强直性脊柱炎累及双髋关节.ppt

Case Disscusion By Group Group 2013-07-11 2011-06-02 History Male,28 years old Hip pain No laboratory examination Final Diagnosis bilateral sacroiliitis seronegative spondyloarthropathy involve 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 involvedone-third of patients with 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 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 DDX Rheumatoid arthritis(RA)Tuberculosis(TB)RA autoimmune disorder of unknown etiology characteristic symmetric erosive synovitis sometimes multisystem involvement hip involved5to15%mainly women RA clinical symptom pain swelling stiffness motion impairment laboratory tests rheumatoid factor(+)elevated ESR and CRP 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 RA imaging appearance MRI early stage(rich vessels of pannus)T1WIlow signal T2WIhigh signal late stage(increased fabre composition)T1WIisosignal T2WIisosignal RA synovial cystrare TB pathogenesis hematogenous dissemination 15%cases of osteoarticular tuberculosis common agethe second and third decades the most common sitevertebral tuberculosis TB lesions on the acetabular side progress less rapidly than lesions on the femoral side TB clinical symptom common symptom joint symptom 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 TB imaging appearance thickening of the synovium subchondral and marginal bony erosion effusion loss of joint space periarticular abscess juxta-articular osteoporosis TB hip dislocation uncommon TB tuberculous bursitisrare common sitetrochanteric region hip joint arthritis clinical symptom、age gender、laboratory examination HLA-27(+)AS RF(+)RA Tubercle bacillus TB imaging appearance enthesitis、osteophytosis、combined SIJ and spine changes AS obvious synovitis polyarticular、bone erosion、uniform narrowing RA monoarticular nonuniform narrowing bone destruction TB Final diagnosis combination Made by chaichao RA Joint TB PVNS Gouty Joint involvement Polyarticular Symmetrical monoarticular monoarticular Knee，80%The first metatarsophalangeal joint sequestrum _+_ _ cold abscess/sinus tract _+_ _ Reactive sclerosis _+_+Osteoporosis wide Local(Periarticular)_ _ joint space narrowing uniform nonuniform _（late）_