inflammatory arthritis

Inflammatory arthritis of the Hip



There are more than 100 different forms of arthritis, a disease that can make it difficult to do daily activities because of pain and stiffness.

Inflammatory arthritis occurs when the body's immune system becomes overactive and attacks healthy tissues. It can affect different joints throughout the body at the same time, as well as many organs, such as skin, eyes and heart.

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

    Rheumatoid arthritis;
    Ankylosing spondylitis; is
    Systemic lupus erythematosus.

The anatomy of the hip.

The most common form of arthritis in the hip is osteoarthritis - the "wear and tear" arthritis that of cartilage damage over time, usually 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 articular cartilage covering the bone. Rheumatoid arthritis often involves the same joint on both sides of the body, so that both hips can be affected.
Ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammation of the spine that most often causes back pain and stiffness. It can affect other joints, as well, between 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 the 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.

    A dull ache, pain in the lower abdomen, external thigh, knee, or buttocks
    Pain that is worse in the morning or after sitting or resting for a while, but decreases with activity
    Increased pain and stiffness with vigorous activity
    Pain in the fairly serious joint to cause a limp or take hard rides

The doctor will ask questions about your medical history and what the symptoms, then conduct a physical exam and order diagnostic tests.
Physical examination

During the physical examination, the doctor will evaluate the range of movement in your hip. Increased pain during some movements may be a sign of inflammatory arthritis. He or she will also be looking for a limp or other problems with your gait (the way you walk) due to stiffness of the hip.
X-ray

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

Blood tests may reveal if a rheumatoid factor or any other antibody indicative of inflammatory arthritis-is present.

(Left) This x-ray shows a normal hip. (Right) This x-ray shows inflammatory arthritis with decreased joint space.
non-surgical treatment

The treatment plan for symptom management will depend on your inflammatory disease. Most people find that a combination of treatment methods works best.



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

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

Physiotherapy. Specific exercises can help increase the range of motion in your hip and strengthen the muscles that support the joint.

Furthermore, regular, moderate exercise can decrease stiffness and improve endurance. Swimming is a favorite exercise for people with ankylosing spondylitis, because the movement of the spine can be limited.

assistance devices. Using a cane, walker, long-handled shoehorn, or Reacher can make it easier for you to perform the activities of everyday life.
Surgical treatment

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

    Your age
    Condition of the hip joint
    Which disease is causing inflammatory arthritis
    Progression of the disease

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

total hip replacement. The doctor will remove the damaged cartilage and bones, and then place 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 alleviate pain and improve range of motion.

In total hip replacement, both the femoral head and the socket are replaced with an artificial device.

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

Complications. Although complications are possible in any surgery, the 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)
    length of limbs inequality (in total hip replacement)

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

Inflammatory arthritis of the hip can cause a wide range of disabling symptoms. Today, new drugs 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 alleviate pain, increase movement, and help you return to enjoy daily activities. Total hip replacement is one of the most successful operations in all of medicine.

AAOS does not endorse any treatments, procedures, products or doctors mentioned in this document. This information is provided as an educational service and is not intended to serve as medical advice. Those looking for specific advice or orthopedic assistance should consult with their orthopedic surgeon, or locate one in your area through the AAOS "Find an Orthopedic" program on this site.