Rapid destructive osteoarthritis: clinical, radiographic, and pathologic features.

Abstract

Twenty-seven cases of an unusual, poorly recognized destructive hip arthropathy with radiographic findings of rapid severe joint destruction are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities. All patients underwent hip arthroplasty, and osteoarthritis was confirmed at pathologic examination. Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average, 18 months) in nine patients documented rapid hip destruction. Involvement was unilateral in 89% (24 of 27 cases). Twenty patients (83%) were elderly women. The authors postulate that these cases represent an uncommon, rapidly destructive subset of osteoarthritis.

Significant increases in serum and plasma concentrations of matrix metalloproteinases 3 and 9 in patients with rapidly destructive osteoarthritis of the hip

“…We found that the mean serum MMP-3 level in women with rapidly destructive hip OA was 100 Ϯ 63 ng/ml, a value 2-3 times higher than that in women with ordinary hip OA. Synovial fibroblast adhesion to articular cartilage is commonly observed in RA (22) as well as in rapidly destructive hip OA (23). Our finding that synthesis of MMP-3 by synovium was significantly higher in patients with rapidly destructive hip OA than in those with OA is consistent with the findings of previous semiquantitative studies (7,8).…”

“…MMP-9 can also be produced by activated osteoclasts (34). A number of osteoclasts in rapidly destructive hip OA, which are one source of MMP-9, have been observed around necrotic bone in subchondral areas (23,24). A recent study also demonstrated that MMP-9 was strongly expressed in the subchondral region in RA patients (35).…”

Elevated levels of serum type I collagen C-telopeptide in patients with rapidly destructive osteoarthritis of the hip

“…Radiographic findings in this disease can mimic those of other disorders, such as septic arthritis, rheumatoid and seronegative arthritis and primary osteonecrosis with secondary OA [21]. However, none of our patients had clinical, pathologic or laboratory evidence of these entities.…”

“…However, none of our patients had clinical, pathologic or laboratory evidence of these entities. Repeated minor trauma with subsequent stress fractures, excessive locomotor activity and femoral-head hypoxia due to atherosclerotic vasculopathy have been proposed as predisposing factors [21]. Yet these factors were only present in two of our patients with a rapid progression of the disease, rendering a causative explanation unlikely.…”

“…Rapidly destructive osteoarthritis (OA) of the hip is an uncommon subset of OA that affects mainly elderly women and leads to painful disability requiring total joint replacement [17,19,21]. Characteristically, the average duration of symptoms is significant shorter in patients with rapidly destructive OA, and joint-space narrowing has been shown to progress consistently faster, exceeding an annual rate of 2 mm in most patients [15].…”