强直性脊柱炎累及双髋关节

pain fixed deformities of the hip painful limitation of movement muscle wasting regional lymph node enlargement form of cold abscess with or without sinuses pathologic dislocation of the hip
bilatreal hip joint synovial cyst at the front margin of
articular
AS
mainly young adults, mostly male age:10 to 40 years old, average 25 hip involved——one-third of patients with
强直性脊柱炎累及双髋关节
History
Male, 28 years old Hip pain No laboratory examination
Final Diagnosis
bilateral sacroiliitis seronegative spondyloarthropathy involve
RA
imaging appearance
MRI
early stage (rich vessels of pannus)
T1WI——low signal T2WI——high signal
late stage (increased fabre composition)
T1WI——isosignal T2WI——isosignal
RA
imaging appearance
synovitis thickening of soft tissue osteoporosis subchondral cyst formation homogeneous narrowing of articular space erosion of cartilage acetabulum and head of femur both involved
AS HLA-B27 positive >90% axial skeletal : bilaterally peripheral arthritis :asymmetrically
AS
conventional radiographs
two typical features
concentric osteoproliferation with osteophytes around the femoral neck
examination combination
enthesitis、 osteophytosis、 combined SIJ
and spine changes
obvious synovitis
Final diagnosis
tuberculosis
TB
lesions on the acetabular side progress less rapidly than lesions on the femoral side
TB
clinical symptom
common symptom joint symptom
hip involved——5to15% mainly women
RA
clinical symptom
pain swelling stiffness motion impairment
laboratory tests
rheumatoid factor(+) elevated ESR and CRP
Hale Waihona Puke TBhip dislocation—— uncommon
TB
tuberculous bursitis——rare common site——trochanteric region
hip joint arthritis
imaging appearance
clinical symptom、age gender、laboratory
RA
synovial cyst——rare
TB
pathogenesis —hematogenous dissemination
15% cases of osteoarticular tuberculosis common age——the second and third
decades the most common site——vertebral
DDX
Rheumatoid arthritis (RA) Tuberculosis (TB)
RA
autoimmune disorder of unknown etiology characteristic
symmetric erosive synovitis sometimes multisystem involvement
TB
imaging appearance
thickening of the synovium subchondral and marginal bony erosion effusion loss of joint space periarticular abscess juxta-articular osteoporosis
erosions of the acetabulum
AS
conventional radiographs
others
sclerosis synovitis ; enthesitis osteophytosis joint space narrowing—— concentric ,uniform joint effusion subchondral bone marrow edema periarticular fat depositions