Hip pain predicts disease progression in osteoarthritis

Denise Mann

June 11, 2004

June 11, 2004

San Francisco, CA - Symptomatic radiographic hip osteoarthritis (RHOA) predicts both radiographic and clinical disease progression, according to a new population-based community study [ 1 ]. The new report appears in the May 2004 issue of Arthritis & Rheumatism.

Of 936 hips among 745 elderly women who were followed for 8 years, 12.9% of women with baseline RHOA underwent total hip replacement (THR) and 22.8% had substantial worsening of lower-extremity disability. Overall, 64.6% of hips with RHOA showed radiographic progression or were replaced. Importantly, progression was greater by all measures in the 37% of hips and 47% of women with both RHOA and hip pain at baseline.

"Hip pain is the major predictor of progression in patients who have RHOA," lead study author Dr Nancy Lane (University of California, San Francisco) tells rheuma wire . "Community-based interventions to slow the progression of hip OA will need to target subgroups of patients with RHOA with the greatest likelihood of progression," the study concludes. Next, Lane says, she plans to ascertain "what the other important predictors of development and progression of hip OA are."


Progression less than seen in the clinic

Although progression was greater among people with hip pain, it was still substantially less frequent than previously reported for hip OA patients in clinical settings, the researchers report.

Specifically, of those with hip pain, 23.6% progressed to THR, compared with 2.7% of those without hip pain. Minimum joint space (MJS) decreased >0.5 mm in 53.7% of hips with pain, compared with 30.7% of hips without pain. Moreover, 29.3% of women with hip pain had worsened lower-extremity disability, compared with 17.6% without hip pain. Asymptomatic RHOA and hips with an isolated finding of mild joint-space narrowing (JSN) (MJS of 1.5 mm to 2.5 mm) were unlikely to progress over 8 years, researchers concluded.

As part of the Study of Osteoporotic Fractures, Lane et al reviewed baseline and follow-up anteroposterior pelvic radiographs in women aged 65 or older. In addition, researchers separately examined progression in hips with an MJS between 1.5 mm and 2.5 mm. Hips with an MJS >1.5 mm and <2.5 mm (n=1868) had primarily superomedial narrowing and comparatively low rates of progression that did not differ by hip pain. Femoral osteophytes, superolateral JSN, and subchondral bone changes were independent predictors of progression, the study showed.

Many studies have looked at the natural history and risk factors of knee OA, but there have been no studies of radiographic progression among community-dwelling individuals with RHOA.


Clinical ramifications

In an editorial accompanying the new study [ 2 ], Dr Maxime Dougados (René Descartes University, Paris, France) says that the new study "provides important data relevant to both the population and the individual."

He writes, "With better understanding of risk factors for disease occurrence and prognosis, it is hoped that new and more effective strategies for prevention and treatment will soon emerge."

Practice considerations based on the new finding that symptoms and pain are risks for structural progression include the fact that patients with painful OA should be considered at risk for subsequent structural progression. He writes that treatments should be aimed at "modifiable" risk factors—especially pain—and should affect the abnormal structures that may cause pain. Due to the diversity of the structures that may be responsible for pain and the phenomena affecting them, "it is important to perform investigations to determine the origin of the pain."

Dougados highlights the role of hydrarthrodial effusion, synovitis, periarticular lesions, cartilage breakdown, and subchondral bone.

Some of these symptoms and phenomena can be detected via physical exam, but complementary tests at the rheumatologist's office, including ultrasonography, may be helpful in identifying hydrarthrodial effusion and synovitis.

"Finally, the long-term structural effects of the suppression of modifiable risk factors such as synovitis and/or hydrarthrodial effusion has to be investigated further," he writes.

Sources

  1. Lane NE, Nevitt MC, Hochberg MC, Hung YY, Palermo L. Progression of radiographic hip osteoarthritis over eight years in a community sample of elderly white women. Arthritis Rheum 2004 May; 50(5):1477-86. 

  2. Dougados M. Structural progression is also driven by clinical symptoms in patients with osteoarthritis. Arthritis Rheum 2004 May; 50(5):1360-5. 

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