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Case number 10

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A 70 year old man with a 10 year history of seropositive rheumatoid arthritis presented with low back pain. Lumbar spine radiographs showed intervertebral disc space narrowing, vacuum phenomena, and irregularity of the subchondral margins of the vertebral bodies with erosions and sclerosis (fig 1). Aspiration, underx ray guidance, of the intervertebral disc space produced a dry aspirate. Bacterial (including acid fast bacilli), and fungal culture of aspirated contrast material was negative.

 Rheumatoid discitis is uncommon in the lumbar spine and the cause remains unclear. Postulated mechanisms include, apophyseal joint synovitis with extension into the vertebral body-intervertebral disc junction; synovial infiltration into the fissures within the degenerating nucleus pulposus of the intervertebral disc; and neuropathic alterations secondary to analgesia or corticosteroid therapy.1 The changes may also relate to apophyseal joint instability with abnormal motion at the corresponding discovertebral junction, leading to herniation of portions of the disc producing cartilaginous node formation.2

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  • Contributors: gary d wright. Department of Rheumatology, Musgrave Park Hospital, Stockman’s Lane, Belfast, BT9 7JB, UK. michael doherty. Department of Rheumatology, City Hospital, Nottingham, NG5 1PB, UK.

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