What is the diagnosis for a 63-year-old male patient presenting with right hip pain and radiographic evidence of early degenerative (osteo)arthritic changes of the right hip?

From the Guidelines

For a 63-year-old male with right hip pain and early degenerative arthritic changes on x-ray, I recommend starting with conservative management, as imaging is not required to make the diagnosis in patients with typical presentation of OA, according to the EULAR recommendations 1. The patient's symptoms and clinical signs should be the primary focus for diagnosis and treatment decisions, rather than relying solely on imaging results.

• The initial treatment plan should include acetaminophen (Tylenol) 650-1000mg every 6 hours as needed for pain, not exceeding 3000mg daily.
• If inadequate relief occurs, add an NSAID like ibuprofen 400-600mg three times daily with food (if no contraindications such as kidney disease, heart failure, or gastric ulcers exist).
• Physical therapy focusing on hip strengthening and range of motion exercises should be initiated twice weekly for 6-8 weeks.
• Weight loss is advised if the patient is overweight, aiming for 5-10% reduction over 6 months.
• Activity modification to avoid high-impact activities while maintaining movement is important.
• A cane held in the opposite hand can reduce hip joint forces by 20-30%.
• Topical NSAIDs like diclofenac gel 1% applied to the hip area four times daily may provide additional relief with fewer systemic side effects. If these measures fail after 4-6 weeks, consider referral to orthopedics for evaluation of intra-articular corticosteroid injections or discussion of surgical options if symptoms significantly impact quality of life, as recommended by the EULAR guidelines 1 and supported by the International Hip-Related Pain Research Network 1.

From the Research

Treatment Options for Hip Pain

The patient is experiencing right hip pain with early degenerative arthritic changes. The following treatment options can be considered:

• First-line pharmacologic agents for mild to moderate pain include acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3
• The choice between acetaminophen and NSAIDs depends on the type of pain and patient risk factors for NSAID-related adverse effects 2, 3
• Intra-articular corticosteroid injections can provide short-term pain relief for joint pain, including hip pain 4, 5
• The efficacy of intra-articular corticosteroid injections may vary depending on the joint and the specific condition being treated 4, 5

Considerations for Treatment

When considering treatment options, the following factors should be taken into account:

• Patient risk factors for NSAID-related adverse effects, such as gastrointestinal, renovascular, or cardiovascular effects 2, 3
• The potential for adverse events associated with intra-articular corticosteroid injections, including increased blood glucose, adrenal suppression, and detrimental effects on cartilage lining the joint 4
• The need for individualized treatment plans, taking into account the patient's specific condition, medical history, and treatment expectations 3

Additional Therapies

Additional therapies that may be considered for the treatment of hip pain include:

• Physical therapy and rehabilitative interventions, which may be used in conjunction with pharmacologic treatments or intra-articular injections 6
• Hyaluronic acid intra-articular injections, which may be used to improve joint lubrication and reduce pain 6, 5