The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Case Report: Rheumatoid Arthritis and Degenerative Disk Disease

Case Report: Rheumatoid Arthritis and Degenerative Disk Disease

March 1, 2015 • By Patricia Frisch, PhD; Ronald R. Butendieck, MD; Andy Abril, MD; Peter M. McIntosh, MD; Salim M. Ghazi, MD; Elliot L. Dimberg, MD; Lynn F. Feldman, DO; David G. Lucas, MD; and Andrea Styron, MSR-PT

  • Tweet
  • Email
Print-Friendly Version / Save PDF
CNS symptoms in a patient with SLE are often a diagnostic conundrum with a very broad differential diagnosis.

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease with potential for multisystem involvement that promotes inflammation. Chronic inflammation of the synovial tissue results in stiffness, pain, warmth and swelling of joints. Untreated, it can lead to joint erosions and deformity resulting in disability and decreased quality of life (QOL). Both genetic and environmental factors have been implicated. Prevalence is estimated to be between 0.5 and 1.0% in the general population. Almost three times as many women as men have RA, with the highest incidence in middle age.1

You Might Also Like
  • Rheumatology Case Report: Systemic Capillary Leak Syndrome and Rheumatoid Arthritis
  • Fellow’s Forum Case Report: Arthritis, Fever, and Weight Loss In a Teenager Suggest A Rheumatic Condition
  • Mesenchymal Stem Cell Therapy May Help Slow, Repair Degenerative Signs of Osteoarthritis, Musculoskeletal Disease
Explore This Issue
March 2015

Osteoarthritis (OA) is primarily the result of mechanical wear over time, leading to the loss of cartilage between the joints. It is the most common form of arthritis, affecting an estimated 12.1% of the U.S. population ages 25 and older. The prevalence of OA increases with age.2 Degenerative disk disease (DDD) is caused by daily stress on the spine and aging, which can be exacerbated by unnoticed major or minor injuries. Early changes of DDD can be apparent on radiographs in otherwise healthy adults between the ages of 30 and 50 years old, the majority of whom will be asymptomatic.3

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Figure 1a and 1b. Radiographs of the bilateral hands demonstrate marked joint space narrowing involving multiple metacarpophalangeal (MCP) joints with significant radiocarpal narrowing on the right. Erosive changes involving both wrists and MCP joints are seen. You can also see subluxations of multiple bilateral MCP joints with ulnar deviation; marked right carpal collapse with milder changes on left; and dorsal subluxation with fragmentation of the patient’s right fourth proximal interphalangeal joint.

Case Report

A 63-year-old woman with a 23-year history of RA presented with concern about her best treatment options. Due to multiple family relocations, she had seven previous rheumatologists. Her pharmacologic treatment over the years had included hydroxychloroquine, gold injections and, at one time, monotherapy with methotrexate (MTX). In 2002, infliximab was added to MTX, but efficacy waned, and she was switched to etanercept in 2008. Her major concern was fear of infection because she had recently experienced acute diverticulitis complicated by sepsis from a perforated bowel, requiring colostomy while she was taking combination therapy with MTX and etanercept. Both immunosuppressive agents were discontinued. After six-and-a-half months, she had a successful laparoscopic colostomy takedown.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

At the time of her visit, she was taking hydroxychloroquine 200 mg twice daily, as well as prednisone. Clinical evaluation demonstrated active bilateral polyarticular synovitis, flexion contractures and elevated inflammatory markers. Radiographs of the bilateral hands demonstrated changes consistent with severe, erosive, chronic rheumatoid arthritis (see Figures 1a and b, p. 50). Her prednisone was weaned off over the next six months, but secondary to persistent, active RA with elevated inflammatory markers, she agreed to start abatacept. At subsequent visits, progressive improvement was observed, and at six months, she achieved clinical remission.

Pages: 1 2 3 | Single Page

Filed Under: Conditions, Rheumatoid Arthritis Tagged With: abatacept, Abril, Butendieck, degenerative disk disease, Dimberg, etanercept, Feldman, Frisch, Ghazi, immunosuppressive, Lucas, McIntosh, Osteoarthritis, Pain Management, quality of life, Rheumatoid arthritis, StyronIssue: March 2015

You Might Also Like:
  • Rheumatology Case Report: Systemic Capillary Leak Syndrome and Rheumatoid Arthritis
  • Fellow’s Forum Case Report: Arthritis, Fever, and Weight Loss In a Teenager Suggest A Rheumatic Condition
  • Mesenchymal Stem Cell Therapy May Help Slow, Repair Degenerative Signs of Osteoarthritis, Musculoskeletal Disease
  • Case Report: A Psoriatic Arthritis Patient with Dactylitis & Enthesitis

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)