Case 79

 A sixty four-year-old female found knee pain and lumbar pain approximately two months ago. One month later, she visited a local orthopedic clinic and got non-steroid anti-inflammatory drugs (NSAIDs) plus both-knees joint puncture to drain joint fluids, inducing the relief of the pain. At that time, she could not take on shoes due to swelling of both lower extremities. The swollen lower extremities worsened approximately 10 days later. Further, she found mild fever and chill, she could neither raise her left shoulder, being unable to take off clothes, nor grasp her hands due to swollen digits. She found weight loss 66kg six months before to 52Kg at present. She presented in our hospital for further examination. Laboratory test revealed CRP 15.35 mg/dL, platelet 544000/mm3 and negative rheumatoid factor. Radiographs did not show any joint erosion. She hoped to be admitted and agreed to take MRI to investigate joints of feet and hands (Figs 1 to 4).

What is your diagnosis based on clinical symptoms and images of MRI?

1. Scleroderma

2. Systemic lupus erythematosus

3. Seronegative rheumatoid arthritis

4. Remittent seronegative systemic synovitis with pitting edema

5. Polymyalgia rheumatica

answer

2017.11.8