What is the treatment for bilateral hip and sacroiliac (SI) joint osteoarthritis (OA) in a 42-year-old male?

From the Guidelines

Treatment for bilateral hip and sacroiliac (SI) joint osteoarthritis (OA) in a 42-year-old male should prioritize a multimodal approach, focusing on non-pharmacological interventions and pharmacotherapy, with the goal of minimizing morbidity, mortality, and improving quality of life. Initially, I recommend non-pharmacological interventions including:

• Weight management if overweight, as suggested by the 2020 VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip & Knee Osteoarthritis 1
• Physical therapy focusing on core strengthening and hip mobility exercises, as recommended by the EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis 1
• Activity modification to reduce joint stress

For pain management, start with:

• Acetaminophen 500-1000mg every 6 hours (not exceeding 3000mg daily), as suggested by the 2020 VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip & Knee Osteoarthritis 1
• Consider NSAIDs like naproxen 500mg twice daily or ibuprofen 400-600mg three times daily with food for 2-4 weeks, then as needed, as recommended by the 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1
• Topical NSAIDs like diclofenac gel 1% applied to the affected areas four times daily can provide localized relief with fewer systemic effects

It is essential to note that opioids, including tramadol, are not recommended for managing OA pain due to their limited benefit and high risk of adverse effects, as stated in the 2020 VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip & Knee Osteoarthritis 1. Instead, consider duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, which has been shown to achieve significant reductions in pain outcomes for patients with OA, as suggested by the 2020 VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip & Knee Osteoarthritis 1.

Intra-articular corticosteroid injections and assistive devices like a cane or walking poles can also be considered to reduce joint loading and provide temporary relief. At this young age, joint preservation is crucial, so surgical options like hip arthroplasty should be reserved for cases with severe functional limitation unresponsive to conservative measures. This comprehensive approach addresses inflammation and pain while preserving joint function and mobility, ultimately prioritizing the patient's quality of life and minimizing morbidity and mortality.

From the FDA Drug Label

In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease For a 42-year-old male with bilateral hip and SI joint OA, naproxen may be used to reduce joint pain or tenderness and improve mobility.

• The therapeutic action of naproxen has been demonstrated in patients with osteoarthritis.
• Key benefits of naproxen in OA patients include:
  • Reduction in joint pain or tenderness
  • Increase in range of motion in knee joints
  • Increased mobility
  • Improvement in capacity to perform activities of daily living impaired by the disease 2

From the Research

Treatment Options for Bilateral Hip and SI Joint OA

• The treatment for osteoarthritis (OA) typically involves a combination of non-pharmacological and pharmacological interventions 3.
• Non-pharmacological interventions include exercises, weight loss, and education, which are considered the cornerstones of OA management 3.
• Pharmacological treatments for OA include:
  • Acetaminophen: shown to be effective in reducing pain, but may not be as effective as non-steroidal anti-inflammatory drugs (NSAIDs) in improving function 4, 5.
  • NSAIDs: effective in reducing pain and improving function, but may have increased risks in patients with certain comorbidities, such as cardiovascular disease 4, 3, 6.
  • Intra-articular corticosteroid injections: provide short-term pain relief and have relatively minor adverse effects 3, 6.
  • Duloxetine: has demonstrated efficacy in reducing OA pain 3.
  • Topical NSAIDs and capsaicin: may be considered for patients who cannot tolerate oral NSAIDs or have certain comorbidities 6.

Considerations for Treatment

• The choice of treatment should be individualized based on the patient's symptoms, medical history, and preferences 5, 6.
• Patients with moderate-to-severe levels of pain may benefit from NSAIDs, while those with mild pain may be managed with acetaminophen or other non-pharmacological interventions 4, 5.
• Clinicians should consider the latest evidence and recommendations when making treatment decisions for patients with OA 6.