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.
Key-words:
Rheumatoid Arthritis - Tempomandibular Joint - Osteolysis - Hip joint
