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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) Papillary, hyperplastic, chronically inflamed synovium is shown with abundant fibrin covering the surface and multiple fragments of bone being degraded by histiocytes and multinucleated giant cells. (b) At higher magnification, fibrin is seen on the surface of the synovium with a hyperplastic synovium consistent with chronic inflammation. (c) Fibrin and bone are detailed at 40x magnification showing multiple bone fragments which is typical of a rapidly destructive joint process. (d) Bone is seen being further broken down by multinucleated giant cells.
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fig3: (a) Papillary, hyperplastic, chronically inflamed synovium is shown with abundant fibrin covering the surface and multiple fragments of bone being degraded by histiocytes and multinucleated giant cells. (b) At higher magnification, fibrin is seen on the surface of the synovium with a hyperplastic synovium consistent with chronic inflammation. (c) Fibrin and bone are detailed at 40x magnification showing multiple bone fragments which is typical of a rapidly destructive joint process. (d) Bone is seen being further broken down by multinucleated giant cells.

Mentions: In order to definitively differentiate between chronic sepsis, malignancy, and a chronic inflammatory process, an open biopsy of the hip was performed by the orthopaedic service, which showed overall morphology with features of chronic inflammation, fibrosis, multinucleated giant cell reaction with dystrophic calcification, and reactive synovial proliferation (Figure 3). Cultures of synovial tissue were negative for fungus and mycobacteria, ruling out tuberculosis. Although the biopsy results were not specific for an exact etiology of rapid joint destruction, we were able to exclude neoplastic, infectious, osteoarthritis, and osteonecrotic etiologies.


Rapidly destructive inflammatory arthritis of the hip.

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

(a) Papillary, hyperplastic, chronically inflamed synovium is shown with abundant fibrin covering the surface and multiple fragments of bone being degraded by histiocytes and multinucleated giant cells. (b) At higher magnification, fibrin is seen on the surface of the synovium with a hyperplastic synovium consistent with chronic inflammation. (c) Fibrin and bone are detailed at 40x magnification showing multiple bone fragments which is typical of a rapidly destructive joint process. (d) Bone is seen being further broken down by multinucleated giant cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4109228&req=5

fig3: (a) Papillary, hyperplastic, chronically inflamed synovium is shown with abundant fibrin covering the surface and multiple fragments of bone being degraded by histiocytes and multinucleated giant cells. (b) At higher magnification, fibrin is seen on the surface of the synovium with a hyperplastic synovium consistent with chronic inflammation. (c) Fibrin and bone are detailed at 40x magnification showing multiple bone fragments which is typical of a rapidly destructive joint process. (d) Bone is seen being further broken down by multinucleated giant cells.
Mentions: In order to definitively differentiate between chronic sepsis, malignancy, and a chronic inflammatory process, an open biopsy of the hip was performed by the orthopaedic service, which showed overall morphology with features of chronic inflammation, fibrosis, multinucleated giant cell reaction with dystrophic calcification, and reactive synovial proliferation (Figure 3). Cultures of synovial tissue were negative for fungus and mycobacteria, ruling out tuberculosis. Although the biopsy results were not specific for an exact etiology of rapid joint destruction, we were able to exclude neoplastic, infectious, osteoarthritis, and osteonecrotic etiologies.

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