Hip swelling and stiffness
The hip joint joins the femur (thigh bone) to the pelvis using a special type of ball and socket joint. It supports much of the weight of the body and provides stability while moving and standing still. Hip involvement in RA can make mobility difficult and is associated with significant disability.
As is true with RA and joints throughout the body, the sooner diagnosis is made and treatment initiated, the greater the likelihood that joint damage can be minimized or prevented. The availability of disease-modifying anti-rheumatic drugs (DMARDs) and newer biologics that are effective at slowing or preventing structural damage to the joints means that the joints and other structures in the region of the hip can often be preserved and function maintained.
How does RA affect the hip?
Involvement in large joints, such as the hip, tends to occur in later stages of RA. Only 10% of patients who have been diagnosed with RA for less than 10 years will experience hip involvement. However, 40% of patients with a longer history of RA may develop problems affecting the hip. Hip involvement may be difficult to detect, as swelling may not be evident on physical examination. Up to half of patients with RA-related hip disease may not experience any symptoms. Others may complain of stiffness and limited range of motion, as well as pain in the groin or the inside of the knee.1,2
How is RA-related hip involvement treated?
Treatment of RA symptoms affecting the hip depends on the severity of symptoms and the nature and extent of damage, as well as the patient’s goals and needs. Options include drug and non-drug treatments, and surgery.3
Drug treatments. The initial approach to treatment should involve medications to control inflammation and pain (including analgesics [NSAIDs], disease-modifying anti-rheumatic drugs [DMARDs], and glucocorticoids).3
Injection of glucocorticoids directly into the hip may be useful in controlling acute inflammation. However, glucocorticoids will not prevent progression of the disease and structural damage to joints.3
Non-drug management approaches. A program of physical therapy to maintain range of motion, strength, and flexibility may be useful in minimizing pain and preventing further joint damage by strengthening supporting musculature. Water exercises may be particularly useful because they minimize stress on the joint. Use of supportive devices, including impact-absorbing inserts or shoes, canes, or braces may improve mobility. Other interventions that may be useful in controlling pain include water exercises or application of heat or cold. Alternative therapeutic techniques, including acupuncture, magnetic pulse therapy, and transcutaneous electrical nerve stimulation (TENS), may also be useful in relieving pain.3
Surgery. If joint symptoms do not respond to medication or other management approaches, surgical interventions may be used. Surgical options include3,4:
Total hip replacement is often used in RA and is effective in providing pain relief and improving motion. The main challenge in performing hip replacement in patients with RA is dealing with bone loss and low bone mineral density.4
Synovectomy involves removal of some or all of the joint lining and may be used in cases where joint damage is limited to the lining and the cartilage is still in tact.3