This can help with pain relief.

Physical therapy may increase the range of motion and strengthen the muscles that support the hip.

Your orthopedic surgeon or rheumatologist will create a customized plan for your situation.

Surgical Treatment

When pain and function limit your lifestyle, you may need to consider surgical treatment.

Total hip replacement: During this procedure, the ball and socket are replaced with metal and plastic parts that imitate the natural joint. In most cases, total hip replacements are very successful in returning function and relieving the pain of severely deteriorated joints.
Synovectomy: A synovectomy may be appropriate when the disease and/or inflammation is limited to the joint lining. During this procedure, part or all of the synovium is removed.

Complications

All treatment options, whether conservative or surgical, come with risks. Discuss these risks and potential complications with your provider. Common risks with surgery include infection, bleeding, blood clots, and damage to blood vessels or nerves.

Reference:

World Health Organization data