Osteolysis of the hips in a patient with long term rheumatoid arthritis

Abstract

Case presentation: A fifty four year old African American female with history of rheumatoid arthritis (RA) presented to the emergency room with signs and symptoms of community acquired pneumonia. Patient was diagnosed with RA 30 years ago and was treated initially with non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and gold injections for 3 months since then she didn't receive any disease modifying anti rheumatic drugs (DMARD) or corticosteroids. On examination, she was wheelchair bound with multiple joint deformities: ulnar deviation, swan neck deformities, without any signs of active synovitis. Rheumatoid nodules were absent. She had severe limitation of passive and active movement of the hip joints bilaterally. Images of the pelvis showed resporption of the femoral (1). Marked subchondral sclerosis was noted in the acetabulum. CT scan of the pelvis was done to rule out subcapital femoral neck fracture. It demonstrated advanced degenerative changes in both hip joints with partial resorption of both femoral heads worse on the left, no fracture was noted. Conclusion: Osteolysis is a complication of long term untreated RA that is rarely seen in adults with RA and is more common in JRA.