Objectives Arthropathy is a consequence of growth hormone excess in acromegalic patients due to articular cartilage and nearby soft tissue involvement. Rheumatoid arthritis (RA) is, on the other hand, another entity, which may sometimes look alike due to the similar clinical findings. We present this case where these both diseases exist at the same time.
Methods A 63-year old male complaining of joint pain and ankle swelling was evaluated. The arthralgia he described, was mainly in his knees, elbows and shoulders, and exaggerated especially at night. Recently accompanying swelling and erythema in his left ankle and in the left second metacarpophalangeal (MCP) joint did exist. He has been diagnosed as acromegalia for 15 years whereas his symptoms related with the joints came out within the last 6 years. He is somatotropinectomized and has also received radiotherapy for his primary disease. His neck, bilateral wrist, elbow and shoulder joints were involved, thus were painful and limited during normal range of motions. MCP joints being worse than the interphalangeal joints were likewise involved. His left ankle and MCP joints were swollen and red additionally. Laboratory and radiological evaluations comprising complete blood count, liver and kidney function tests, serological tests, direct x-rays of the joints were carried out. His erythrocyte sedimentation rate (ESR) was 93 mm/h, RF: 685 IU/ml. The diagnosis of rheumatoid arthritis other than the concurrent acromegalic arthropathy was confirmed with the radiological and clinical findings according to the ARA criteria. He was then treated with steroids.
Results We considered this case challenging and notifying since an acromegalic patient can easily be misdiagnosed as having RA especially when high ESR and morning stiffness accompanies the case. We think the uncommon coexistence i.e. not mentioned up to date in the literature, may enlighten the still unknown pathogenesis of RA with the probability of growth factors mastering the whole event.
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