1、Case DisscusionBy Group Group 2013-07-112011-06-02强直性脊柱炎累及双髋关节1History nMale,28 years oldnHip painnNo laboratory examination强直性脊柱炎累及双髋关节2强直性脊柱炎累及双髋关节3强直性脊柱炎累及双髋关节4强直性脊柱炎累及双髋关节5强直性脊柱炎累及双髋关节6强直性脊柱炎累及双髋关节7强直性脊柱炎累及双髋关节8强直性脊柱炎累及双髋关节9强直性脊柱炎累及双髋关节10强直性脊柱炎累及双髋关节11强直性脊柱炎累及双髋关节12强直性脊柱炎累及双髋关节13 Final Diagnosis
2、nbilateral sacroiliitis nseronegative spondyloarthropathy involve bilatreal hip jointnsynovial cyst at the front margin of articular 强直性脊柱炎累及双髋关节14 ASnmainly young adults,mostly male nage:10 to 40 years old,average 25nhip involvedone-third of patients with ASnHLA-B27 positive 90%naxial skeletal:bila
3、terallynperipheral arthritis:asymmetrically强直性脊柱炎累及双髋关节15 ASnconventional radiographsntwo typical featuresnconcentric osteoproliferation with osteophytes around the femoral necknerosions of the acetabulum强直性脊柱炎累及双髋关节16强直性脊柱炎累及双髋关节17 ASnconventional radiographsnothersnsclerosisnsynovitis;enthesitisno
4、steophytosis njoint space narrowing concentric,uniform njoint effusionnsubchondral bone marrow edema nperiarticular fat depositions 强直性脊柱炎累及双髋关节18强直性脊柱炎累及双髋关节19强直性脊柱炎累及双髋关节20强直性脊柱炎累及双髋关节21强直性脊柱炎累及双髋关节22强直性脊柱炎累及双髋关节23 DDXnRheumatoid arthritis(RA)nTuberculosis(TB)强直性脊柱炎累及双髋关节24 RAnautoimmune disorder
5、of unknown etiologyncharacteristicnsymmetricnerosive synovitisnsometimes multisystem involvementnhip involved5to15%nmainly women强直性脊柱炎累及双髋关节25 RAnclinical symptomnpainnswellingnstiffness nmotion impairmentnlaboratory testsnrheumatoid factor(+)nelevated ESR and CRP强直性脊柱炎累及双髋关节26 RAnimaging appearance
6、nsynovitisnthickening of soft tissue nosteoporosisnsubchondral cyst formationnhomogeneous narrowing of articular spacenerosion of cartilagenacetabulum and head of femur both involved强直性脊柱炎累及双髋关节27 RAnimaging appearancenMRInearly stage(rich vessels of pannus)nT1WIlow signalnT2WIhigh signalnlate stage
7、(increased fabre composition)nT1WIisosignalnT2WIisosignal强直性脊柱炎累及双髋关节28 强直性脊柱炎累及双髋关节29 RAnsynovial cystrare强直性脊柱炎累及双髋关节30强直性脊柱炎累及双髋关节31强直性脊柱炎累及双髋关节32 TBnpathogenesis hematogenous disseminationn15%cases of osteoarticular tuberculosisncommon agethe second and third decadesnthe most common sitevertebra
8、l tuberculosis强直性脊柱炎累及双髋关节33 TBnlesions on the acetabular side progress less rapidly than lesions on the femoral side强直性脊柱炎累及双髋关节34 TBnclinical symptomncommon symptomnjoint symptomnpainnfixed deformities of the hipnpainful limitation of movementnmuscle wastingnregional lymph node enlargementnform of
9、 cold abscess with or without sinusesnpathologic dislocation of the hip强直性脊柱炎累及双髋关节35强直性脊柱炎累及双髋关节36 TBnimaging appearancenthickening of the synoviumnsubchondral and marginal bony erosion neffusionnloss of joint spacenperiarticular abscessnjuxta-articular osteoporosis强直性脊柱炎累及双髋关节37强直性脊柱炎累及双髋关节38强直性脊柱
10、炎累及双髋关节39强直性脊柱炎累及双髋关节40强直性脊柱炎累及双髋关节41强直性脊柱炎累及双髋关节42强直性脊柱炎累及双髋关节43强直性脊柱炎累及双髋关节44强直性脊柱炎累及双髋关节45强直性脊柱炎累及双髋关节46强直性脊柱炎累及双髋关节47 TBnhip dislocation uncommon强直性脊柱炎累及双髋关节48强直性脊柱炎累及双髋关节49 TBntuberculous bursitisrarencommon sitetrochanteric region强直性脊柱炎累及双髋关节50强直性脊柱炎累及双髋关节51强直性脊柱炎累及双髋关节52hip joint arthritiscli
11、nical symptom、agegender、laboratory examinationHLA-27(+)ASRF(+)RATubercle bacillus TBimaging appearanceenthesitis、osteophytosis、combined SIJ and spine changesASobvious synovitispolyarticular、bone erosion、uniform narrowingRAmonoarticularnonuniform narrowing bone destructionTBFinal diagnosiscombination
12、强直性脊柱炎累及双髋关节53Made by chaichao强直性脊柱炎累及双髋关节54RAJoint TBPVNSGouty Joint involvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%The first metatarsophalangeal jointsequestrum_+_cold abscess/sinus tract _+_Reactive sclerosis_+_+OsteoporosiswideLocal(Periarticular)_joint space narrowinguniformnonuniform_（late）_强直性脊柱炎累及双髋关节55强直性脊柱炎累及双髋关节56
