Case reportLate-onset spondyloarthropathy mimicking reflex sympathetic dystrophy syndrome
Section snippets
Case-report 1
A 62-year-old farmer experienced spontaneous onset of painful swelling of his right foot in December 1999. In May 2000, radiographs showed severe demineralization of the ankle and entire foot. The erythrocyte sedimentation rate (ESR) was 57 mm/h and the C-reactive protein (CRP) level was 82 mg/l. Naproxen therapy provided only short-lived relief. In July 2000, a Tc99m bone scan revealed marked diffuse hyperactivity of the ankle and foot, starting at the early vascular phase (Fig. 1). RSDS was
Case-report 2
Painful swelling of the right ankle and foot developed in May 2000, in this 75-year-old man, after a moderate-energy trauma. Radiographs taken in August 2000 showed severe patchy demineralization of the tarsal bones, forefoot, and ankle, without joint space loss (Fig. 2). This pattern suggested RSDS. However, the results from the laboratory tests showing marked inflammation (ESR, 74 mm/h and CRP 78 mg/l) prompted admission of the patient. A low-grade fever of 37.8 °C was noted. He had no
Discussion
In these two patients, the diagnosis of spondyloarthropathy was based on the presence of rheumatoid-factor negative asymmetric oligoarthritis of the lower limbs with a relapsing course, presence of HLA B27, and sacroiliitis visible on radiographs in one patient and by bone scanning in the other. In both patients, NSAIDs were only partly effective, as is often the case in the elderly [3]. The laboratory test evidence of severe inflammation, decline in general health, and asymmetric lower limb
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