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Rapidly destructive inflammatory arthritis of the hip.

Shu J, Ross I, Wehrli B, McCalden RW, Barra L - Case Rep Rheumatol (2014)

Bottom Line: She required a right total hip arthroplasty, but arthritis in other joints showed improvement with triple disease modifying antirheumatic drugs (DMARD) therapy and almost complete remission with the addition of adalimumab.We contrast our case of RDC as an initial presentation of RA to 8 RDC case reports of patients with established RA.Furthermore, this case highlights the importance of obtaining serial imaging to evaluate a patient with persistent hip symptoms and rapid functional deterioration.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Rheumatology, Western University, London, ON, Canada N6A 5W9.

ABSTRACT
Rapidly destructive coxarthrosis (RDC) is a rare syndrome that involves aggressive hip joint destruction within 6-12 months of symptom onset with no single diagnostic laboratory, pathological, or radiographic finding. We report an original case of RDC as an initial presentation of seronegative rheumatoid arthritis (RA) in a 57-year-old Caucasian woman presenting with 6 months of progressive right groin pain and no preceding trauma or chronic steroid use. Over 5 months, she was unable to ambulate and plain films showed complete resorption of the right femoral head and erosion of the acetabulum. There were inflammatory features seen on computed tomography (CT) and magnetic resonance imaging (MRI). She required a right total hip arthroplasty, but arthritis in other joints showed improvement with triple disease modifying antirheumatic drugs (DMARD) therapy and almost complete remission with the addition of adalimumab. We contrast our case of RDC as an initial presentation of RA to 8 RDC case reports of patients with established RA. Furthermore, this case highlights the importance of obtaining serial imaging to evaluate a patient with persistent hip symptoms and rapid functional deterioration.

No MeSH data available.


Related in: MedlinePlus

(a) Axial proton density with fat saturation sequence through the right hip joint (a) shows destruction of the femoral head (arrow) and a complex joint effusion (arrowhead). (b) Axial T1 fat saturated sequence after gadolinium reveals synovial thickening and enhancement (arrow).
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fig2: (a) Axial proton density with fat saturation sequence through the right hip joint (a) shows destruction of the femoral head (arrow) and a complex joint effusion (arrowhead). (b) Axial T1 fat saturated sequence after gadolinium reveals synovial thickening and enhancement (arrow).

Mentions: Initial plain films of her right hip and pelvis showed femoral head lucencies compatible with subchondral cysts (but no definite fracture) and moderate diffuse articular joint space loss with flattening of the femoral head (Figure 1(a)). Over a 5-month span, there was complete destruction of the right femoral head, erosion of the right acetabulum, and lateral subluxation of the proximal femur (Figure 1(b)). CT pelvis with contrast (Figure 1(c)) showed fragmented bone within the acetabular fossa, which was remnants of the femoral head resorption process. Magnetic resonance imaging (MRI) of the right hip showed extensive synovial hypertrophy consistent with inflammatory arthritis (Figure 2). There were also minimal bone marrow edema and a fluid collection in the iliopsoas bursa extending posteriorly to the sciatic notch and enlargement of the hip joint capsule (Figure 2). X-rays of her feet revealed erosive changes in the MTPs and X-rays of her hands showed periarticular osteopenia in her metacarpal phalangeal (MCP) joints and ulnar deviation. There were degenerative changes on imaging of her knees, shoulders, and spine.


Rapidly destructive inflammatory arthritis of the hip.

Shu J, Ross I, Wehrli B, McCalden RW, Barra L - Case Rep Rheumatol (2014)

(a) Axial proton density with fat saturation sequence through the right hip joint (a) shows destruction of the femoral head (arrow) and a complex joint effusion (arrowhead). (b) Axial T1 fat saturated sequence after gadolinium reveals synovial thickening and enhancement (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4109228&req=5

fig2: (a) Axial proton density with fat saturation sequence through the right hip joint (a) shows destruction of the femoral head (arrow) and a complex joint effusion (arrowhead). (b) Axial T1 fat saturated sequence after gadolinium reveals synovial thickening and enhancement (arrow).
Mentions: Initial plain films of her right hip and pelvis showed femoral head lucencies compatible with subchondral cysts (but no definite fracture) and moderate diffuse articular joint space loss with flattening of the femoral head (Figure 1(a)). Over a 5-month span, there was complete destruction of the right femoral head, erosion of the right acetabulum, and lateral subluxation of the proximal femur (Figure 1(b)). CT pelvis with contrast (Figure 1(c)) showed fragmented bone within the acetabular fossa, which was remnants of the femoral head resorption process. Magnetic resonance imaging (MRI) of the right hip showed extensive synovial hypertrophy consistent with inflammatory arthritis (Figure 2). There were also minimal bone marrow edema and a fluid collection in the iliopsoas bursa extending posteriorly to the sciatic notch and enlargement of the hip joint capsule (Figure 2). X-rays of her feet revealed erosive changes in the MTPs and X-rays of her hands showed periarticular osteopenia in her metacarpal phalangeal (MCP) joints and ulnar deviation. There were degenerative changes on imaging of her knees, shoulders, and spine.

Bottom Line: She required a right total hip arthroplasty, but arthritis in other joints showed improvement with triple disease modifying antirheumatic drugs (DMARD) therapy and almost complete remission with the addition of adalimumab.We contrast our case of RDC as an initial presentation of RA to 8 RDC case reports of patients with established RA.Furthermore, this case highlights the importance of obtaining serial imaging to evaluate a patient with persistent hip symptoms and rapid functional deterioration.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Rheumatology, Western University, London, ON, Canada N6A 5W9.

ABSTRACT
Rapidly destructive coxarthrosis (RDC) is a rare syndrome that involves aggressive hip joint destruction within 6-12 months of symptom onset with no single diagnostic laboratory, pathological, or radiographic finding. We report an original case of RDC as an initial presentation of seronegative rheumatoid arthritis (RA) in a 57-year-old Caucasian woman presenting with 6 months of progressive right groin pain and no preceding trauma or chronic steroid use. Over 5 months, she was unable to ambulate and plain films showed complete resorption of the right femoral head and erosion of the acetabulum. There were inflammatory features seen on computed tomography (CT) and magnetic resonance imaging (MRI). She required a right total hip arthroplasty, but arthritis in other joints showed improvement with triple disease modifying antirheumatic drugs (DMARD) therapy and almost complete remission with the addition of adalimumab. We contrast our case of RDC as an initial presentation of RA to 8 RDC case reports of patients with established RA. Furthermore, this case highlights the importance of obtaining serial imaging to evaluate a patient with persistent hip symptoms and rapid functional deterioration.

No MeSH data available.


Related in: MedlinePlus