Rheumatoid arthritis

Abstract Introduction Protrusio acetabuli secondary to rheumatoid arthritis (RA) presents a complex reconstructive challenge during total hip arthroplasty (THA), particularly in the presence of medial wall deficiency and osteoporotic bone. Restoration of hip biomechanics and medial support is essential to prevent cup migration and recurrence of protrusion. Case Report A 75-year-old female with long-standing RA presented with bilateral end-stage hip arthritis and advanced protrusio acetabuli. Radiographs demonstrated Tönnis grade 3 osteoarthritis and Sotelo-Garza grade 3 (left) and grade 2 (right) protrusio. Intraoperatively, Paprosky Type 2C medial wall defects were identified. Staged bilateral cemented THA was performed using titanium mesh and impacted morselized autologous femoral head graft prior to cementation of the acetabular component. Results At five-year follow-up, radiographs demonstrated graft incorporation and restoration of the hip center without evidence of cup migration or loosening. Harris Hip Score improved from 36 preoperatively to 86 at final follow-up. Conclusion Titanium mesh combined with impacted autologous cancellous graft provides a biologically favorable and cost-effective option for medial wall reconstruction in rheumatoid protrusio acetabuli undergoing cemented THA.

The early diagnosis is essential, as it has been observed that progression occurs within 2 years of disease onset.. An aggressive intervention with new and effective biological treatments can alter the course of the disease, prevent joint destruction, lengthen life, and improve function . RA is known to be associated with broad range or the presence of a large number of autoantibodies The present study was designed as a case-control study, carried out in the National Ribat University Hospital, in Khartoum State, Sudan. The aim of this study was to assess the diagnostic value of RA serological markers. The study group composed of 88 patients with RA; all patients had fulfilled the criteria of the American College of Rheumatology (ACR) (5), whereas control group composed of 53 healthy individuals. Blood samples were collected from the study population in order to determine RF-isotypes namely (RF-IgM, RF-IgA), and ACCP2. RF-isotypes and ACCP2 were measured quantitatively using a Sandwich Enzyme–Linked Immunosorbant Assay ELISA (Euroimmune, Germany). displayed that 56.8% of the study group had positive RF-IgM, where it was 22.6% in control group. RF-IgA showed positive reaction in 47.7% and 30.2% of study group and control group, respectively Both RF-isotypes were found to be positive in 33(37.5%) and 6(11.3%) of study group and control group respectively. The ACCP2 was found positive in 52(59.1%) of study group and in 3(5.7%) of control group (table 2). The mean value of ACCP2 in RA patients was statistically significant than that of control group (p.value =0.000). Sensitivity for RA was highest for ACCP2 59%, followed by RF-IgM 56.82%. Utility of two combined RF-isotypes autoantibodies sensitivity for RA was 69(78.4%) and will be 90.9% when ACCP2 was enrolled with the 2 RF-isotypes. In this study 11(12.5%) patients were RF-isotypes negative and positive for ACCP2. Correlation between ACCP2 & RF-IgM was 0.386 and was 0.255 between ACCP2 and RF-IgA and there was no such correlations with the controls. This study showing that the ACCP2 had slightly better sensitivity than RFs among RA patients, and the diagnostic sensitivity of RA increased when ACCP2 was added in the panel along with RF-isotypes.