Article Text
Statistics from Altmetric.com
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.
Case history
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 acid, prostatic specific antigen (PSA), rheumatoid factor, iron studies, liver function tests, complete blood picture, and serum calcium. All these investigations were normal except for a PSA of 50 μg/l (normal <4), radiographs showing mild osteoarthritis of the thoracic and lumbar spine, a CRP 80 mg/l (normal<6) and an ESR of 47 mm 1st h. The increased PSA …