How Does Psoriatic Arthritis Affect the Hips?

Psoriatic arthritis (PsA) is a chronic inflammatory disease that can affect any joint in the body, including the hips. When one or both hips are involved in PsA, people can experience pain, stiffness, and trouble walking.¹

PsA is less common in the hips than in other joints in the body, such as the hands, feet, wrists, and ankles. When a person has PsA in the hips, it is commonly linked with pain in the spine and back as well. This is caused by inflammation in the joints between the vertebrae of the spine, which is called spondylitis.^1,2

PsA might affect only one hip (asymmetrical) or both hips (symmetrical).^1,2

What are the symptoms?

PsA symptoms vary from person to person. When the hips are affected, symptoms can include:^1-3

• 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 motion
• Waking up in the night with pain
• Pain during sex

These symptoms stem mainly from inflammation in the hip joints. In addition to its effects on the joints, PsA can cause inflammation where tendons and ligaments connect to bones (enthesitis). Tendons connect muscles to bones, and ligaments connect bones to one another.^2,3

PsA can also appear as sacroiliitis, which is inflammation in the joints between the spine and the pelvis.^2,3

How is it diagnosed?

Unfortunately, there is no single test that can tell whether you have PsA. Your doctor or rheumatologist may perform multiple exams to make a diagnosis. These include:^1-3

• Medical history – Your doctor will go over your medical history, ask whether anyone in your family has or had PsA, and ask you about your symptoms.
• Physical exam – Your doctor will look for joint pain, swelling, tenderness, limited range of movement, and skin and nail changes.
• Lab tests – Blood tests can be used to look for signs of inflammation.
• Advanced imaging – X-ray, MRI, and ultrasound can provide clearer pictures of bones and joints inside your body.

An early PsA diagnosis is critical in helping to slow down disease progression and manage symptoms. Tell your doctor if you have any signs or symptoms that you think might be PsA.³

How is PsA in the hips treated?

For mild cases of PsA and minor hip pain, non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling. Your doctor might also use steroid injections.^1-3

For moderate to severe pain, drugs that target joint disease can treat symptoms and prevent the disease from progressing further. Recommended treatment options may include:^1-3

• Disease-modifying anti-rheumatic drugs (DMARDs) – These drugs can reduce symptoms as well as slow down the disease and resulting joint damage.
• Biologics – Biologics are targeted drugs that fight inflammation in people with PsA.
• Anti-tumor necrosis factor (TNF) agents – These drugs are also meant to stop inflammation in the body. Anti-TNF agents may be considered if DMARDs or biologics are not working.

Surgery may be needed if PsA in the hips is severe. Arthroscopic surgery to the tissue lining the inside of the hip joint (synovial capsule) has been effective in some people. In arthroscopic surgery, the surgeon uses just a small incision and a camera to guide their work. Joint replacement or reconstructive surgery is occasionally necessary.¹

Physical and occupational therapy can help protect the hips and maintain function. This therapy may include low-impact exercises like swimming, as well as stretching, heat/cold therapy, and massage therapy. Physical therapy can be an effective complementary treatment to drug treatment.^1-3

Treatment for PsA in the hips may be different from that for other PsA symptoms. If you have PsA and start to experience any hip, back, or spine pain, talk to your doctor about your treatment options. They may recommend a combination of drug treatment and non-drug therapies like regular exercise and physical therapy.^1-3

Healthy habits and self-care for hip pain

Healthy lifestyle habits can help reduce hip pain. Try to do some of these in your everyday routine:^1-4

• Manage stress. Stress can add inflammation to the body. Take steps to reduce your overall stress. Try meditation, yoga or tai chi, or talk therapy.
• Eat an anti-inflammatory diet. Sugar and processed foods cause inflammation in the body. Cutting back on these foods can improve your overall health and reduce inflammation. Eating an anti-inflammatory diet of lean protein, vegetables, and whole grains also can help lower inflammation. Finally, these steps may help you lose weight, which can ease pressure on your body’s joints.
• Exercise regularly. Regular exercise is an important part of maintaining joint mobility and function for people with PsA in the hips. It can also ease pain and discomfort. But do not forget to rest, and do not overdo it. You can modify certain exercises if you experience frequent hip pain.
• Use heat and cold. A warm bath can help with sore joints. A cold compress can help reduce swelling.
• Stop smoking. Smoking can speed up PsA disease progression and interfere with PsA treatment. If you smoke, take steps to quit.