Abstract
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.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Corbett M., Dalton S., Young A., Silman A., Shipley M. Factors predicting death, survival and functional outcome in a prospective study of early rheumatoid disease over fifteen years. Br J Rheumatol. 1993 Aug;32(8):717–723. doi: 10.1093/rheumatology/32.8.717. [DOI] [PubMed] [Google Scholar]
- DIAGNOSTIC criteria for rheumatoid arthritis: 1958 revision by a committee of the American Rheumatism Association. Ann Rheum Dis. 1959 Mar;18(1):49–53. [PMC free article] [PubMed] [Google Scholar]
- Eberhardt K. B., Rydgren L. C., Pettersson H., Wollheim F. A. Early rheumatoid arthritis--onset, course, and outcome over 2 years. Rheumatol Int. 1990;10(4):135–142. doi: 10.1007/BF02274837. [DOI] [PubMed] [Google Scholar]
- Ekdahl C., Eberhardt K., Andersson S. I., Svensson B. Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. Scand J Rheumatol. 1988;17(4):263–271. doi: 10.3109/03009748809098795. [DOI] [PubMed] [Google Scholar]
- Fleming A., Crown J. M., Corbett M. Early rheumatoid disease. I. Onset. Ann Rheum Dis. 1976 Aug;35(4):357–360. doi: 10.1136/ard.35.4.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fries J. F., Spitz P., Kraines R. G., Holman H. R. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. doi: 10.1002/art.1780230202. [DOI] [PubMed] [Google Scholar]
- Koski J. M., Anttila P. J., Isomäki H. A. Ultrasonography of the adult hip joint. Scand J Rheumatol. 1989;18(2):113–117. doi: 10.3109/03009748909099926. [DOI] [PubMed] [Google Scholar]
- Koski J. M., Anttila P., Hämäläinen M., Isomäki H. Hip joint ultrasonography: correlation with intra-articular effusion and synovitis. Br J Rheumatol. 1990 Jun;29(3):189–192. doi: 10.1093/rheumatology/29.3.189. [DOI] [PubMed] [Google Scholar]
- Koski J. M. Ultrasonographic evidence of hip synovitis in patients with rheumatoid arthritis. Scand J Rheumatol. 1989;18(3):127–131. doi: 10.3109/03009748909095409. [DOI] [PubMed] [Google Scholar]
- Larsen A., Dale K., Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977 Jul;18(4):481–491. doi: 10.1177/028418517701800415. [DOI] [PubMed] [Google Scholar]
- Lehtimäki M. Y., Kaarela K., Hämäläinen M. M. Incidence of hip involvement and need for total hip replacement in rheumatoid arthritis. An eight-year follow-up study. Scand J Rheumatol. 1986;15(4):387–391. doi: 10.3109/03009748609098209. [DOI] [PubMed] [Google Scholar]
- Roberts W. N., Daltroy L. H., Anderson R. J. Stability of normal joint findings in persistent classic rheumatoid arthritis. Arthritis Rheum. 1988 Feb;31(2):267–271. doi: 10.1002/art.1780310215. [DOI] [PubMed] [Google Scholar]