Deforming Polyarthropathy with Excess Deposition of Cholesterol

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THE accumulation of cholesterol in rheumatoid nodules is well recognized.1–4 However, there heretofore has been no report of deforming polyarthropathy in association with cholesterol in nodules and, in addition, with cholesterol-containing pleural and joint effusions, deposition of cholesterol in synovial membranes, and normal concentration of serum cholesterol. The above-mentioned lesions and mild hepatic cirrhosis of the postnecrotic type occurred in a patient who will be described and discussed in this report.

Case Report

A 54-year-old white man had been in good health until the age of 39 years when, after a severe, acute, infectious illness that had been diagnosed as pericarditis with effusion, he developed severe pain with redness, warmth, and swelling in nearly all of the joints. The acute illness subsided within six weeks, but joint manifestations persisted and were characterized by exacerbations and remissions that resulted in synovial and periarticular thickening, tendon contracture, ankylosis, subluxations, and atrophy of adjacent muscles of the hands, wrists, elbows, knees, ankles, and feet. He had been unable to work since the onset of illness in 1939.

Ten years after the onset of illness (1949) he was first admitted to the Cleveland Clinic Hospital. At that time he had pain, swelling, and tenderness of the fingers, wrists, elbows, shoulders, jaws, ankles, and feet, and mild blurring of vision. Extension of both wrists was limited to 20 degrees and there was a 15-degree flexion deformity of the right elbow. Moderate effusion was present in each knee joint and there was pain on motion.. . .



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