A Clinical Case of Acute Polyarthritis Unmasking Severe Comorbidity

Acute polyarthritis requires a comprehensive differential diagnosis in order to establish its etiology. Moreover, sometimes it may unfold unexpected comorbidities, thus necessitating an individualized management approach. This article describes the case of an elderly patient whose initial presentation of acute polyarthritis was interpreted as crystal induced-arthritis demonstrated by the presence of calcium pyrophosphate and lipid crystals in the synovial fluid. The clinical deterioration of the patient along with the suspicion of a systemic infection required interdisciplinary collaboration and led to his transfer to the infectious diseases department where the diagnosis of sepsis from unknown origin was added. Further investigations unmasked a large complicated pancreatic pseudocyst that eventually ruptured into the peritoneal cavity and led to the patient's death.

Löfgren’s Syndrome

Löfgren’s syndrome presents as acute sarcoid arthritis, with a triad of hilar adenopathy, acute polyarthritis and erythema nodosum. Löfgren’s syndrome is self-limited, erythema nodosum, hilar adenopathy and acute polyarthritis usually resolve within a few weeks to months, however polyarthritis can last for up to 2 years. Treatment involves symptomatic control with NSAIDs/colchicine or oral glucocorticoids until symptoms resolve, if disease is resistant to these therapies, hydroxychloroquine, methotrexate or infliximab can be used. Löfgren’s syndrome is a rare presentation of sarcoidosis occurring in only about 5–10% of sarcoid patients. It is, however, important to recognize as it is the most common form of acute sarcoid arthritis and prompt treatment can prevent unnecessary prolonged discomfort for patients.

Acute polyarthritis revealing celiac disease of the elderly

Introduction: Celiac disease (CD) is an autoimmune disease that typically occurs in childhood and young age. Late-onset forms (after 60 years) are rare and often underestimated in current medical practice, as is joint damage during this disease. We report an original case of CD in an elderly patient revealed by acute polyarthritis. Observation: A 62-year-old patient with no significant pathological history was explored for acute polyarthritis of both large and small joints. The physical examination noted synovitis of the hands and wrists without articular deformities, and a marked mucocutaneous pallor. The biology revealed a microcytic anemia at 8 g/dl with stigmas of malabsorption (low cholesterol and hypocalcemia). No inflammatory syndrome was noted. Joint X-rays were without abnormalities. Immunological tests for chronic inflammatory rheumatisms were negative. Gastroduodenal fibroscopy was performed and histological examination of duodenal biopsies showed diffuse villous atrophy with marked inflammatory infiltrate. Anti- endomysium and anti-transglutaminase antibodies were positive confirming the diagnosis of CD. Under gluten-free diet, the evolution was favorable with totally disappearance of articular signs. Conclusion: Joint manifestations during CD are rare. The revealing forms are exceptional and can make a differential diagnosis with chronic inflammatory rheumatism, in particular that associations with CD was described. CD deserves to be evoked in front of any unexplained arthritis of the elderly, even without any specific digestive symptomatology of this disease.

Problem based review: The patient with recent onset Polyarthritis

A wide variety of conditions can present as acute polyarthritis, ranging from those that are potentially life threatening, to those that are self-limiting, and those that represent the early stages of a persistent and potentially destructive form of arthritis. In this article, we describe the diagnostic approach and initial management of patients with recent onset polyarthritis, with the aid of an illustrative case vignette.