Diagnosis of rheumatoid arthritis and systemic lupus erythematosus

✍ Scribed by Sheldon D. Solomon

• Publisher: John Wiley and Sons
• Year: 1979
• Tongue: English
• Weight: 87 KB
• Volume: 22
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780220425

✦ Synopsis

illustrates the difficulty we have in placing diagnostic labels on patients with rheumatic complaints. The following case emphasizes this point even further.

A 42-year-old gentleman presented in March 1977 with a 10-year history of "rheumatoid arthritis." He admitted to morning stiffness that lasted for several hours and a low grade insidious joint swelling over the years. Physical examination revealed bilateral ulnar drift, subluxation of the metacarpophalangeal joints, moderate synovial proliferation with caput ulnar syndrome of both wrists, 30" flexion contractures of both elbows, and multiple nodules over the proximal ulnae and within both olecranon bursae. Nodules were also present within both Achilles tendons. He had 75% limitation of motion of both shoulders, and hallux valgus was present with splay forefoot and dropped metatarsophalangeal joints. Significant laboratory data included normal routine urinalysis, completely normal CBC, Westergren ESR of 74 mm/hour, latex fixation of titer 1:320, and negative ANA study by the immunofluorescent technique.

High dose salicylates were started and the patient's response to basic therapy was good. He was seen at 3-month intervals, during which he refused secondary therapy such as gold or penicillamine. During a routine physical examination at work in July 1978 (approximately 15 months after his initial evaluation), he was found to have proteinuria and hematuria and was referred to me for further evaluation. (He was still receiving only high dose salicylates and no other medication.) At this time he was admitted to the hospital where the following pertinent information was obtained: urinaly-