Polyarthritis in an aged male positive for HLA B27;A case of late onset peripheral spondyloarthropathy

Abstract

A 50-year-old man was admitted to the hospital because of acute onset polyarthritis, which involved his bilateral ankles, wrists, elbows and left knee. He also had back pain and a limited range of flexure in his lumbar column. He was HLA B27 positive and rheumatoid factor negative with a highly elevated erythrocyte sedimentation rate (ESR) of 158mm/h. No radiological changes were seen in the sacroiliac (SI) and other involved joints, except small osteophytes in lumbar spine. Bone scintigraphy revealed increased uptake in bilateral ankles, wrists, the first right MP, and the second right PIP joints. Ankylosing spondylitis was suspected but not diagnostic because of his intact SI joints. During 5 years follow up, his polyarthritis and spinal symptoms exacerbated several times with constitutional signs. However, no abnormal radiological findings were obtained in lumbar spine, SI joint, and peripheral joints.
Our patients was characterized by late onset, positive HLA B27, minimal axial symptom, moderate peripheral non-erosive arthritis with elevated ESR, and no radiological changes in spine and SI joint. These findings were considered to be compatible with “late onset peripheral spondyloarthropathy” described recently by Dubost and Sauvezie.