类风湿关节炎晚期累及髋关节18例临床病理分析

目的探讨类风湿关节炎(RA)晚期累及髋关节的临床病理学特征、诊断、鉴别诊断。方法收集18例晚期RA累及髋关节行人工关节置换股骨头,回顾性分析其临床及影像学资料、组织形态,并复习相关文献。结果18例患者中,男性8例,女性10例,年龄18~81岁。临床症状主要为多发关节肿痛伴髋关节疼痛。影像学检查关节间隙变窄,关节面下骨质吸收,股骨头半脱位。组织形态表现为关节面变形较轻,较少骨赘形成,股骨头软骨面毛球样粗糙,软骨明显纤维化。软骨表面血管翳形成,侵蚀软骨,并可侵蚀骨质。股骨颈软骨与骨质交接处血管翳和滑膜相延续。股骨头骨质广泛的骨质疏松改变。骨内囊肿壁常为纤维血管肉芽组织,伴有较多的慢性炎细胞浸润,中心常有类似类风湿结节的纤维素样坏死。滑膜表面纤维素样坏死,细胞毛刺状突起,表面间质常有细碎的软骨,增生的乳头间质纤维化。结论晚期RA股骨头在组织形态学上有其特征性病理改变,可与髋关节骨关节炎、强直性脊柱炎、髋关节结核、股骨头坏死等鉴别。病理组织学的深入观察,可为该病的诊断和早期的防治提供理论依据。

Clinicopathological analysis of 18 cases with advanced rheumatoid arthritis involving hip joint

Objective To investigate the clinicopathological features,diagnosis and differential diagnosis of advanced rheumatoid arthritis(RA)involving hip join.Methods Eighteen cases of advanced RA involving hip joint were collectded for artificial joint replacement of femoral head,the clinical and imaging date,tissue morphology and related literature were analyzed retrospectively.Results The patients included 8 males and 10 females,with an age of 18~81 years.The main clinical symptoms were multiple joint swelling and pain accompanied by hip pain.Imaging ex-amination of joint space narrowing,subarticular bone resorption,femoral head subluxation.The morphological manife-stations were less joint surface deformation,less osteophyte formation,rough hairball shape of cartilage surface of femor-al head,and obvious fibrosis of cartilage.Cartilage surface vessels ilium formation,erosion of cartilage,and can erode bone.Pannus and synovium continued at the joint of femoral neck cartilage and bone.The femoral head had extensive bone loss changes.The wall of the intraosseous cyst was usually fibrovascular granulation tissue with more chronic inflammatory cell infiltration and fibrinoid necrosis similar to rheumatoid nodules in the center.There was fibrinoid necrosis on the surface of the synovial membrane,with burriness of the cells.There was often fine cartilage on the surface of the interstitium and hyperplasia of papillary interstitial fibrosis.Conclusion The femoral head or advanced rheumatoid arthritis has its characteristic pathological changes in morphology and histology,which can be distinguished from osteoarthritis(OA)of Hip Joint,ankylosing spondylitis(AS),tuberculosis of hip joint and necrosis of femoral Head.The indepth observation of histopathology can provide theoretical basis for the diagnosis and early prevention of diseases.