J Korean Hip Soc.  2010 Sep;22(3):234-240. 10.5371/jkhs.2010.22.3.234.

Rapidly Destructive Coxarthrosis in Patients with Rheumatoid Arthritis: Report on 3 Cases

• Yun HH
• Yoon JR
• Lim DS
• Yi JW

• KMID: 1461176
• DOI: http://doi.org/10.5371/jkhs.2010.22.3.234

Abstract

Rapidly destructive coxarthrosis may be caused by osteoarthritis, osteonecrosis of the femoral head and rheumatoid arthritis, but its etiology has not been clarified. Rapidly destructive coxarthrosis generally occurs in old age patients and the patients clinically show severe pain, but a relatively preserved range of motion. Rapidly destructive coxarthrosis is characterized by a rapid destruction, resorption and subluxation of the femoral head, destruction of the articular area in the acetabulum, above 50% or 2 mm/year loss of the joint space and minimal osteophyte formation. The radiologic changes are dramatic and they may mimic neuropathic or septic arthritis. We report here on three cases of rheumatoid arthritis that had acute destruction of the hip joint and rapid resorption of the femoral head, and we also review the relevant medical literature. We recommend taking repetitive radiographs for rheumatoid arthritis patients who suffer with continuing severe hip pain.

Keyword

Hip; Rapidly destructive coxarthrosis; Rheumatoid arthritis

MeSH Terms

Acetabulum
Arthritis, Infectious
Arthritis, Rheumatoid
Head
Hip
Hip Joint
Humans
Hydrazines
Joints
Osteoarthritis
Osteoarthritis, Hip
Osteonecrosis
Osteophyte
Range of Motion, Articular
Hydrazines

Figure

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  Fig. 1 Case 1. Radiographs of a 67-year-old woman with an 18-year history of rheumatoid arthritis (A) Anteroposterior view of the both hip joint, obtained at the onset of right hip joint pain. The radiograph showed joint space narrowing in the joint and sclerosis of the femoral head in the right side. (B) Anteroposterior view of the same patient obtained 1 year later showed almost total disappearance of the left femoral head and osteolysis of the pelvic side. (C) Anteroposterior view of the left hip joint, obtained at the 1 year after total hip arthroplasty. The radiograph showed no loosening in both side.

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  Fig. 2 Case 2. Radiographs of a 66-year-old man with a 20-year history of rheumatoid arthritis, obtained at the onset of left hip joint pain. The radiographs showed even joint space narrowing and sclerosis in the both wrist joints, right knee joint, and left hip joint. Arthroplasty were already performed in the left knee joint.

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  Fig. 3 Case 2. (A) Anteroposterior view of the left hip joint, obtained at the onset of left hip joint pain. The radiograph showed joint space narrowing in the joint and sclerosis of the femoral head in the left side. (B-D) Anteroposterior views (radiography, CT, MRI) of the same patient obtained 7 month later showed almost total disappearance of the left femoral head and osteolysis of the pelvic side. (E) Hip joint aspiration was performed under fluoroscopy guided.

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  Fig. 4 Case 3. Radiographs of a 65-year-old man with an 18-year history of rheumatoid arthritis, obtained at the onset of right hip joint pain. The radiographs showed even joint space narrowing and sclerosis in the both elbow and wrist joints, left hip joint, left knee joint, and right ankle joint. Almost total disappearance of the femoral head and osteolysis of the pelvic side was seen in the right hip joint area.

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  Fig. 5 Case 3. (A, B) Coronal view (CT, MRI) of the right hip joint showed almost total disappearance of the right femoral head and osteolysis of the pelvic side. (C) Hip joint aspiration was performed under fluoroscopy guided. (D) Anteroposterior view of the both hip joint, obtained at the 1 year after total hip arthroplasty in the right hip joint. There was no loosening in the right hip joint.

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