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43. Kongress der Deutschen Gesellschaft für Rheumatologie, 29. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie, 25. Wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie

02.-05. September 2015, Bremen

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An 84-year old patient with refractory arthritis of the knee joint

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  • Vanessa Jantsch - Asklepios Klinikum Bad Abbach Klinik für Rheumatologie und klinische Immunologie, Rheumatologie und klinische Immunologie, Bad Abbach
  • Magnus Diller - Asklepios Klinikum Bad Abbach, Klinik und Poliklinik für Rheumatologie und klinische Immunologie, Bad Abbach
  • Georg Pongratz - Universitätsklinik Regensburg und Asklepios Klinikum Bad Abbach, Klinische und experimentelle Rheumatologie und klinische Immunologie und Neuroendokrinoimmunologie, Regensburg
  • Boris Ehrenstein - Asklepios Klinikum Bad Abbach, Klinik und Poliklinik für Rheumatologie und klinische Immunologie, Bad Abbach
  • Martin Fleck - Universitätsklinik Regensburg und Asklepios Klinikum Bad Abbach, Klinik und Poliklinik für Rheumatologie und klinische Immunologie, Bad Abbach

Deutsche Gesellschaft für Rheumatologie. Deutsche Gesellschaft für Orthopädische Rheumatologie. Gesellschaft für Kinder- und Jugendrheumatologie. 43. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 29. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 25. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR). Bremen, 02.-05.09.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocFA.20

doi: 10.3205/15dgrh105, urn:nbn:de:0183-15dgrh1059

Published: September 1, 2015

© 2015 Jantsch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: An 84-year old female patient was admitted to our tertiary Rheumatology center due to refractory arthritis of the left knee joint since 14 months. During the disease course, the diagnosis of seronegative rheumatoid arthritis had been established and DMARD treatment with MTX in combination with prednisolone was initiated prior to the admission without improvement.

Results: At the time of presentation, the patient complained about pain and persistent swelling of her left knee as well as morning stiffness for about 30 min. duration. Otherwise, there were no complaints including fever, rash, Raynaud’s phenomenon, weight loss, or night sweats. Inflammatory markers were slightly elevated, and routine laboratory testing as well as immunodiagnostics including RF, ACPA, ANA and ANCA were unremarkable. Musculoskeletal ultrasound revealed monoarthritis of the left knee with hyperperfusion, synovial proliferation, and effusion. MRI-scanning was performed additionally, showing signs of severe bony abscesses. Therefore, synovial and bone biopsies were obtained for histological and microbiological analyses. Histology revealed a granulomatous inflammation, and PCR-analysis was positive for mycobacterium-tuberculosis-complex. Additionally, acute infection with mycobacterium tuberculosis was confirmed by positive culture results. Therefore, immunosuppression was terminated and an antituberculotic therapy was initiated including pyrazinamide, ethambutol, isoniacide, and rifampicine.

Conclusion: After 6 months of therapy, the patient´s condition improved markedly, demonstrating that infection with mycobacterium tuberculosis should be considered particularly in patients presenting with seronegative atypical rheumatoid arthritis and persistent monoarthritis.