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Hip joint disease in psoriatic arthritis: risk factors and natural history
  1. C J Michet,
  2. T G Mason,
  3. M Mazlumzadeh
  1. Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to:
    Dr C J Michet Jr
    Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA;


Objective: To determine the natural history of hip joint disease in psoriatic arthritis (PsA) and identify clinical risk factors for its early identification.

Patients and methods: 504 patients with PsA according to ESSG criteria were studied. Mean follow up was 5.7 years (range <1–45). Mean age at onset of psoriasis was 32 years and of PsA, 39 years. The most common pattern of PsA at onset was oligoarticular (49%) and at the latest examination, polyarticular (65%). Sacroiliitis or spondylitis was diagnosed in 94 (18.7%) patients.

Results: 32 (6.3%) patients developed psoriatic hip arthropathy, and of these, 26 (81%) also had sacroiliitis or spondylitis. In 7/17 (41%) patients the hip became affected within 1 year after the onset of PsA. Hip disease occurred more often in younger patients. Sex, pattern of peripheral arthritis, duration of psoriasis before arthritis affected the distal interphalangeal joints, dactylitis, or enthesitis were not associated with the risk of hip disease. Seventeen patients were followed up and nine required hip arthroplasty. Sixteen (50%) first had arthroplasty within 5 years after the onset of hip pain.

Conclusions: Psoriatic hip arthropathy occurs infrequently in PsA and is associated with earlier onset of arthritis and psoriatic spondylitis. Bilateral hip involvement and rapid progression to hip arthroplasty are common.

  • DIP, distal interphalangeal
  • PsA, psoriatic arthritis
  • arthritis
  • hips
  • psoriatic arthritis
  • total hip arthroplasty

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  • Mayo Foundation is the author under the work-for-hire provision of the US copyright law. As authorised agent, permission is granted on behalf of all Mayo authors, an exclusive license on a worldwide basis to the BMJ Publishing Group Ltd and its Licensees to permit this article (if accepted) to be published in the Annals of the Rheumatic Diseases editions and any other BMJ Publishing group products to exploit all subsidiary rights, as set forth in our licence. The copyright remains with Mayo Foundation and the manuscript cannot be used to imply endorsement by Mayo. Signed: Mrs Roberta Schwartz, Agent for Mayo Foundation (17 February 2005). ©2004 Mayo Foundation for Medical Education and Research.