Simultaneous Occurrence of Ankylosis of the Cricoarytenoid Joints with Dyspnoe and L.E.-Syndrome in Rheumatoid Arthritis

Background:Rheumatoid arthritis (RA) is characterised by inflammation of the synovial lining. In addition to synovitis, the tendon sheaths of small hand and foot joints are also frequently inflamed. This results in tenosynovitis, which is often missed at clinical evaluation in early RA but visible on imaging, such as MRI. A third anatomical structure surrounded by a synovial lining is formed by the intermetatarsal bursae in the forefeet. Inflammation of these bursae (intermetatarsal bursitis; IMB) was recently identified at MRI-studies and shown to be specific for early RA.[1] This suggests that IMB is also a feature of early RA.Objectives:We hypothesised that if IMB is indeed an RA-feature, then (1) at diagnosis its presence associates with other measures of local inflammation (synovitis, tenosynovitis and osteitis) and (2) it responds to DMARD therapy similarly as these other local inflammatory measures. These hypotheses were tested in a comprehensive MRI-study.Methods:157 consecutive early RA patients underwent unilateral contrast-enhanced 1.5T MRI of the forefoot at diagnosis. MRIs were evaluated for presence of IMB and for synovitis, tenosynovitis and osteitis in line with the RA MRI scoring system (summed as RAMRIS-inflammation). MRIs at 4, 12 and 24 months were evaluated for presence and size of IMB-lesions in patients who had IMB at baseline and received early DMARD-therapy. Logistic regression was used for analyses at patient-level; generalised estimating equations were used for bursa-level analyses. Stratification for ACPA was performed.Results:69% of RA patients had ≥1 IMB. In multivariable analyses on bursa-level, presence of IMB was independently associated with local presence of synovitis and tenosynovitis (OR 1.69 (95%CI 1.12–2.57) and 2.83 (1.80–4.44), respectively), but not with osteitis. On patient-level, presence of IMB was most strongly associated with tenosynovitis (OR 2.92 (1.62–5.24)). During treatment with DMARDs, the average size of IMB-lesions decreased (Figure 1). This decrease was associated with decrease in RAMRIS-inflammation scores; most strongly with a decrease in synovitis but not in osteitis. Within ACPA-positive and ACPA-negative RA similar results were obtained.Conclusion:IMB particularly accompanies inflammation of the synovial lining of joints and tendon-sheaths, both regarding simultaneous occurrence at diagnosis and simultaneous treatment-response. These findings suggest that IMB represents juxta-articular synovial inflammation and indeed is a hallmark of early RA.References:[1]Dakkak YJ et al. Increased frequency of intermetatarsal and submetatarsal bursitis in early rheumatoid arthritis: a large case-controlled MRI study. Arthritis Res Ther 22, 277 (2020).Disclosure of Interests:None declared.

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Simultaneous occurrence of accelerated nodulosis in lungs, liver, and kidneys, and acute exacerbation of interstitial pneumonia in a patient with rheumatoid arthritis: an autopsy case report

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01806-x ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Akitake Suzuki ◽

Shigeki Morita ◽

Miho Ohshima ◽

Nobuyoshi Minemura ◽

Takeshi Suzuki ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Acute Exacerbation ◽

Case Reports ◽

Pulmonary Nodules ◽

Rapid Onset ◽

Simultaneous Occurrence ◽

Intravenous Cyclophosphamide ◽

Internal Organs ◽

Case Presentation ◽

Rheumatoid Nodules

Abstract Background Accelerated nodulosis (ARN) is a rare variant of rheumatoid nodules (RNs) that is characterized by a rapid onset or the worsening of RNs. It generally develops at the fingers in patients with rheumatoid arthritis (RA) receiving methotrexate (MTX). Few case reports have described ARN at an extracutaneous location. Case presentation An elderly patient with long-standing RA was admitted to our hospital with acute respiratory failure. Computed tomography upon admission showed diffuse ground-glass opacities superimposed with subpleural reticular shadowing and honeycombing and multiple nodules in the lungs and liver. Despite the discontinuation of MTX and introduction of an immunosuppressive regimen with pulse methylprednisolone followed by a tapering dose of prednisolone and intravenous cyclophosphamide, the patient died due to the acute exacerbation (AE) of RA-related interstitial lung disease (ILD) following the parallel waxing and waning of a diffuse interstitial shadow and pulmonary and liver nodules. At autopsy, RNs were scattered throughout both lung fields in addition to extensive interstitial changes. RNs were also detected in the liver and kidneys. The foci of cryptococcosis were mainly identified in alveolar spaces. Based on the clinical and pathological findings, these nodules were most consistent with ARN because of acute increases in the size and number of previously detected pulmonary nodules. Conclusion The present case is noteworthy because ARN was concurrently detected in multiple internal organs and may be associated with the AE of RA-related ILD.

