强直性脊柱炎累及双髋关节.ppt

强直性脊柱炎累及双髋关节History nMale,28 years oldnHip painnNo laboratory examination2021/1/1222021/1/1232021/1/1242021/1/1252021/1/1262021/1/1272021/1/1282021/1/1292021/1/12102021/1/12112021/1/12122021/1/1213 Final Diagnosisnbilateral sacroiliitis nseronegative spondyloarthropathy involve bilatreal hip jointnsynovial cyst at the front margin of articular 2021/1/1214 ASnmainly young adults,mostly male nage:10 to 40 years old,average 25nhip involvedone-third of patients with ASnHLA-B27 positive 90%naxial skeletal:bilaterallynperipheral arthritis:asymmetrically2021/1/1215 ASnconventional radiographsntwo typical featuresnconcentric osteoproliferation with osteophytes around the femoral necknerosions of the acetabulum2021/1/12162021/1/1217 ASnconventional radiographsnothersnsclerosisnsynovitis;enthesitisnosteophytosis njoint space narrowing concentric,uniform njoint effusionnsubchondral bone marrow edema nperiarticular fat depositions 2021/1/12182021/1/12192021/1/12202021/1/12212021/1/12222021/1/1223 DDXnRheumatoid arthritis(RA)nTuberculosis(TB)2021/1/1224 RAnautoimmune disorder of unknown etiologyncharacteristicnsymmetricnerosive synovitisnsometimes multisystem involvementnhip involved5to15%nmainly women2021/1/1225 RAnclinical symptomnpainnswellingnstiffness nmotion impairmentnlaboratory testsnrheumatoid factor(+)nelevated ESR and CRP2021/1/1226 RAnimaging appearancensynovitisnthickening of soft tissue nosteoporosisnsubchondral cyst formationnhomogeneous narrowing of articular spacenerosion of cartilagenacetabulum and head of femur both involved2021/1/1227 RAnimaging appearancenMRInearly stage(rich vessels of pannus)nT1WIlow signalnT2WIhigh signalnlate stage(increased fabre composition)nT1WIisosignalnT2WIisosignal2021/1/1228 2021/1/1229 RAnsynovial cystrare2021/1/12302021/1/12312021/1/1232 TBnpathogenesis hematogenous disseminationn15%cases of osteoarticular tuberculosisncommon agethe second and third decadesnthe most common sitevertebral tuberculosis2021/1/1233 TBnlesions on the acetabular side progress less rapidly than lesions on the femoral side2021/1/1234 TBnclinical symptomncommon symptomnjoint symptomnpainnfixed deformities of the hipnpainful limitation of movementnmuscle wastingnregional lymph node enlargementnform of cold abscess with or without sinusesnpathologic dislocation of the hip2021/1/12352021/1/1236 TBnimaging appearancenthickening of the synoviumnsubchondral and marginal bony erosion neffusionnloss of joint spacenperiarticular abscessnjuxta-articular osteoporosis2021/1/12372021/1/12382021/1/12392021/1/12402021/1/12412021/1/12422021/1/12432021/1/12442021/1/12452021/1/12462021/1/1247 TBnhip dislocation uncommon2021/1/12482021/1/1249 TBntuberculous bursitisrarencommon sitetrochanteric region2021/1/12502021/1/12512021/1/1252hip joint arthritisclinical symptom、agegender、laboratory examinationHLA-27(+)ASRF(+)RATubercle bacillus TBimaging appearanceenthesitis、osteophytosis、combined SIJ and spine changesASobvious synovitispolyarticular、bone erosion、uniform narrowingRAmonoarticularnonuniform narrowing bone destructionTBFinal diagnosiscombination2021/1/1253Made by chaichao2021/1/1254RAJoint TBPVNSGouty Joint involvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%The first metatarsophalangeal jointsequestrum_+_cold abscess/sinus tract _+_Reactive sclerosis_+_+OsteoporosiswideLocal(Periarticular)_joint space narrowinguniformnonuniform_（late）_2021/1/12552021/1/1256资料整理仅供参考,用药方面谨遵医嘱