Inflammatory arthritis of the hip can cause a wide range of disabling symptoms. Patients with long-standing inflammatory arthritis or those who do not respond to medical treatment may end up with joint destruction, which can lead to the need for a joint replacement. Although there is no cure for inflammatory arthritis, there have been many advances in treatment  Early diagnosis and treatment can help patients maintain mobility and function by preventing severe damage to the joint. You needn’t suffer from inflammatory arthritis when you can see the experienced and knowledgeable orthopedic specialists at Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado.

OVERVIEW

There are more than 100 different forms of arthritis. Inflammatory arthritis refers to any type of arthritis caused by an overactive immune system. These types of arthritis are also known as autoimmune disorders. With inflammatory arthritis, the body’s defense system begins to attack the tissues of the joints instead of germs, viruses, and foreign substances. The most common type of arthritis in the hip is osteoarthritis—the “wear-and-tear” arthritis that can damage cartilage over time, typically causing painful symptoms in people after they reach middle age. Unlike osteoarthritis, inflammatory arthritis—often in the hip—affects people of all ages, often showing signs in early adulthood.

ABOUT THE HIP

The hip joint is one of the largest joints in the body after the knee. It is a ball-and-socket joint and the connection point between the thigh bone (femur) and the hip bone (pelvis). The acetabulum, which is part of the pelvis bone, forms the socket. The femoral head, which is the top part of the thigh bone, forms the ball. The function of the hip joint is to provide balance and support for the upper body, move the upper leg, and hold body weight. Because it is a ball-and-socket joint it allows the leg to flex, extend, rotate, make a back-and-forth motion and a circular motion. Several components make up the hip joint: bones, cartilage, ligaments, tendons, muscles, synovium (a thin fluid cover that wraps around bones providing lubrication), and bursa (fluid-filled sacs that provide cushioning and a smooth surface for the bones, muscles, and tendons in the joints to move on).

WHAT IS INFLAMMATORY ARTHRITIS OF THE HIP?

Also classified as an autoimmune disorder, inflammatory arthritis is a grouping of the types of arthritis involving the immune system. In autoimmune disorders, the body sends errant messages to cells with immune function, including white blood cells, instructing them to attack the body’s tissues. The damaged tissues cause deformity, instability, and scarring within the joints. These diseases are characterized by the presence of white blood cells in the joint fluid. The most common types of inflammatory arthritis affecting the hip include:

Rheumatoid Arthritis (RA): Rheumatoid arthritis is a chronic auto-immune disease that primarily affects the joints. The hip joint, like other joints in the body, is protested by a special capsule that completely. surrounds the joint. This capsule has a special lining (the synovial lining) and is filled with lubricant that helps the joint move smoothly. Rheumatoid arthritis typically causes a swelling of the synovial lining. This causes pain and swelling, but eventually, rheumatoid arthritis can cause the bone and cartilage of the joint itself to deteriorate. Rheumatoid arthritis often involves the same joint on both sides of the body, so both hips may be affected. Rheumatoid arthritis is more common in people with a family history of the condition. And similarly to OA, it also tends to affect more women than men. About 1.3 million Americans suffer from rheumatoid (RA) arthritis. This chronic inflammatory arthritis affects two to three times as many women as men. Although it is most commonly associated with joints of the hands and wrists, RA is a chronic, progressive autoimmune disease that can also affect the hip in 15% to 28% of patients with RA.

Ankylosing spondylitis (AS): Hip pain with AS can be caused by inflammation where tendons and ligaments attach to the hip bones. Many people with AS who have hip pain experience it bilaterally, meaning it happens in both hips. It tends to be diagnosed much more frequently in men than women, at a ratio of four to one. With ankylosing spondylitis hip pain, the sacroiliac (SI )joint is swollen, deformed, and painful, as there’s some bony erosion. This triggers the body to create new bone, which is responsible for the hip joint becoming rock solid which greatly limits movement. Ankylosing spondylitis is a chronic inflammation of the spine and sacroiliac joint (the joint where the spine meets the pelvis) which can sometimes cause inflammation and pain in the hip joint. Ankylosing spondylitis can occur in people of all ages, including children, and typically starts in a person between the ages of 17 and 35. It is more common in men than women. It is typical for people with ankylosing spondylitis to experience flares, when the condition is worse, followed by periods of remission with mild to no symptoms.

