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Disease flare of ankylosing spondylitis presenting as reactive arthritis with seropositivity: a case report

Manoj E, Ragunathan M - J Med Case Rep (2012)

Bottom Line: Differentiation of spondyloarthropathy from rheumatoid arthritis is important, since the natural history, complications, treatments and prognosis of the two diseases differ significantly.Subsequently, he developed a skin rash suggestive of keratoderma blenorrhagica and circinate balanitis.The prognostic implications of seropositivity in spondyloarthritis are discussed.

Affiliation: Ward 42, National Hospital of Sri Lanka, Colombo, Sri Lanka. manojediri@yahoo.com.

ABSTRACT

Introduction: Concurrent rheumatoid factor seropositivity is occasionally detected in ankylosing spondylitis and often causes confusion in clinical routine. Overlap between various seronegative arthritides is a known but uncommon association. Differentiation of spondyloarthropathy from rheumatoid arthritis is important, since the natural history, complications, treatments and prognosis of the two diseases differ significantly.

Case presentation: Here, we report the case of a 47-year-old Sri Lankan man who had a long history of intermittent joint pains worsening following a recent episode of self-resolving non-bloody diarrhea. Subsequently, he developed a skin rash suggestive of keratoderma blenorrhagica and circinate balanitis. He had classical radiological evidence of ankylosing spondylosis (previously undiagnosed) associated with human leukocyte antigen B27 antigen, but was positive for rheumatoid factor.

Conclusions: A disease flare of ankylosing spondylitis prompted by a minor diarrheal illness showing well documented features of reactive arthritis is remarkable. The prognostic implications of seropositivity in spondyloarthritis are discussed.

X-ray of hands.
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Figure 2: X-ray of hands.

Mentions: Radiography of his hands (Figure 2), wrists, right shoulder joint and foot did not reveal any erosive changes. Both sacroiliac joints were markedly sclerosed (Figure 3) and the typical bamboo spine with widespread bridging syndesmophytes (Figure 4) was seen. Biopsy of his skin lesions (Figure 5) revealed hyperkeratosis forming a thin horny layer and psoriasiform hyperplasia, and papillary dermis showed chronic inflammatory cell infiltrates and superficial dermal edema.

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Disease flare of ankylosing spondylitis presenting as reactive arthritis with seropositivity: a case report

Manoj E, Ragunathan M - J Med Case Rep (2012)

X-ray of hands.
© Copyright Policy
Figure 2: X-ray of hands.
Mentions: Radiography of his hands (Figure 2), wrists, right shoulder joint and foot did not reveal any erosive changes. Both sacroiliac joints were markedly sclerosed (Figure 3) and the typical bamboo spine with widespread bridging syndesmophytes (Figure 4) was seen. Biopsy of his skin lesions (Figure 5) revealed hyperkeratosis forming a thin horny layer and psoriasiform hyperplasia, and papillary dermis showed chronic inflammatory cell infiltrates and superficial dermal edema.

Bottom Line: Differentiation of spondyloarthropathy from rheumatoid arthritis is important, since the natural history, complications, treatments and prognosis of the two diseases differ significantly.Subsequently, he developed a skin rash suggestive of keratoderma blenorrhagica and circinate balanitis.The prognostic implications of seropositivity in spondyloarthritis are discussed.

Affiliation: Ward 42, National Hospital of Sri Lanka, Colombo, Sri Lanka. manojediri@yahoo.com.

ABSTRACT

Background:

Introduction: Concurrent rheumatoid factor seropositivity is occasionally detected in ankylosing spondylitis and often causes confusion in clinical routine. Overlap between various seronegative arthritides is a known but uncommon association. Differentiation of spondyloarthropathy from rheumatoid arthritis is important, since the natural history, complications, treatments and prognosis of the two diseases differ significantly.

Case presentation: Here, we report the case of a 47-year-old Sri Lankan man who had a long history of intermittent joint pains worsening following a recent episode of self-resolving non-bloody diarrhea. Subsequently, he developed a skin rash suggestive of keratoderma blenorrhagica and circinate balanitis. He had classical radiological evidence of ankylosing spondylosis (previously undiagnosed) associated with human leukocyte antigen B27 antigen, but was positive for rheumatoid factor.

Conclusions: A disease flare of ankylosing spondylitis prompted by a minor diarrheal illness showing well documented features of reactive arthritis is remarkable. The prognostic implications of seropositivity in spondyloarthritis are discussed.

View Similar Images In: Results  - Collection
View Article: Medline Plus - Pubmed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3295684&rFormat=json&query=null&req=5