MUSCULOSKELETAL IMAGING: Arthritis of the Proximal Joints

Case Author: Kirkland W. Davis, MD, University of Wisconsin School of Medicine and Public Health

History

28-year-old man with hip and back pain.

Imaging Findings

Anteroposterior radiograph of the pelvis shows symmetric narrowing of the hip joint spaces and osteophytes. Enthesophyte production (whiskering) is evident at the ischial tuberosities. The sacroiliac joints are poorly defined.

• Ankylosing spondylitis (AS)
• Femoroacetabular impingement
• Juvenile idiopathic arthritis (JIA)
• Psoriatic arthritis (Ps A)
• Rheumatoid arthritis (RA)

Diagnosis

Ankylosing spondylitis (AS)

Teaching Points

Rheumatoid arthritis (RA) does not lead to osteophyte production in the hips; erosions are small when present; and protrusio acetabuli can result. Protrusio acetabuli is not a prominent feature of ankylosing spondylitis (AS). Sacroiliitis should be present when AS involves the hip. It is unusual for psoriatic arthritis (Ps A) to affect the hips. Sacroiliac joint involvement is rare in juvenile idiopathic arthritis (JIA).

Suggested Readings

Boutry N, Khalil C, Jaspart M, et al. Imaging of the hip in patients with rheumatic disorders. Eur J Radiol 2007; 63:49–58
Brower AC, Flemming DJ. Arthritis in black and white, 2nd ed. Philadelphia, PA: Saunders, 1997:105–121

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