A 14-year-old girl has referred left knee pain for 3 years. In the last year, she developed left groin pain and limping that responded partially to ibuprofen. No history of: Sacroiliac joint tenderness Inflammatory lumbosacral pain Symptomatic anterior uveitis At presentation, Trendelenburg and log roll tests were positive on the affected side and the movements of the left hip were significantly reduced. There was no enthesitis. HLA-B27 was positive, ANA and RF were negative.
PPD testing was negative. X-ray of the pelvis done 6 months prior to presentation showed shortening of the left femoral neck, premature closure of the proximal femoral physis and decreased hip joint space (see image 1). MRI with gadolinium at presentation demonstrated diffuse synovial enhancement, marked joint space loss and subchondral edema of the femoral head and acetabulum. The SI joints were normal. Management…
