强直性脊柱炎累及双髋关节

强直性脊柱炎累及双髋关节HistoryMale,28yearsoldHippainNolaboratoryexamination2021/3/1022021/3/1032021/3/1042021/3/1052021/3/1062021/3/1072021/3/1082021/3/1092021/3/10102021/3/10112021/3/10122021/3/1013FinalDiagnosisbilateralsacroiliitisseronegativespondyloarthropathyinvolvebilatrealhipjointsynovialcystatthefrontmarginofarticular2021/3/1014ASmainlyyoungadults,mostlymaleage:10to40yearsold,average25hipinvolved——one-thirdofpatientswithASHLA-B27positive>90%axialskeletal:bilaterallyperipheralarthritis:asymmetrically2021/3/1015ASconventionalradiographstwotypicalfeaturesconcentricosteoproliferationwithosteophytesaroundthefemoralneckerosionsoftheacetabulum2021/3/10162021/3/1017ASconventionalradiographsotherssclerosissynovitis;enthesitisosteophytosisjointspacenarrowing——concentric,uniformjointeffusionsubchondralbonemarrowedemaperiarticularfatdepositions2021/3/10182021/3/10192021/3/10202021/3/10212021/3/10222021/3/1023DDXRheumatoidarthritis(RA)Tuberculosis(TB)2021/3/1024RAautoimmunedisorderofunknownetiologycharacteristicsymmetricerosivesynovitissometimesmultisysteminvolvementhipinvolved——5to15%mainlywomen2021/3/1025RAclinicalsymptompainswellingstiffnessmotionimpairmentlaboratorytestsrheumatoidfactor(+)elevatedESRandCRP2021/3/1026RAimagingappearancesynovitisthickeningofsofttissueosteoporosissubchondralcystformationhomogeneousnarrowingofarticularspaceerosionofcartilageacetabulumandheadoffemurbothinvolved2021/3/1027RAimagingappearanceMRIearlystage(richvesselsofpannus)T1WI——lowsignalT2WI——highsignallatestage(increasedfabrecomposition)T1WI——isosignalT2WI——isosignal2021/3/1028

2021/3/1029RAsynovialcyst——rare2021/3/10302021/3/10312021/3/1032TBpathogenesis—hematogenousdissemination15%casesofosteoarticulartuberculosiscommonage——thesecondandthirddecadesthemostcommonsite——vertebraltuberculosis2021/3/1033TBlesionsontheacetabularsideprogresslessrapidlythanlesionsonthefemoralside2021/3/1034TBclinicalsymptomcommonsymptomjointsymptompainfixeddeformitiesofthehippainfullimitationofmovementmusclewastingregionallymphnodeenlargementformofcoldabscesswithorwithoutsinusespathologicdislocationofthehip2021/3/10352021/3/1036TBimagingappearancethickeningofthesynoviumsubchondralandmarginalbonyerosioneffusionlossofjointspaceperiarticularabscessjuxta-articularosteoporosis2021/3/10372021/3/10382021/3/10392021/3/10402021/3/10412021/3/10422021/3/10432021/3/10442021/3/10452021/3/10462021/3/1047TBhipdislocation——uncommon2021/3/10482021/3/1049TBtuberculousbursitis——rarecommonsite——trochantericregion2021/3/10502021/3/10512021/3/1052hipjointarthritisclinicalsymptom、agegender、laboratoryexaminationHLA-27(+)ASRF(+)RATuberclebacillus

TBimagingappearanceenthesitis、osteophytosis、combinedSIJandspinechangesASobvioussynovitispolyarticular、boneerosion、uniformnarrowingRAmonoarticularnonuniformnarrowingbonedestructionTBFinaldiagnosiscombination2021/3/1053Madebychaichao2021/3/1054RA

JointTBPVNSGoutyJointinvolvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%Thefirstmetatarsophalangealjointsequestrum_+__coldabscess/s