The 457th case: polyarthralgia, back pain and subcutaneous masses

VernacularTitle:第457例——多关节肿痛、腰背痛、全身多发包块
Author: Meng LI ; Di WU ; Wenjie ZHENG ; Mengtao LI ; Xiaofeng ZENG
Keywords: Arthritis; theumatoid; Multiple theumatoid bursal cysts
From: Chinese Journal of Internal Medicine 2017;56(6):477-480
CountryChina
Language:Chinese
Abstract: A 54-year-old man was admitted to the Department of Rheumatology in Peking Union Medic.al College Hospital due to polyarthritis.back pain and multiple subcutaneous masses.He had symmetrical polyarthritis at onset.which was diagnosed as theumatoid arthritis.His follow-up and treatment were irregular.Back pain and multiple subcutaneous masses developed 2 year ago.Erythrocyte sedimentation rate and C-reac.tive protein were elevated.Rheumatoid fac.tor and Anti-cylic citrullinated peptide antibody were positive.No evidence of infection or malignancy was detected.Chest CT suggested pulmonary fibrosis and osteolytic lesions of stemum.Spinal MRI showed paravertebral soft tissue.Biopsy of the soft tissue suggested the pathologic.al finding of a theumatoid nodule.The patient was diagnosed as theumatoid arthritis complic.ated with multiple theumatoid bursal cysts.Combination therapy of methylprednisolone (40mg/d) and cyclophosphamide (0.4g/w) lead to a rapid improvement of clinical symptoms and laboratory parameters.The patient was still in remission at 6-month follow-up.