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Inflammatory arthtitis of the hip
#263416 01/15/14 04:24 PM
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daisy55 Offline OP
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I have AS and have suffered for over 10 years with hip pain, loss of range of motion and its progressively getting worse. For the past several years they have been telling me that I have OA that there are bone spurs around each femoral head but no loss of cartilage. So yesterday I go in to the doctor after another x-ray this is what the report said: "Cartilage thickness maintained. Bony protrude grams so as of presumed osteophytes are present of moderate degree apparently arising from the femoral heads primarily. Feature similar to 2012 but the pattern is unusual and review by orthopedics is suggested"
Now I had a CT scan last June for right side pain they thought was bowel. My GP never mentioned to me about the fact that back then they reported this unusual bone spurs. I am happy that I'm finally going to get some answers. My question is if the AS is attacking my hip joint is this what happens and why some have to have hip relacement? I guess I just don't understand what actually happens to the hip joint with AS? If you have any links to AS and hip replacement? Thanks I appreciate your input.

Re: Inflammatory arthtitis of the hip
daisy55 #263423 01/15/14 05:47 PM
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Yes, hips can be an inflammation point. Also AS can comorbid with osteoporosis.

"The hips and shoulders are affected in about one third of people with ankylosing spondyltis (AS). The hip involvement usually comes on gradually, and although the pain often is felt in the groin area, it can sometimes be felt in other areas of the body such as the knees or the front of the thigh. When this happens it is called "referred pain" and it can be very misleading to both the doctor and affected person." http://www.spondylitis.org/about/complications.aspx#

I have restricted range of motion in hips and I have had some pretty severe pain in that area. I also had a ridiculous surgery prior to my AS dx on a hip. Several people with AS have hip replacement. When I was first dx, my doc said that I could expect to need both my hips replaced in 10 years (that would have been in 1999).

http://www.spondylitis.org/patient_resources/surgery_links.aspx


AS, U C, Iritis, migraines. HLA-B27neg. Yoga (instructor) & spin. No meds at this time. Dx 1989. SAA member/donor since 1993. All my posts are personal opinion/feelings and do not represent the SAA. Help find a cure & support others by donating to the SAA.
Re: Inflammatory arthtitis of the hip
daisy55 #263428 01/15/14 08:40 PM
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The term "bone spurs" usually refers to OA (osteophytes.) SpA's bony growths look different on imaging and are called syndesmophytes. A decent radiologist ought to be able to tell the difference.

Given the report didn't use the word "inflammatory," it sounds to me as if you have OA in your hip in addition to the systemic disorder SpA. Will you follow up with ortho as recommended?


Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates
Re: Inflammatory arthtitis of the hip
daisy55 #263435 01/16/14 01:52 AM
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Thanks Rhamba, I have looked at the first link but will check out the surgery.
Jen, you're right they didn't mention inflammatory...the doctor felt that they didn't know I have AS but like you said the radiologist should be able to tell the difference? I have chosen my ortho and a letter of referal was done up today. I go see my rheumy in February so I'll get her to look at the x-ray and CT scan and see what she thinks? Anyways thanks for the input it all helps.

Re: Inflammatory arthtitis of the hip
daisy55 #263440 01/16/14 12:31 PM
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I have hip pain as well. Right hip had a labral tear, I had surgery on it. Left hip has a labral tear and a bone spur. No clue what kind of bone spur, just assumed it was from impact exercises. Im debating that surgery to repair the tear and shave down the bone. But combined with my SI joint flaring up lately I am wondering if AS is causing my hip problems as well. I thought my AS was under control, now realizing it may be in control of me!! How the heck do you find a radiologist who know the difference? My hospital radiologist (where I'm captitated too) never even saw a bone spur, my ortho did. So frustrating.

Re: Inflammatory arthtitis of the hip
daisy55 #263447 01/16/14 03:35 PM
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Thank Jdog, it sounds like you've been having a lot of issues with your hips, believe me I understand about hip pain. You certainly could be right about the AS starting in the hips...I don't quite understand either...most people I know who have had OA of the hip talk about bone on bone pain? My cartilage is maintained..yet I have these large bone spurs on both femurs. Like Jen said it could be a combo of both AS and OA, I guess I'll find out. I was just hoping to hear what type of damage AS'ers had that brought them to the doctor in the first place. Most of what I read was deterioration of the hip joint? I haven't read anything about syndesmophytes growing out of the femur...I am happy that I will finally get some answers.

