Rapidly destructive arthropathy of the hip joint in patients with rheumatoid arthritis

Abstract

This article describes 3 patients with rheumatoid arthritis in which hip joint conditions were similar to rapidly destructive arthropathy of the hip joint. The patients had the following additional characteristics: (1) age at diagnosis was comparatively older; (2) rheumatoid arthritis had an onset after age 40 years; (3) severe rheumatoid arthritis was present in >4 major joints; (4) long-term steroids and disease-modifying antirheumatic drugs were taken due to the high activity of rheumatoid arthritis; and (5) patients were underweight, with body mass indexes <20 kg/m(2).Rapidly destructive arthropathy of the hip joint rarely occurs in osteoarthritis, avascular necrosis of the femoral head, and rheumatoid arthritis. Clinically, rapidly destructive arthropathy of the hip joint occurs in elderly patients who report severe pain but have a relatively preserved range of motion. Typical radiologic changes in rapidly destructive arthropathy of the hip joint are rapid destruction, resorption, or subluxation of the femoral head, destruction of the acetabulum, and minimal spur formation developing 6 to 12 months after symptom onset. Destruction of the hip joint in rheumatoid arthritis occurs in the sequence of depression, flattening, and loss, and commonly progresses gradually. When patients with rheumatoid arthritis report persistent and severe pain in the hip joint with no specific cause, rapidly destructive arthropathy of the hip joint must be identified through repetitive follow-up radiographic observations.