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 involved——one-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 involved——5to15% 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) T1WI——low signal T2WI——high signal late stage (increased fabre composition) T1WI——isosignal T2WI——isosignal 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 tubercu