Rheumatoid Arthritis of the Hip

• Pain, often severe, is present over the hip joint, groin, and can be referred down the leg to the knee, often affecting both the right and left joints.
• Swelling and inflammation of the joint.
• The joint will feel hot or warm to the touch.
• Stiffness and loss of motion of the hip when moving the hip in several different directions.
• Weakness, which may be manifested as difficulty walking, getting up from a sitting position, kneeling, squatting and climbing stairs.
• Fatigue or tiring easily when performing normal daily activities

Treatment of Rheumatoid Arthritis of the hip will depend on the severity of the condition. Some important guidelines should be followed at the onset:

The ideal treatment involves a combination of medication, rest, joint range of motion and strengthening exercises, joint protection strategies and patient education. Restoring range of motion and strength is paramount to maintaining function. Treatment is customized depending on the individual’s age, level of function, acute vs. chronic flare up, pain level and general health.

• Rest: avoid the activities that produce the pain. Avoid jumping, running, going up and down stairs, kneeling, squatting and walking for extended periods of time.
• Ice or moist heat: apply ice to the joint or area experiencing pain or inflammation. It is one of the fastest ways to reduce swelling, pain, and inflammation. Individuals with rheumatoid arthritis may not tolerate ice well. The application of moist heat may be helpful with stiff joints. The application of ice or heat should be done at intervals for about twenty minutes at a time. Do not apply directly to the skin.
• Compression: when using ice, apply light compression. This is especially helpful if swelling is present.
• Elevation: elevate the area to help reduce swelling.
• Movement: keep your joints moving whenever possible. When pain occurs the tendency is not to move, but this will only result in further loss of motion and lead to increased pain and loss of function.

Mild: In mild cases rest, ice and medication may be all that is needed to reduce the pain. Once the pain is reduced physical therapy is recommended to develop a series of stretching and strengthening exercises to prevent loss of motion, weakness, and function. Individuals are advised to avoid becoming sedentary; however, return to full activity should be gradual to prevent a flare-up of symptoms.

Moderate to Severe: If the problem persists, consulting your healthcare provider should be the next step. Your physician and/or physical therapist will perform a thorough evaluation to determine the severity of the condition and the best course of treatment.

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.

Your physical therapist will perform a thorough evaluation to assess and determine the following:

• Joint: a series of measurements will be performed to determine which joint is involved and the extent to which the inflammation is acute
• Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances
• Flexibility: range of motion measurements will be taken to determine if there is reduced joint movement
• Technique and ADL: the therapist will review what activities you have difficulty with and will help you make modifications in technique to reduce stress on the involved joint.
• Gait, Balance, and Alignment: the therapist will assess your gait and balance on even and uneven surfaces. An assistive device such as a cane or walker may be indicated to improve safety, gait and reduce stress on the affected joint.

Physical therapy for hip arthritis must remain conservative at the onset to avoid aggravating the condition. Emphasis will be placed on rest, reducing the inflammation, protecting the joint and increasing the blood circulation for healing. Once the initial inflammation has reduced, a program of stretching and strengthening will be initiated to restore flexibility and improve strength to reduce stress on the hip joint. An assistive device for ambulation, or moving around, may be necessary to decrease weight bearing on the hip and normalize the gait.

Common Physical Therapy interventions in the treatment of Rheumatoid Arthritis of the Hip include:

• Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility, and range of motion of the hip. The use of mobilization techniques also helps to modulate pain.
• Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the hip and lower extremity to support, stabilize and decrease the stresses placed on joint cartilage and the hip joint.
• Neuromuscular Re-education (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, walking, bending, or stair climbing) of the involved lower extremity to reduce stress on the joint surfaces in daily activities. Gait and balance training may be indicated in those individuals who have problems with walking.
• Modalities including the use of ultrasound, electrical stimulation, ice, cold, laser, and others to decrease pain and inflammation of the involved joint.

Avoiding the activities that produce the pain or stress the involved joint is the first line of treatment.

• RICE: Rest, Ice, Compression, Elevation should be used to reduce the stress on the joint.
• NSAIDs (Non-steroidal anti-inflammatory drugs) to reduce pain
• Use of an assistive device such as a cane or walker may reduce stress on the hip while reducing a limp or gait deviation.
• Injection of steroids may be indicated to reduce inflammation of the involved joint.
• In severe recurrent conditions, surgery may be indicated. In cases of severe arthritis or joint degeneration, a hip joint resurfacing or total hip replacement procedure may be recommended.

Medical Management of Rheumatoid Arthritis

Early aggressive medical care is recommended for individuals with Rheumatoid Arthritis. Interventions may include the following:

• The use of DMARD (disease modifying anti-rheumatic drugs).
• The use of NSAIDs (non-steroidal anti-inflammatory drugs)
• When indicated steroids in low doses will be prescribed to reduce joint inflammation.
• Physical and Occupational Therapy to develop a stretching and strengthening program.
• Bracing and splinting to protect and rest the involved joints
• Surgery may be indicated in severe cases. An arthroscopic procedure to remove an inflamed synovial lining is one surgical option. In the case of severe joint and cartilage degeneration, a total hip replacement is the preferred procedure.