Psoriatic arthritis (PsA): PsA  Like other forms of inflammatory arthritis, PsA develops when the body mistakenly attacks healthy tissue, joints, and ligaments which can cause stiffness, pain, and tenderness. As the name sounds, this type of arthritis is related to the skin condition psoriasis.  Most people with psoriatic arthritis have the skin condition first (scaly red patches of skin). Approximately 30% of people with psoriasis may develop PsA within 10 years after psoriasis begins. It is estimated that up to 15% of people living with PsA will develop inflammatory arthritis of the hip

Juvenile Idiopathic Arthritis (JIA): JIA is an umbrella term for several types of inflammatory arthritis that occur before the age of 16. In approximately 20-40% of JIA patients, the hip joint will be afflicted by chronic synovitis that leads to pain and stiffness due to ongoing inflammation and progressive joint destruction.

Less common types of inflammatory arthritis of the hip include:

• Systemic lupus erythematosus
• Reactive arthritis
• Inflammatory bowel disease-related arthritis
• Sarcoidosis
• Arthritis induced by immune checkpoint inhibitors (chemotherapy)

CAUSES

While it’s not known what causes inflammatory arthritis in every patient, what is known is that the immune system does not know when to put on the brakes. Normally when one is exposed to bacteria, viruses, or fungi, the immune system produces white blood cells called lymphocytes as well as immune proteins to mount an attack against these invaders. Lymphocytes and immune proteins cause inflammation, which under typical circumstances is limited and resolves once the foreign substance is defeated. But in someone with inflammatory arthritis, the immune response does not know when to stop. It turns on your body, attacking one’s tissues instead of the foreign substance, and causes continued inflammation. If someone has lived with it for some time, arthritis can develop and become worse, spreading from affected areas. Early rheumatoid arthritis tends to affect smaller joints first — particularly the joints that attach the fingers to the hands and the toes to the feet. As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, shoulders, and on to inflammatory arthritis of the hip.

SYMPTOMS

Regardless of the type of arthritis, symptoms of arthritis of the hip include:

Pain in the hip joint that may include pain in the groin, outer thigh, or buttock

Pain that is typically worse in the morning and lessens with activity

Difficulty walking or walking with a limp

Pain that worsens with vigorous or extended activity

Stiffness in the hip or limited range of motion

NON-SURGICAL TREATMENTS

• Conservative treatments aim to reduce inflammation, relieve pain, preserve joint function, and prevent further damage. This may include:
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
• Disease-modifying antirheumatic drugs (DMARDs) that act on the immune system to help slow the progression of disease
• Biologic therapies are genetically engineered proteins that target specific parts of the immune system that trigger inflammation Corticosteroids taken by mouth or injections.
• Physical therapy to increase the range of motion in the hip and strengthen muscles that support the joint
• Regular moderate exercise such as swimming
• Assistive devices such as a cane, walker, or reacher device make it easier to perform tasks of daily living

WHEN IS SURGERY INDICATED?

If nonsurgical treatments do not sufficiently relieve pain, surgery may be recommended. The type of surgery performed depends on several factors, including age, condition of the hip joint, which disease is causing the inflammatory arthritis and 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 is often recommended for patients with rheumatoid arthritis or ankylosing spondylitis to relieve pain and improve range of motion. 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.

GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.

Diagnosing inflammatory arthritis of the hip is like diagnosing many different conditions. Each type presents with its own symptoms and it takes skilled, experienced experts like those at Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, to determine your unique situation and be able to create the best treatment plan. Diagnosis of inflammatory arthritis of the hip typically involves a combination of medical history, physical examination, blood tests (to check for markers of inflammation like C-reactive protein and antibodies like rheumatoid factor), imaging studies (X-rays, MRI, or ultrasound), and sometimes joint fluid analysis (arthrocentesis) to rule out infection. Although there is no cure for inflammatory arthritis, there have been many advances in treatment, particularly in the development of new medications. Ever attentive to their patient’s needs, the first-class surgeons at CCOE are always at the cutting edge. In addition to their advanced knowledge and extensive skills, their compassionate and approachable surgeons can help alleviate anxiety and build trust, making your journey to recovery smoother and more successful.