Вы находитесь на странице: 1из 23

Rheumatoid Arthritis Of The Hip

Musculoskeletal Education Program


RCSI Professorial Unit
Cappagh National Orthopaedic Hospital

Rheumatoid Arthritis of the Hip

Chronic, systemic inflammatory disorder of unknown


aetiology, characterised by joint involvement

The inflammatory process is often intermittent, and


frequently leads to progressive joint destruction,
deformity, and incapacity

Rheumatoid Hands

Pathological Features of RA

Starts in the synovial membrane of the involved


joints or tendon sheaths

Swollen synovium produces exudate which


contains many destructive agents
Proteolytic

Regulatory agents are also produced


Hyaluronic

enzymes, collagenases, proteases)

acid, prostaglandins, lymphokines)

In addition, plasma cells and lymphocytes are


present in varying quantities

Pathological Features of RA

The latter plays a major role in polyclonal


immunoglobulin
Some

of which is rheumatoid factor (RF)

Within the synovial fluid, immune complexes form


Can

activate complement, release chemotactic agents, and


encourage further ingress of inflammatory cells

The synovium thickens, proliferates (pannus) and


spreads over the surface
Forms

marginal erosions and destroys articular cartilage

Pathological Features of RA

Rheumatoid Factor (RF)

IgM antibody

Its presence is a consequence of the disease process,


and it is used to group cases into seropositive and
seronegative
Seropositive

pts have rheumatoid nodules on extensor

surfaces

It is an autoantibody against -globulin


May

be responsible for aggravating the inflammatory process

Serological titre is related to virulence of the disease


A low

titre can be found in a proportion of normal population

Rheumatoid Nodules

Clinical Features of RA

Peak presentation is 35 45 years of age


F>M
Can

occur at any age (eg Stills disease in children)

Most frequently starts as a symmetrical


polyarthritis
Affects

small joints of hands and feet

May be slowly progressive (worse prognosis),


episodic, or fulminating

Clinical Features of RA

Clinical Features of RA

General Symptoms
Early

morning stiffness
Weight loss
Fever
Malaise
Fatigue

Local Symptoms
Joint
Pain

swelling

Clinical Features of RA

Signs
Tenderness
Redness

local heat

Swelling

boggy to palpation

Clinical Features of RA

Signs Hips
Disability

here may be marked

Even when radiological signs are minor

Rheumatoid

patients take high doses of steroids

High risk for avascular necrosis of femoral head

Extra-articular Manifestations

Primarily a joint disease


Other

organs may be involved, often insidiously

Eye
Scleritis

can cause blindness


Keratoconjunctivitis sicca 10% of patients
Sjgren Syndrome

Lungs
Pulmonary

Effusions
Pulmonary Fibrosis assoc with high RF titre

Extra-articular Manifestations

CVS

Pericardial

Skin rheumatoid vasculitis


Ulcers,

effusions, pericarditis

haemorrhages, even gangrene

Urinary tract
Amyloidosis

of kidneys (not common can be fatal)

CNS
Primary

neuropathy
Cervical myelopathy 2 subluxation of C-Spine

Investigations

Few investigations are specific


High

titre of RF is highly suggestive (indicative of a


poor prognosis)

FBC, ESR, C-reactive protein (CRP)

Biopsy is useful to exclude other conditions


affecting synovium
TB

Radiological Features

Soft tissue swelling

Juxta-articular osteoporosis

Marginal erosions

Joint space narrowing

Deformity
Hands

are often affected earliest

Radiographic Features of Hip RA

Treatment - Medical

NSAIDs

Reduce stiffness and synovitis, improve mobility

Second Line Tx
Gold salts, penicillamine, immunosuppressants
(azothioprine)
Known as the DMARDs

Third Line Tx
Corticosteroids (prednisolone) lowest dose to
control symptoms and minimize side effects
Intra-articular steroids may be utilised in accessible
joints

Treatment - Surgical

Early in disease process synovectomy


Can

be perfomed arthroscopically

Advanced disease
Joint

replacement (Arthroplasty) particularly hip and

knee

Restores pain free function

Joint

fusion (arthrodesis) now confined to digital


joints, ankle and wrist

Hip Arthrodesis

Arthroplasty of Hip for RA

Arthroplasty of Hip for RA

Вам также может понравиться