Hip osteoarthritis symptoms naturally stabilise over time

Osteoarthritis in the hip increases steadily over time, but signs and symptoms are relatively stable.

INTRODUCTION
Osteoarthritis is a common condition that makes a person’s joints stiff and painful, particularly in the morning. It is caused by thinning of the cartilage within the joints, which allows the bones to rub against each other. Joint swelling and pain are frequent symptoms. It is the most common of all the different types of arthritis, and typically becomes more common as people get older.

Osteoarthritis in the hip is common, and affects up to a quarter of all people over the age of 55. Despite this, not much is known about how hip complaints develop and progress over time. This information could be useful for people with hip osteoarthritis and healthcare professionals.

WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to find out how pain and other symptoms (such as morning stiffness) progress in people with hip complaints who were suspected to be in the early stage of hip osteoarthritis.

WHO WAS STUDIED?
This study looked at 588 people with hip complaints and followed them for 10 years. Everyone was aged 45–65 and had not yet or just recently consulted a healthcare professional for their hip complaints. This was part of the Cohort Hip and Cohort Knee (CHECK) study in the Netherlands.

HOW WAS THE STUDY CONDUCTED?
This was a prospective longitudinal study, which means that the patients were observed over a period of time and measurements taken, but there was no study intervention or medicine being tested. Information from the CHECK study was collected at baseline and after 2, 5, 8 and 10 years. Each measurement included a questionnaire, a physical exam, and a radiograph (X-ray). The authors analysed the natural
course of the hip complaints by looking at changes in clinical signs and symptoms, physical functioning, and features seen on the X-rays.

WHAT WERE THE MAIN FINDINGS OF THE STUDY?
Of the 588 people studied, 249 met the criteria for a diagnosis of hip osteoarthritis at some point during the next 10 years.

The main finding was that about 12% of people with early hip complaints needed a hip replacement during
the study. Over time, the number of people with hip osteoarthritis diagnosed either by clinical examination or X-ray increased steadily; however, people’s complaints about symptoms remained stable. After 10 years, only 51% still reported hip pain, and fewer people reported morning stiffness in their hip.

ARE THESE FINDINGS NEW?
Yes. To the author’s knowledge, this is the first study that provides long-term follow-up information about the clinical signs and symptoms in people suspected of having early hip osteoarthritis.

WHAT ARE THE LIMITATIONS OF THE STUDY?
A limitation to the study is that follow-up assessments were done only every 2 or 3 years. During these appointments, people were asked about their pain intensity in the past week. This means the study misses information about pain variation in the periods between assessments.

WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
The authors plan to share this information with Dutch primary-care physicians, and hope to include it in materials for patients. CHECK data will be used for more studies, including about fluctuations in pain, nocturnal pain, and fatigue. The information will also be shared on the Dutch website for people with osteoarthritis.

WHAT DOES THIS MEAN FOR ME?
If you have pain and stiffness in your hip, you may have early signs of osteoarthritis. Although you may go on to develop osteoarthritis, and might need a hip replacement, it is likely that your symptoms will stabilise.

If you have any concerns, you should talk to your doctor.

ADDITIONAL INFORMATION
Information (in Dutch) from this study will soon be available on the Dutch website for people with osteoarthritis. https://artrosegezond.nl/

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Date prepared: March 2021
Summary based on research article published on: 15 January 2021
From: van Berkel AC, et al. 10-Year natural course of early hip osteoarthritis in middle-aged persons with hip pain: a CHECK study. Ann Rheum Dis 2021;80(4):487–93. doi:10.1136/annrheumdis-2020-218625

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