A focus on identifying osteoarthritis of the hip early
It comes on gradually, a stiffness in the hip that is worse in the morning and improves as the day goes on. As the months go by, the pain becomes more pronounced and is exacerbated by physical activity. Rest helps, but after a while even that doesn't make the pain go away completely. By the time most people go to the doctor, the cause of their discomfort — osteoarthritis — is well advanced.
But researchers at UC Davis Center for Healthy Aging are working to identify biological markers so that doctors may one day diagnose the disorder early, before extensive joint deterioration has occurred.
"Osteoarthritis of the hip is a silent disease," explained Nancy E. Lane, professor of internal medicine and director of the UC Davis Center for Healthy Aging. "Even patients who see their doctor before the pain is much of a problem learn that they are in the grip of osteoarthritis. Our goal is to identify biological markers for osteoporosis of the hip so that we can diagnose the disease early and hopefully prevent damage."
Osteoarthritis of the hip is fairly common condition in the elderly, with nearly 200,000 total hip replacements performed in the United States annually. The painful condition occurs when bones rub against each other due to a breakdown in cartilage.
"Osteoarthritis of the hip is a silent disease. Even patients who see their doctor before the pain is much of a problem learn that they are in the grip of osteoarthritis. Our goal is to identify biological markers for osteoporosis of the hip so that we can diagnose the disease early and hopefully prevent damage."
— Nancy E. Lane, director of the UC Davis Center for Healthy Aging
Lane, a nationally recognized expert in osteoporosis, also is at the forefront of research that is focused on better understanding what causes osteoarthritis of the hip. She recently published a case study on problem in the New England Journal of Medicine (http://content.nejm.org/cgi/content/short/357/14/1413) and her team is now studying cell-signaling pathways and how specific proteins relate to a progression of the disease.
"One of the proteins we found circulating in the blood inhibits bone formation and may be a marker for someone with osteoarthritis of the hip," she said. "Research at the molecular level right now is moving into an exciting area, and we're starting to understand how the joint struggles to repair itself."
Identifying osteoarthritis before the pain is so pronounced offers hope that eventually therapies may be developed to delay or reverse the onslaught of the disease. The hope is that one day these very different approaches will be as commonplace as the medications and surgeries now used to blunt or overcome the physical discomfort so many people experience each day.
Current treatments for osteoarthritis of the hip
While osteoarthritis gradually worses with time, the following treatments can help relieve pain and help patients remain active.
- Aquatic therapy can help improve function and reduce pain. In a recent randomized, controlled study of patients with osteoarthritis of the knee or hip, 70 percent who underwent aquatic therapy for six weeks showed improvement, compared to just 17 percent of those who did not undergo such therapy.
- Weight loss may help overweight or obese patients. While good data from large, randomized trials of weight loss remain less than optimum for physicians and researchers to draw conclusions, less rigorous case-control studies have shown an association between increased weight and the osteoarthritis of the hip.
- Acupuncture. A team of scientists reported in 2006 that the ancient Chinese medical treatment significantly reduced pain in a group of patients with osteoarthritis of the hip or knee and that the benefit was maintained after three months of follow-up treatment.
- Acetaminophen and ibuprofen are effective but frequent doses will be needed as hip pain worsens. Codeine also is effective but comes with a host of side effects, including nausea, constipation, lightheadedness, dizziness and sedation.
- Steroid injections are effective and can reduce pain for as long as six months.
- Hip replacement, a treatment that Lane recommends sooner rather than later to get most benefit before serious deterioration of function and muscle atrophy have occurred.
"Progress in artificial hip technology has made total hip replacements a more attractive alternative," she said. While we used to put off joint replacement for as long as possible so that a patient would not have to have the procedure repeated due to wear and tear on the artificial joint, advances in prostheses and fixation techniques for artificial hips have improved to the point where they can last 20 to 25 years."