How Does Psoriatic Arthritis Affect the Hips?
The chronic, inflammatory disease process of psoriatic arthritis (PsA) can affect any joint in the body. When one or both hips are involved in PsA, individuals can experience pain, stiffness, and difficulty walking. PsA can be either asymmetrical (affecting only one hip) or symmetrical (affecting both hips).
In addition to its effects on the joints, PsA can cause inflammation, known as enthesitis, in the tendons and ligaments that attach muscle to the bones. The synovial tissue, the fluid-filled capsule between the bones, can become inflamed. PsA can appear as sacroiliitis, which refers to inflammation in the joints between the spine and the pelvis.1-4
How can inflammation in the hips be diagnosed?
Diagnosis is often made through clinical evaluation and imaging, particularly using ultrasound or MRI (magnetic resonance imaging), which are more sensitive than x-ray to detect inflammatory changes in individuals with PsA. Ultrasound is useful for detecting structural changes and abnormal blood flow. MRI allows for visualization of soft tissue as well as bony changes.1
The hips are rarely involved in those with PsA, and it is estimated that the hips become inflamed due to PsA in less than 10% of cases.5,6 Individuals with the onset of PsA before age 30 seem to be at the greatest risk for hip involvement, especially if they have axial (spinal) involvement.5
What do symptoms look like?
Symptoms of PsA in the hips include:
- Pain in the hip joint, which may include pain in the groin, outer thigh, or buttocks
- Pain or stiffness, especially first thing in the morning or after a period of rest
- Difficulty walking, or walking with a limp
- Stiffness or reduced range of motion2,3
- Sexual intercourse may be painful, especially for women with PsA that affects the hips.7
What are treatment options?
Minor pain and stiffness of mild PsA can be alleviated with non-steroidal anti-inflammatory drugs (NSAIDs). In addition, injections of corticosteroids may be used.4
For moderate to severe disease, treatments that target joint disease in PsA can reduce symptoms and prevent disease progression. Recommended treatments include disease-modifying anti-rheumatic drugs (known as DMARDs).
The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor (TNF), a chemical that produces a wide range of inflammation in PsA. Examples of TNF blockers include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi), and certolizumab pegol (Cimzia). Other DMARDs that have proven effective in clinical trials include ustekinumab (Stelara), brodalumab (which is awaiting FDA approval), and secukinumab (Cosentyx). 1 The FDA has also recently approved Inflectra (infliximab-dyyb), a biosimilar to infliximab, for the treatment of psoriatic arthritis.8
Physical and occupational therapy can be critical treatment approaches to both protect the involved joints and maintain function. A physical therapy program generally includes various exercises and stretches, applied heat and/or cold, orthotics, assistive devices for gait, and possible vocational readjustments.2
Surgical care may be indicated for severe disease. Arthroscopic surgery to the synovial capsule has shown to be effective, and joint replacement or reconstructive surgery are occasionally necessary.2