Rapidly Destructive Inflammatory Arthritis of the Hip

Table 1

Major clinical, lab, and imaging findings.

(1) Rapid progressive right hip destructive arthritis
(2) Morning stiffness greater than 1 hour
(3) Maximum active joint count of 11
(4) Chronic metatarsal phalangeal joints arthritis with erosions, periarticular osteopenia on imaging of hands
(5) Right knee arthritis with no imaging evidence of crystal arthropathy
(6) Erythrocyte sedimentation rate (ESR) of 56 mm/h and C-reactive protein (CRP) 106.4 mg/L, antinuclear antibody (ANA) was weakly positive at 1:80, with a negative rheumatoid factor (RF), anticitrullinated peptide (anti-CCP), antidouble stranded DNA (anti-dsDNA), and extractable nuclear antigen (ENA) screen
(7) Two incidental pulmonary nodules
(8) A soft tissue calcified mass in the right sacroiliac (SI) fossa and right gluteal muscles
(9) Presence of extracellular calcium pyrophosphate dehydrate (CPPD) crystals in right hip joint, negative synovial biopsy for crystals
(10) Biopsy showed chronic inflammation, fibrosis, multinucleated giant cell reaction with dystrophic calcification, and reactive synovial proliferation