REVIEW - Seronegative polyarthritis as severe systemic disease

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Neth J Med. 2010 Jun;68(6):236-41.

Seronegative polyarthritis as severe systemic disease.

Rozin AP, Hasin T, Toledano K, Guralnik L, Balbir-Gurman A.

Departments of Rheumatology, Rambam Health Care Campus and Technion,

Haifa, Israel.

Abstract

BACKGROUND: Severe extra-articular disease is associated with high

levels of rheumatoid factor (RF ) in patients with seropositive

rheumatoid arthritis (RA ) and a poor prognosis. It is said that

patients with seronegative rheumatoid arthritis have a more benign

course and less destructive disease. We observed several patients with

seronegative non-rheumatoid polyarthritis, with aggressive

extra-articular systemic disease.

OBJECTIVES: Review of seronegative systemic polyarthritis with

clinical presentation of typical cases.

METHODS: Medline search for systemic manifestations of seronegative

polyarthritis. Clinical presentations: 1. A 56-year-old woman was

admitted to the cardiac intensive care unit with stabbing presternal

chest pain aggravated by breathing and progressive dyspnoea, which

gradually developed over a period of two weeks with one episode of

fever at 38.0 degrees C. She had suffered chronic pain in her buttocks

for three years with polyarthralgia and evanescent palmar-plantar

rash. Imaging showed bilateral sacroiliitis (HLA B27 negative) and a

large pericardial effusion. Extra-articular manifestations of SAPHO

syndrome were proposed and she was successfully treated with combined

therapy: pulse methylprednisolone, azathioprine, colchicine and

prednisone. 2. A 47-year-old woman with psoriatic arthropathy

developed high fever with leucocytosis and thrombocytosis and lung

infiltrates during exacerbation of her joint disease . She was treated

with pulse methylprednisolone followed by corticosteroid tapering,

anti-TNF (infliximab) and methotrexate with complete resolution. 3. A

19-year-old man with inflammatory bowel disease developed acute

pericarditis with response to 6-mercaptopurine, salazopyrine and

prednisone.

RESULTS: We discuss a range of seronegative arthritis diseases with

possible systemic manifestations including the main procedures for

early diagnosis. Infection, malignancy, hypersensitivity,

granulomatous disease and other collagen diseases such as systemic

lupus erythematosus should be excluded, but investigations for an

underlying disease should not delay early corticosteroid and

immunosuppressive therapy.

CONCLUSION: A high level of suspicion of extra-articular disease

should always be maintained when treating active seronegative

polyarthritis.

http://www.ncbi.nlm.nih.gov/pubmed/20558853

Read the full article here:

http://www.zuidencomm.nl/njm/getpdf.php?id=10000594

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