Rapidly destructive arthrosis of the hip joint in a young adult with systemic lupus erythematosus

Abstract

A 37-year-old female had been treated with corticosteroids for systemic lupus erythematosus clinically diagnosed at age 10. She suddenly had right hip pain without any antecedent trauma. Four months after the onset of pain, she visited her primary care physician. On magnetic resonance imaging, joint space narrowing at the weight-bearing area was already seen with bone marrow edematous lesions in both the femoral head and acetabulum. She was treated non-operatively; however, her pain continued to worsen in severity. Thirteen months after the onset of pain, she was referred to our hospital. A plain radiograph showed subluxation of the collapsed femoral head accompanied by destruction of the acetabular rim. Because of her severe intractable pain, she underwent total hip arthroplasty 1 month after her first visit. Histological examination of the resected femoral head revealed pseudogranulomatous lesions along with prominent callus formation, suggesting rapid destruction of the femoral head.

The mysteries of rapidly destructive arthrosis of the hip joint: a systemic literature review

“…Several potential risk factors have been proposed in the literature, including: (I) ageing; (II) female gender; (III) underlying health problems such as rheumatoid arthritis, diabetes mellitus and systemic lupus erythematosus; (IV) lower bone mineral density; (V) higher BMI; (VI) medicinal drug use including NSAIDs and corticosteroid; (VII) alcoholism (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(19)(20)(21)(22)(23)(24)27,29). In this study, we evaluated the risk factors and found the only prevalent factors were: (I) age greater than 60 years; (II) female gender; (III) underlying systemic disease such as rheumatoid arthritis, diabetes mellitus or systemic lupus erythematosus (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(19)(20)(21)23,24). There is insufficient evidence to support the relationship between BMD, BMI, medication and alcoholism and the o...…”

“…In this study, we evaluated the risk factors and found the only prevalent factors were: (I) age greater than 60 years; (II) female gender; (III) underlying systemic disease such as rheumatoid arthritis, diabetes mellitus or systemic lupus erythematosus (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(19)(20)(21)23,24). There is insufficient evidence to support the relationship between BMD, BMI, medication and alcoholism and the occurrence of RDA (2,3,5,8,10,23,27,29). We did not find these factors to increase the risk of RDA.…”

“…It was reported that a unique presentation of severe bone destruction as a manifestation of chronic myeloid leukemia in the absence of blast crisis (33). There were bone marrow edema on acetabulum, femoral head and neck and the weight-bearing area and the articular cartilage was absent with the subchondral insufficiency fracture or subchondral bone destroyed (2,3,(5)(6)(7)(8)10,34,35).…”

“…All of these studies were retrospective. Fourteen were reported in Asia (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), six in Europe (16)(17)(18)(19)(20)(21) and three in America (22)(23)(24). In total, 17 detailed patient cases were included (one article reported two cases, see Table 1).…”

Bilateral rapidly destructive coxopathy in rheumatoid arthritis

“…Our investigation yielded 26 articles suggesting a potential correlation between RDC and endocrine [10][11][12][13], metabolic [13][14][15][16][17], hematologic [18,19], toxic [20][21][22], rheumatic conditions [23][24][25][26][27][28][29][30], or fractures/injuries [31][32][33][34][35] which we included in our analysis. Table I summarizes the clinical characteristics of patients with RDC associated with secondary conditions identified throughout the studies in the review, while Table II focuses specifically on RDC associated with RA.…”