QuestionSBA
QuestionChoice
The involvement of a large, isolated joint is not classical of rheumatoid arthritis (RA). RA usually causes multiple small-joint arthritis. The most likely diagnosis here is avascular necrosis.
10034893
b
Rheumatoid arthritis
QuestionChoice
No history of trauma has been given. The most likely diagnosis in this case is avascular necrosis, likely due to steroid use for ulcerative colitis.
10034896
e
Trauma
QuestionChoice
The pattern of single large joint involvement is not typical of psoriatic arthritis. There are no features in the history (e.g. DIP joint involvement, psoriasis, asymmetrical arthritis, dactylitis) to suggest this as the diagnosis. The most likely diagnosis in this case is avascular necrosis, likely due to steroid use for ulcerative colitis.
10034895
d
Psoriatic arthritis
QuestionChoice
This patient likely has avascular necrosis of the femoral head, contributed to by long-term steroid use for ulcerative colitis. Other risk factors for this condition include smoking, alcohol use, and sickle cell anaemia. The insidious onset and pain in the groin/buttock region, as well as painful internal rotation, are classic findings in this condition. X-rays and an MRI scan will most likely be required.
10034892
a
Avascular necrosis
QuestionChoice
While osteoarthritis often affects the hips and has a gradual onset, this is a more likely diagnosis in an older patient. The most likely diagnosis in this case is avascular necrosis, likely due to prolonged steroid use for ulcerative colitis.
10034894
c
Osteoarthritis
QuestionComment
if it's poorly controlled then surely she's not on steroids in the first place...?
46113
QuestionComment
poorly controlled suggests that she has had repeated steroids to manage flares because steroids are not initially used in mild/moderate disease and reserved for more persistent or severe flares of UC.  
46610
User
subscriber
Ketone Odor
User
subscriber
Poisoning Contusion
Concept
Chapter
2693
4079
Avascular Necrosis
Topic
145
Orthopaedics
19382
Avascular necrosis often presents with gradual hip pain and restricted movement, commonly associated with long-term steroid use.
A 30-year-old woman with a history of poorly controlled ulcerative colitis is referred to the musculoskeletal clinic due to severe left groin and buttock pain that is stopping her from being able to mobilise as usual. She says this has developed gradually.

On examination of her legs, she has restricted, painful active and passive movement in the left hip joint, especially on internal rotation.

What is the most likely diagnosis?
a