A randomized clinical trial: should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs?

Abstract

The diagnosis of transient synovitis of the hip ("irritable hip") is made frequently in the pediatric emergency department. We hypothesized that an anti-inflammatory agent (ibuprofen syrup) would shorten the duration of symptoms. Patients who were clinically diagnosed with transient synovitis of the hip in the ED between July 1997 and July 1998 were randomized in a double-blind, placebo-controlled trial to receive either ibuprofen syrup (10 mg/kg 3 times a day for 5 days) or placebo. There were stringent exclusion criteria, and patients were only included if there was a low index of suspicion of more serious pathology. All patients had a hip ultrasonography performed at enrollment and at day 7. Symptoms were monitored by the use of a parental diary and clinical review. Forty patients were initially enrolled, but 4 patients were subsequently excluded, leaving 17 patients in the ibuprofen group and 19 in the placebo group. Although symptoms resolved in more than 80% (30 of 36) of patients in both groups by 7 days, the median duration of symptoms was shorter in the ibuprofen group (2 days compared with 4.5 days in the placebo group; P =.05 on Wilcoxon-Breslow test). The medication was well tolerated, with only minor gastrointestinal side effects being reported by 6 patients (4 ibuprofen and 2 placebo). In this small study, ibuprofen shortened the duration of symptoms in children with a clinical diagnosis of transient synovitis of the hip.