Tarsal arthritis with ankylosis in late onset still's disease

✍ Scribed by L. A. Healey; Robert F. Willkens

• Publisher: John Wiley and Sons
• Year: 1982
• Tongue: English
• Weight: 248 KB
• Volume: 25
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780251015

✦ Synopsis

Medsger and Christy have described the roentgenographic pattern of carpometacarpal or intercarpal ankylosis that is distinctive of the systemic-onset (Still's-type) variant of juvenile rheumatoid arthtitis, particularly with adult onset (1). We report here 2 patients with an illness consistent with adult onset Still's disease whose radiographs show changes in the carpal joints as previously reported by Medsger and Christy, but in addition, demonstrate similar changes in the tarsal bones. To our knowledge, this change in the ankles has not previously been reported.

CASE REPORTS

Patient 1. In 1966 at the age of 32, this white woman experienced her first episode of arthritis which started in her shoulders and then involved her feet, ankles, knees, hips, wrists, and jaw. She had fever but did not notice a rash. She was treated with aspirin, Indocin, and a corticosteroid that provided relief but was stopped after 3 months. The arthritis then flared, with pain and swelling of her right wrist and both ankles. These gradually subsided over a 4-year period.

When first seen by one of us in 1977, she had no acute symptoms, but examination showed marked limitation of flexion and extension of the right wrist and a "knobby" irregularity of the anterior ankles in the area of the tarsal joints.