Lesson of the month
Pulse methylprednisolone therapy for arthritis causing muscle weakness
E Michael Shanahan, Malcolm D Smith, Michael J Ahern
Department of
Rheumatology Research, Repatriation General Hospital, Daw Park, South
Australia
Correspondence to: Dr M Shanahan, Rheumatology Research Unit, Repatriation General Hospital, Daws Road, Daw Park, South Australia 5041.
Accepted for publication 4 May 1999
| The first 150 words of the full text of this article appear below. |
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Introduction |
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The occurrence of multiple autoimmmune conditions in the same patient is a well recognised phenomenon. In this case, we present a patient with an inflammatory arthritis (late onset rheumatoid arthritis) with previously unrecognised myasthenia gravis that was unmasked by high dose intravenous pulse methylprednisolone succinate used to treat the arthritis.
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Case history |
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A 78 year old man was admitted to hospital complaining of progressive small joint pain, stiffness and swelling. This had been present for four weeks and was on a background of several months of systemic symptoms including weight loss of approximately 14 kg, fatigue, anorexia, intermittent dysphagia, and headaches. In addition he had suffered from intermittent mid-thoracic spine, shoulder and left hind foot pain and stiffness.
Two months previously he had been investigated for these
constitutional symptoms with plain radiographs, a bone scan,
abdominal ultrasound, erythrocyte sedimentation rate (ESR), C
reactive protein (CRP), serum electrophoresis, urinary Bence Jones
protein, uric
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Degenerative joint disease
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Musculoskeletal syndromes
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