Re: Inflammatory arthtitis of the hip
daisy55 #263454 01/16/14 06:05 PM
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Now I'm starting to think I need to go get my hips imaged...

All of my pain so far has just been attributed to AS and my rheumatologist has only been focusing on the right combo of meds before we start any PT. But recently I have been walking a little bit more (because if I do it in short 5 min walks around my department at work I don't get too sore), and riding my horse occasionally (probably more the cause of the hip soreness than anything).

But I've been feeling a lot of "grinding" going on in both hip joints...which I know is not normal for them.

OP- I would be very careful about looking into hip surgery immediately. Get a second opinion on your x-rays and see if there are any other options.


22 years old. Female. Diagnosed with AS in June of 2013 but experienced symptoms for two years prior. Fused SI joints, fused L5-S1. Love and own 4 horses who keep me walking and riding around despite the pain. Married to a wonderful man, and struggling to deal with this chronic illness while being a newlywed and starting my first desk job.
Re: Inflammatory arthtitis of the hip
daisy55 #263520 01/17/14 04:49 PM
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Thanks Luckypony, I've been suffering for 10 years and they just kept saying mild osteoarthritis, it would be worth having an x-ray on your hips to see whats happening.
I had a CT scan done on my abdomen and the one thing they reported on was my hips saying "bi-lateral hip joint with exuberant osteophytes with preserved joint spaces" It just doesn't make sense to me if I have these large osteophytes and have no ROM left how can the joint space be preserved...sorry I just don't quite get all of this. I know I have to wait and talk to my rhuemy and the orthopedic surgeon. Which I will not take surgery as my first option, although its tempting...Take care and I hope you get some answers.

Re: Inflammatory arthtitis of the hip
daisy55 #263521 01/17/14 04:56 PM
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Originally Posted By: daisy55
I had a CT scan done on my abdomen and the one thing they reported on was my hips saying "bi-lateral hip joint with exuberant osteophytes with preserved joint spaces" It just doesn't make sense to me if I have these large osteophytes and have no ROM left how can the joint space be preserved...

It's all part of the degenerative/OA process. Degeneration happens with time and/or overuse - cartilage wears away in articulating joints and intervertebral discs dessicate and flatten in the spine. Osteophytes are the body's way of maintaining the space that is lost by the degenerative processes by which cartilage that normally provides cushioning, is lost. Sometimes osteophytes cause problems/pain, other times they do not. I'm sure that varies by the part of the body where they're located.

I'm pretty sure that osteophytes don't result in fusion the way syndesmophytes can. So it's not clear to me how the lost ROM ties in with the osteophytes - are both results of the same degenerative process or does the presence of osteophytes cause loss of ROM ... ?

A good surgeon will not just jump on surgery as the solution, but will do a thorough evaluation of the issues and weigh the potential effectiveness of various medical and surgical approaches for your situation. Certainly if a surgical solution is pushed, you should feel comfortable asking for an explanation of why it is the best course as well as this doc's experience and success with that type of procedure for people with the sort of problems you are having (though many surgeons either don't have, or won't share, that data!)

Keep us posted!

Re: Inflammatory arthtitis of the hip
daisy55 #263542 01/18/14 02:07 PM
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just a quick blurb... my rheumy has been treating my SI joint pain and telling me my hip pain is radiating from the SI to my hips, WRONG. after major surgery on my r hip on NOV 1, (open SDD) i have not had ANY SI joint pain, I had to go off remicade for the surgery, and have not yet been able to go back on (because my dr;s staff are worthless) and i have had NO NONE SIJ pain. the question of SpA/AS USPA what ever you wanna call it is now in question. LOOK at your hips people! have a hip specialist check them out.


Carrie
Small business owner, 50 / mother of 5, Fort Worth, Texas
Remicade, Seroquel, Folic Acid, MTX, gabapentin
Undifferented spondylopathy HLA-B27+ (onset 2007- DXed 2008) with associated uveitis, psoriasis
EPI and IBS - gastritis due to NSAIDs
Right Hip replacement 2017 with subsequent 4" heterotopic ossification (removed 2019)
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