Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

8. Groin Pain Etiology: Hip- Referred Groin Pain
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may all present with polyarticular complaints that may involve the hip.
Generally, patients with inflammatory arthritides present with
symmetrical joint complaints. It is important to note that these will rarely
cause isolated hip pain without other systemic complaints. Evaluation
for low back pain and other articular complaints is important for accurate
diagnosis. Classically, patients with RA will complain of at least 1 h of
morning stiffness.
A similar clinical picture is present among those with SLE, with the
addition of further systemic complaints such as skin rashes with sun
exposure and possible renal complications. Consideration to the diagnosis
of SLE should be given with any workup for rheumatological
disease.
In patients with ankylosing spondylitis, involvement of the lumbar
spine needs to be evaluated. Patients will report chronic low back or hip
pain that waxes and wanes, with limited range of motion, sometimes
with groin pain and pain down the inner thigh.
Physical Exam The disease predominantly affects the cervical spine,
wrist, elbows, knees, hands, and feet. It is not classically described as
affecting the hip and typically spares the lumbosacral spine and distal
interphalangeal joints [ 9 ]. The presence of rheumatoid nodules on the
extensor surface of the forearm is considered pathognomonic and is seen
in up to 30 % of patients with the disease. Examination is otherwise often
nondiagnostic and needs to be combined with other modalities for
accurate diagnosis.
Diagnostic Exams X-rays may show periarticular osteopenia, with
loss of joint space and minimal to no osteophytes. Laboratory examination
shows elevated inflammatory markers (ESR and CRP). If the clinical
presentation fits with an inflammatory condition, it is not unreasonable
to consider sending specific blood tests checking for rheumatoid factor
(RF), antinuclear antibody (ANA), and HLA-B27 antigen. It may be
reasonable to defer the workup to a rheumatologist.
Appropriate Treatment/Referral In situations where an inflammatory
arthritis is suspected, referral to a rheumatologist for a complete yet
targeted workup and treatment is warranted. In severe cases with
advanced joint disease, total joint arthroplasty is an option for treatment,
and referral to an orthopedic surgeon should be considered in patients
with advanced disease .