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Park, Lee, Kim, Hurr, Chun, Rhyu, and Cho: Acute Phase of Sero-negative Rheumatoid Arthritis Misdiagnosed as Pyogenic Arthritis - A Case Report -
Case Report
Hip & Pelvis

Hip & Pelvis 2012; 24(4): 328-332.

Published online: 31 December 2012

DOI: https://doi.org/10.5371/hp.2012.24.4.328

Acute Phase of Sero-negative Rheumatoid Arthritis Misdiagnosed as Pyogenic Arthritis - A Case Report -

Cheol Hee Park, MD, Joo Hyun Lee, MD, Tae Jin Kim, MD, Dong Hurr, MD, Young Soo Chun, MD, Kee Hyung Rhyu, MD, Yoon Je Cho, MD, PhD

Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

Address reprint request to Yoon Je Cho, MD, PhD. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea. TEL: +82-2-958-8346, FAX: +82-2-964-3865, yjcho@khmc.or.kr

Received 14 October 2012       Revised 15 November 2012       Accepted 16 November 2012

Copyright © 2012 by Korean Hip Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In cases of sero-negative rheumatoid arthritis (RA), no abnormal findings are observed on blood tests and its clinical course is favorable, compared to sero-positive RA. In the acute phase of sero-negative RA, infiltration of neutrophils may be the only pathologic finding on frozen section biopsy. Thus, it might be misdiagnosed as pyogenic arthritis. We report on a case of acute sero-negative RA misdiagnosed as pyogenic arthritis during hip surgery with review of the literature.

Keywords: Hip, Seronegative rheumatoid arthritis, Pyogenic arthritis

Figures and Tables

Fig. 1
Preoperative radiographs of the hip joint showing sclerotic change of both femoral head, subchondral bone cysts & fracture, joint destructive change. (A) AP view, (B) Frogleg view.
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Fig. 2
MRI view showing joint fluid collection, synovial hypertrophy, subchondral bone cyst & fracture. (A) T1 weighted coronal view (B) T2 weighted coronal view.
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Fig. 3
Postoperative radiographs showing antibiotics pregnated cement spacer insertion of the right hip joint.
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Fig. 4
(A) Histologic examination of hematoxyline and eosin stained specimen showed of neutrophils infiltration in the tissues around the hip joint and did not show the lymphoid follicle (×100). (B) The same findings above figure (×400), (C) Small pannus (dark arrow) formation ingrowing cartilage (×100).
hp-24-328-g004

References

1. Rozin AP, Hasin T, Toledano K, Guralnik L, Balbir-Gurman A. Seronegative polyarthritis as severe systemic disease. Neth J Med. 2010. 68:236–241.
2. Bullough PG. Orthopaedic pathology. 2004. 4th ed. Edinburgh: Mosby;286–297.
3. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988. 31:315–324.
crossref
4. Cascão R, Rosário HS, Souto-Carneiro MM, Fonseca JE. Neurtophils in rheumatoid arthritis: More than simple final effectors. Autoimmun Rev. 2010. 9:531–535.
5. Morel J, Combe B. How to predict prognosis in early rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2005. 19:137–146.
crossref
6. van Zeben D, Hazes JM, Zwinderman AH, Cats A, van der Voort EA, Breedveld FC. Clinical significance of rheumatoid factors in early rheumatoid arthritis: results of a follow up study. Ann Rheum Dis. 1992. 51:1029–1035.
crossref
7. Nishimura K, Sugiyama D, Kogata Y, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med. 2007. 146:797–808.
crossref
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