Hip involvement in early RA

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ls of the Rheumatic Diseases, 1995, Vol 54, 45-48

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PAPERS

Hip involvement in early rheumatoid arthritis

K Eberhardt, E Fex, K sson and P Geborek

Department of Rheumatology, Lund University Hospital, Sweden.

OBJECTIVE--To study early hip involvement in rheumatoid arthritis (RA)

and to evaluate the usefulness of ultrasonography in the detection of

hip joint synovitis in RA. METHODS--Study I: The number of hip joint

replacements was recorded in a cohort of 113 patients with RA of at

least five years disease duration followed from an early stage. Study

II: Ultrasonography was evaluated as a method to identify hip joint

synovitis in 76 patients with RA of shorter disease duration, by

relating it to radiograms and clinical findings. RESULTS--Study I:

Twenty one hip joint replacements were performed in 15 of the 113

patients. The median disease duration at the time of first arthroplasty

was 48 (range 10-76) months; the annual incidence was approximately

constant between two and six years. High disease activity at the start

of the study was predictive of requirement for hip prosthesis. Study II:

Hip ultrasonography was pathological in 13 of the 76 patients studied,

bilaterally in nine. Hip joint synovitis could not be confirmed on

clinical grounds only as seven of the patients with positive

ultrasonographic findings were asymptomatic, and the remaining six

patients had only mild symptoms of hip involvement. Also, six of the 63

patients with normal ultrasonography had mild symptoms. There was no

difference regarding demographic, clinical, and laboratory findings in

patients with and without hip synovitis.

CONCLUSIONS--Early hip joint destruction giving symptoms mostly at a

very late stage is frequent in RA. Ultrasonography rather than signs or

symptoms could identify patients with hip joint involvement and provide

a rationale for early treatment.

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