viernes, 22 de febrero de 2019

Hip Rheumatoid Arthritis

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By Ananya Mandal, MDReviewed by April Cashin-Garbutt, MA (Cantab)

Rheumatoid Arthritis (RA) may affect the hip joints. In this condition there may be severe inflammation of the hip joint resulting from systemic illness. Rheumatoid arthritis is a disease that affects the immune system and affects multiple joints on both sides of the body at the same time.

Symptoms of rheumatoid arthritis affecting the hips

The classic symptom of rheumatoid arthritis affecting the hips is joint pain. The pain is usually dull, aching and is located near the groin, outer thigh, or buttocks.

Like typical rheumatoid arthritic joints, the pain is worse in the morning and lessens with activity. With vigorous activity, however, the pain may worsen.

Accompanied with pain is stiffness and disability. The patient slowly is restricted in his or her movements until completely disabled and crippled with the disease.

Diagnosis of hip rheumatoid arthritis

The diagnosis is based on the same principles as diagnosis of rheumatoid arthritis of other joints. The diagnosis is initiated with a detailed history of the onset and severity of the symptoms as well as family history of rheumatoid arthritis or other autoimmune disorders.

The next step involves physical examination where the affected and other joints are examined for swelling, pain and signs of inflammation. The range of movement of the hips is noted.

There are several patient based questionnaires and measures called health assessment questionnaires (HAQ) that measure patient disability and quality of life. In addition these questionnaires also measure the patient’s own perception of the disease burden.

There are batteries of tests that may be employed in the diagnosis, however, none of these are definitive. Due to inflammation, blood tests such as C Reactive protein and Erythrocyte sedimentation rate (ESR) may be raised. These are, however, non specific markers of inflammation.

Rheumatoid factor is a relatively specific test. There is presence of this indicative factor in nearly 80% of all persons with rheumatoid arthritis. Presence of rheumatoid factor may not be detected in early stages of the disease. In addition around 1 in 20 healthy persons may test positive for rheumatoid factor. Thus presence of rheumatoid factor is not absolutely indicative of rheumatoid arthritis.

Several imaging studies like X rays, MRI scans and CT scans may be ordered to look at the extent of joint damage caused by the disease.

Treatment of hip rheumatoid arthritis

The aims of treatment are twofold:

to relieve the symptoms of the disease
to prevent the disease progression and joint damage

Pain relievers and anti-inflammatory agents

To ease the symptoms pain relievers and anti-inflammatory agents are the primary mode of therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) are the drugs used widely to control symptoms of rheumatoid arthritis.

Over years NSAIDs have been replaced by other more effective agents in reducing joint inflammation. This is because of their adverse side effect profiles. NSAIDs are notorious for causing gastric ulcers, gastrointestinal complications, kidney damage and heart disease. These agents, however, may be administered over the short term.

Disease-modifying anti-rheumatic drugs (DMARDs)

To prevent progression of joint damage Disease-modifying anti-rheumatic drugs or DMARDs are widely used. These agents have a varied mechanism of action and they act by reducing joint swelling and pain, decreasing markers of acute inflammation in blood and halting the progressive joint damage.

DMARDs include Methotrexate, Sulfasalazine, Leflunomide, Hydroxychloroquine, Gold salts and Ciclosporin. DMARDs, however, are also associated with a varying degree of side effects.

Biological agents

A newer approach is to use biological agents. TNF inhibitors were the first licensed biological agents including etanercept, infliximab, adalimumab and certolizumab. This was followed by monoclonal antibodies like abatacept, rituximab, and tocilizumab.

Supportive treatment

Supportive treatment includes exercise, joint protection, psychological support to help deal with the associated symptoms and disability.

Physiotherapy is an important part of therapy of debilitating arthritis. This helps maintain optimum joint flexibility and strength.

Assistive devices, such as a cane, walker, long shoehorn etc. may help cope with disability associated with hip rheumatoid arthritis.

Surgery

Surgery may be performed to retain joint function or prevent loss of joint function. Joint replacement therapy may be chosen. This is vital when joints fail.

There are different types of surgery to correct joint problems. Total hip replacement is often recommended for patients with rheumatoid arthritis.