Massive accumulation of osteoclastic giant cells in rapid destructive hip disease

Abstract

ABSTRACT:The term rapid destructive hip disease (RDHD) designates a rare coxarthropathy characterized by a rapid destruction of the femoral head within a few weeks to several months. The etiology and pathogenesis of RDHD are not understood. The goal of this study was to define the histological and histomorphometric hallmarks of RDHD to provide a basis for a deeper understanding of the underlying mechanisms. Fifteen consecutive RDHD patients (mean age 78.9 AE 6.4 years, 14 females) demonstrated the characteristic radiographic appearance of vanishing femoral head bone stock without signs of reactive anabolic changes. Histologic and histomorphometric analyses revealed severe bone resorption with significantly increased numbers of morphologically altered giant osteoclasts, the formation of giant cell granulomas both in bone marrow and the synovium and significantly increased osteoblast numbers and osteoid as compared to controls with primary osteoarthritis (OA). These results suggest that in RDHD, an unknown stimulus leads to a massive activation of osteoclasts and this in turn provokes a reactive increase in osteoblast activity that is too weak to counteract the rapid destruction of the hip, thus providing a rationale for a prospective systematic search for the stimuli upstream of the massively increased osteoclast activation in RDHD. ß

Characterization of multinucleated giant cells in synovium and subchondral bone in knee osteoarthritis and rheumatoid arthritis

“…Despite the first description of synovial giant cells in RA by Grimley and Sokoloff in 1966 [ 21 ], their role in the pathogenesis of OA remains largely unknown. Some recent reports described the presence of these cells in OA synovium [ 22 , 23 ], whereas others report few or none [ 24 , 25 ].…”

Bilateral vanishing hips, coincidence or systemic disease? A case report and overview of current literature

“…It is reported that in the histological sections of patients with vanishing of the femoral head an increased amount of osteoclasts were found which were morphologically altered and there was formation of resorptive giant cell granulomas. 4 A case series study did not found histopathological traceable reason for infection or malignant disease. 5 The pathophysiology of rapid destructive arthritis is not fully understood.…”

Rapid destructive arthritis of the hip revisited

“…Seitz et al [33] found histomorphometric signs of high bone turnover with vanishing of the femoral head bone stock due to a severe resorptive reaction to osseous debris with a strongly increased number of morphologically altered osteoclasts along with the formation of resorptive giant cell granulomas both in intertrabecular bone marrow and in the synovial membrane. These findings indicate that rapid destructive arthritis of the hip is a distinct entity with massive osteoclast activation being a central hallmark of the pathogenesis; massive synovial proliferation is likely to be the cause of the disease as a trigger for the massive activation of osteoclastic cells [33].…”

“…These findings indicate that rapid destructive arthritis of the hip is a distinct entity with massive osteoclast activation being a central hallmark of the pathogenesis; massive synovial proliferation is likely to be the cause of the disease as a trigger for the massive activation of osteoclastic cells [33].…”