From healthcentral.com
Stiff, sore joints are par for the course with this disease. We asked the experts what you can do about it
If you’re living with psoriatic arthritis (PsA), you know how hip pain can be a major life-disrupter. The challenge with psoriatic arthritis—an autoimmune condition with no cure—is finding ways to manage chronic pain so that it doesn’t prevent you from living an active life. When it comes to your hips, there are a few tools you can use to lessen your discomfort.
Let’s take a look at how PsA affects the hips, other possible causes of hip pain, and how you can treat it. Experts say the sooner you begin treating hip pain in psoriatic arthritis, the better your health outcomes. Start here.
Psoriatic Arthritis and Inflammation
To understand the root of your hip discomfort, you need to begin with the underlying cause of PsA itself. Psoriatic arthritis is a disease in which the immune system mistakenly attacks the body, triggering inflammation that often leads to stiff and sore joints. While the specific joints causing you pain may differ than someone else with the disease, psoriatic arthritis doesn’t discriminate when it comes to causing pain. “Psoriatic arthritis is a full body disease,” says Laura Coates, Ph.D., an associate professor and researcher of psoriatic arthritis at the University of Oxford in England. “PsA can affect many different types of tissues, including tendons, skin, and spine, and can affect any joint in the body.”
Psoriatic arthritis symptoms related to inflammation can be mild or severe and can come and go. When inflammation-driven symptoms are at their worst, it is called a flare.
Signs of Inflamed Hips
For some people, that inflammation makes it’s way down to the hips. Your hip joint sits between your thigh bone (femur) and your hip bone (pelvis). This joint is made up of a ball and socket—the round part of your femur fits into a cup-like socket in your pelvis. It is one of the largest joints in your body and involves ligaments, tendons, and muscles as well as a fluid filled sac called a bursa.
If your psoriatic arthritis is affecting one or both of your hip joints (known as bilateral hip pain), it won’t come as a surprise to your rheumatologist. In a study published in the journal Annals of Rheumatic Diseases, almost half of the participants with PsA developed hip pain within one year after the onset of the disease.
So what are the signs to look for with psoriatic arthritis-related hip pain? “Hip involvement with PsA can be tricky to identify since swollen hips are hard to see or feel,” says Coates. These are a few red flags to watch for:
Arthritis in other joints. Pain in hands and/or feet may indicate a higher risk for hip pain, says Coates.
Back pain. “Some patients with hip pain have significant spinal arthritis,” Coates explains.
Morning hip pain. Also, pain at night when you are lying in bed.
Pain at rest
Pain when going from a seated position to a standing position
Walking pain
Diagnosing Hip Pain in Psoriatic Arthritis
When diagnosing hip pain, the type of pain as well as location can reveal a lot. Is the pain short and sharp? Throbbing? Or a constant dull ache? With psoriatic arthritis, hip pain is likely to feel like significant morning stiffness, pain with activity, and limited range of motion, per The American Journal of Orthopaedics.
What’s more, it’s important to determine if the pain is directly related to the hip or if it’s what doctors call referred pain, meaning it originates somewhere else on your body even though you feel the pain sensation in your hip area, says Waseem Mir, M.D., a rheumatologist at Lenox Hill Hospital in New York City. “It’s possible the pain is coming from the bursa, back, or knee,” he says. Pain related to the bursa is known as psoriatic arthritis hip bursitis.
“If the pain is coming from the hip, then it needs to be determined if the pain is due to osteoarthritis (caused by wear and tear) or inflammatory arthritis,” Dr. Mir says, adding that there are some clues that can help differentiate between the two types of arthritis. “Some hints that can help include the age of the patient—if someone is in their 60s or 70s, it’s possible the pain is due to osteoarthritis,” he says. “An x-ray can help us understand more. If the x-ray is normal, then it is more likely it is due to inflammation.”
Another piece of information your doctor will use in making a diagnosis? Whether your hip pain is following a previous pattern of joint pain. “We can narrow it to inflammation-related psoriatic arthritis pain if it is following a pattern, such as previously there was hand pain, then elbow pain, then knee pain,” Dr. Mir explains.
Other Conditions That Can Cause Hip Pain
While hips are a common target of psoriatic arthritis, other causes of hip pain that should be investigated, according to the Mayo Clinic, include:
Bursitis
Hip fracture
Hip labral tear
Inguinal hernia
Iliotibial band syndrome
Infection
Sprains
Osteoarthritis of the hip
Osteonecrosis of the hip
Treating Hip Pain Due to Psoriatic Arthritis
The good news: “There are lots of different treatments we can use to help hip pain,” says Coates. For short term relief, local therapies are used to reduce the inflammation around the hip, such as a steroid injection into the hip joint, she says.
“For longer term relief, the whole-body inflammation caused by psoriatic arthritis needs to be addressed,” Coates adds. “We use systemic treatments, particularly if people have quite a few joints involved.” These include:
Anti-inflammatory drugs
Corticosteroids
Methotrexate and other traditional disease-modifying anti-rheumatic drugs (DMARDs)
Biologic therapies
There are also ways to help manage the pain at home, which—while no substitute for medication—may offer temporary relief, including:
Gentle stretching
Ice packs
Moderate exercise
Moist heat
Physical therapy for psoriatic arthritis may also be an important tool to ease hip pain both short term and long term. “Physical therapy should happen alongside treating the inflammation,” says Coates. “It’s really important for controlling pain and maximising function.” Usually, she explains, your rheumatologist will work to control inflammation first and then use physical therapy as a supplementary treatment to people regain strength and muscle tone that can be lost from lack of activity in people with PsA-related hip pain.
Complications of Psoriatic Arthritis Hip Pain
Even if you feel like you are learning to live with stiff and achy hips, you should still bring it to your provider’s attention, says Dr. Mir. “Untreated psoriatic arthritis is erosive, and the constant inflammation can damage joints over time,” he explains.
Left untreated, psoriatic arthritis hip pain can result in complications that include causing you to walk with a different gate or put less weight on that leg, called compensation. Over time, that can lead to weakness on one side of the body, or the development of new pain further along the kinetic chain (interconnection of muscles that are involved in specific movements like walking). In the worst cases, hip pain can become so severe that you’re unable to walk, according to Harvard Medical School.
Though it’s little consolation, if you are living with PsA, it’s not surprising that you have hip pain. The experience is common—and also treatable. Whether it’s a signal to your rheumatologist that you need more or different medication to control the inflammation associated with your disease, or it’s a sign that you should adopt certain lifestyle changes to lessen your hip discomfort, there are meaningful ways to manage PsA hip pain.
https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-hip-pain
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