What are the early degenerative arthritic changes of the right hip, specifically osteoarthritis (OA)?

From the Guidelines

Early degenerative arthritic changes in the right hip can be managed with a combination of non-pharmacological and pharmacological approaches, prioritizing weight management, low-impact exercises, and physical therapy to reduce inflammation and mechanical stress on the joint. According to the most recent evidence from 1, non-pharmacological core management of hip osteoarthritis is crucial in alleviating symptoms and improving physical function.

Non-Pharmacological Interventions

Key non-pharmacological interventions include:

• Weight management, as each pound lost reduces hip pressure by 3-6 pounds
• Engaging in low-impact exercises such as swimming, cycling, or water aerobics for 30 minutes, 3-5 times weekly
• Physical therapy focusing on hip-specific exercises to improve function and reduce pain
• Applying heat before activity and ice after to manage inflammation
• Using assistive devices like a cane in the opposite hand if walking is painful

Pharmacological Interventions

If non-pharmacological interventions provide insufficient relief, consider pharmacological approaches. Although the evidence for specific pharmacological interventions in hip OA is limited, as noted in 1, acetaminophen and NSAIDs are commonly recommended for pain management.

Recommendations

I recommend starting with acetaminophen (Tylenol) 650-1000mg every 6 hours as needed for pain, not exceeding 3000mg daily. If this provides insufficient relief, consider non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 400-600mg three times daily with food or naproxen 220-500mg twice daily. It is essential to consult a physician before starting any new medication, especially if considering corticosteroid injections or referral to an orthopedic specialist for further management.

Future Directions

Given the lack of hip-specific data for some interventions, as highlighted in 1, and the increasing global burden of OA, there is a need for more clinical trial data specific to hip OA. The update of EULAR recommendations for the non-pharmacological core management of hip and knee OA, as discussed in 1, emphasizes the importance of evidence-based management and the need for increased awareness and uptake of best evidence care.

From the Research

Early Degenerative Arthritic Changes of the Right Hip

• Early degenerative arthritic changes of the right hip can be associated with osteoarthritis (OA), which is the most common joint disease, affecting an estimated more than 240 million people worldwide, including an estimated more than 32 million in the US 2.
• Osteoarthritis can involve almost any joint but typically affects the hands, knees, hips, and feet, and is characterized by pathologic changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of valued activities 2.
• Risk factors for OA include age, female sex, obesity, genetics, and major joint injury, and persons with OA have more comorbidities and are more sedentary than those without OA 2.
• Several physical examination findings are useful diagnostically, including bony enlargement in knee OA and pain elicited with internal hip rotation in hip OA, and radiographic indicators include marginal osteophytes and joint space narrowing 2.

Diagnosis and Treatment

• The cornerstones of OA management include exercises, weight loss if appropriate, and education-complemented by topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) in those without contraindications 2.
• Intra-articular steroid injections provide short-term pain relief and duloxetine has demonstrated efficacy, while opiates should be avoided 2.
• Clinical trials have shown promising results for compounds that arrest structural progression or reduce OA pain 2.
• Persons with advanced symptoms and structural damage are candidates for total joint replacement, and education, exercise, and weight loss are cornerstones of management, complemented by NSAIDs, corticosteroid injections, and several adjunctive medications 2, 3.

Weight Loss and Physical Function

• Overweight and obesity increase the risk of development and progression of knee OA, with higher levels of fat mass and lower levels of lean mass associated with poorer functional status 4.
• Weight loss interventions may provide small to moderate improvements in pain and disability for OA compared to minimal care, and better retention of lean mass and muscle strength was observed in participants with higher protein intake 4, 3.
• A systematic review with meta-analysis found that weight-loss interventions had a moderate effect on pain intensity and a small effect on disability in people with OA 3.