Background The hip joint is a site of involvement in a number of rheumatic conditions. Patients are often complaining of hip pain. The “Hip” as a complaint or a joint involved in disease is being used, as a metric in a number of indices or questionnaires, to evaluate IBP (1) or Spondyloarthropathies (such as BASDAI question 2) (2). However, what patients are describing as “hip” pain is not always referred to the actual hip joint.
Objectives To assess which structure(s) patients indicate when they are referring to hip pain.
Methods A diagram has been developed which has been used as a proforma to design on the site of “hip pain” from patients (new and/or follow up) when seen in clinic. After detailed history and examination, an accurate description of the site referred to as “hip” was recorded. Radiological imaging was utilised, for those patients with either multiple sites or clinically unclear causes of “hip” pain, to confirm or exclude the clinical diagnosis for the pain. The study classified as an audit and took place at a single centre between August 2014 and September 2015.
Results A total of 54 patients (M:F 10:44) have been assessed [mean age of 57.6 years (sd ±14.1)]. Total sites identified and evaluated were 72 as 14 patients of 54 (25.9%) indicated more than 1 site when describing their hip pain [10 patients:2 sites (18.5%), 4 patients (7.4%) 3 sites]. A total of 8 structures have been described by patients as the site of their hip pain. These (in addition to the hip joint) were: trochanterum, iliac crests (including anterior superior, posterior superior and anterior inferior) lumbar spine, sacroiliiac joint. Radiological evaluation performed on 40/54 patients (74%). From those, 23 patients had X-rays (57.5%), 13 patients had ultrasound (32.5%), 4 patients (10%) had MRI.
Following clinical and radiologic evaluation the structures identified and confirmed as the source of the hip pain were: Trochanterum (n=19; 26.3%), followed by hip joint (n=15; 20.8%), Iliac crest (n=13; 18%), Lumbo-sacral spine (n=6; 8.3%), posterior superior iliac crest (n=6; 8.3%), anterior superior iliac crest (n=5; 6.9%), Sacro-iliac joint (n=5; 6.9%), and anterior inferior iliac crest (n=3; 4.1%).
Conclusions A total of 80% of patients presented with “Hip pain” were referring to a different structure than the hip joint in our study. The greater trochanter was the most commonly reported anatomical structure of pain from patients when they were referring to hip pain. The hip joint itself was 2nd in the frequency of reported hip pain, seen in only 1 in 5 patients coming to clinic complaining of hip pain. We therefore suggest the “hip pain” item, used in questionnaires that do not include clinical evaluation, has to be interpreted with caution.
Keeling SO, Mjundar SR, Conner-Spady B. et al. Preliminary validation of a self reported screening questionnaire for IBP. J. Rheumatol 2012;39:822–29
Garrett S, Jenkinson T, Kennedy LG, et al. A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21: 2286–2291
Disclosure of Interest None declared