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Simultaneous Occurrence of Systemic Lupus Erythematosus, Rheumatoid Arthritis, Hashimoto’s Thyroiditis and Membranous Glomerulonephritis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2014_000122 ◽

2014 ◽

Vol 1 (1) ◽

Author(s):

Lilia Baili ◽

Imène Rachdi ◽

Fatma Daoud ◽

Zohra Aydi ◽

Basma Ben Dhaou ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Hashimoto’S Thyroiditis ◽

Membranous Glomerulonephritis ◽

Hashimoto's Thyroiditis ◽

Simultaneous Occurrence ◽

Systemic Lupus

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A Case Report Describing a Rare Presentation of Simultaneous Occurrence of MPO-ANCA-Associated Vasculitis and Rheumatoid Arthritis

Case Reports in Nephrology ◽

10.1155/2016/9340524 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

Nathalie Foray ◽

Tamer Hudali ◽

Muralidhar Papireddy ◽

John Gao

Keyword(s):

Rheumatoid Arthritis ◽

Renal Failure ◽

Acute Renal Failure ◽

Early Recognition ◽

Dependent Diabetes Mellitus ◽

Simultaneous Occurrence ◽

Crescent Formation ◽

Rare Presentation ◽

Anca Associated Vasculitis ◽

Necrotizing Glomerulonephritis

Background. Renal-limited myeloperoxidase vasculitis with simultaneous rheumatoid arthritis is reported as a rare occurrence. Review of literature suggests that most patients had a diagnosis of rheumatoid arthritis for several years prior to presenting with renal failure from myeloperoxidase vasculitis.Case Presentation. A 58-year-old Caucasian male presented to the hospital experiencing malaise, fevers, decreased oral intake, nausea, and vomiting for one week duration. His past medical history consisted of newly diagnosed but untreated rheumatoid arthritis, hypertension, and non-insulin-dependent diabetes mellitus. He was found to have acute renal failure, proteinuria, and hypoglycemia. Standard therapy, including intravenous fluids, did not improve his acute renal failure. A vasculitis workup resulted in a positive myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). Renal biopsy revealed crescentic glomerulonephritis (GN) pauci-immune type, suggestive of MPO-ANCA-associated vasculitis (MPO-AAV). Treatment consisted of prednisone, cyclophosphamide, and seven cycles of plasmapheresis, in addition to hemodialysis for uremia. Upon discharge, he received hemodialysis for another week and continued treatment with cyclophosphamide and prednisone.Conclusion. Patients with longstanding rheumatoid arthritis may develop renal failure due to nonsteroidal anti-inflammatory medication use and AA type amyloidosis; however, necrotizing glomerulonephritis with crescent formation has been rarely reported. This stresses the importance of early recognition and swift initiation of treatment.

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Pseudochylothorax Combined with Spontaneous Pneumothorax: Case Report of a Rare Complication of Rheumatoid Arthritis

Case Reports in Medicine ◽

10.1155/2018/7846962 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Raquel Rosa ◽

Dionísio Maia ◽

Nídia Caires ◽

Rita Gerardo ◽

Inês Gonçalves ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Pleural Effusion ◽

Rare Complication ◽

Bronchopleural Fistula ◽

Immunosuppressive Treatment ◽

Laboratory Evaluation ◽

Simultaneous Occurrence ◽

Rare Presentation ◽

Glucose Levels

Pleural involvement is the most frequent thoracic complication of rheumatoid arthritis (RA), usually occurring in patients with known RA. Typical rheumatoid pleural effusion is an exudate characterized by low pH and glucose levels and high LDH activity. Rarely, it has features of pseudochylothorax. Other uncommon complications are pneumothorax, hydropneumothorax, empyema, and bronchopleural fistula. The case of a 51-year-old man with a spontaneous, small, and asymptomatic hydropneumothorax with features of pseudochylothorax is presented. After careful clinical and laboratory evaluation, he was diagnosed with rheumatoid arthritis, and we admitted that the pleural changes were secondary to the connective tissue disease. He started immunosuppressive treatment and maintained stability during follow-up, without need of specific pleural treatment. We hypothesized that the pleural nodule found on the chest computed tomography scan was related with the simultaneous occurrence of pleural effusion and pneumothorax. This is a rare presentation and complication of RA, highlighting the utility of a comprehensive clinical and laboratory evaluation and focusing on the importance of pleural rheumatoid nodules in the pathogenesis of RA pleural disease.

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