In Reply: We apologize for the confusion. We wanted to convey that, in that patient at that time, synovitis with erosions and edema indicating inflammation (greater on the right than on the left left) was suggestive of rheumatoid arthritis despite the asymmetry seen (findings greater in the right wrist than in the left). Given the patient’s clinical findings at that time and the above imaging findings, the initial diagnosis of rheumatoid arthritis was correct. But since the patient was not responding to therapy and since the abdominal pain was worsening, we probed further. Subsequently, the patient was diagnosed with Whipple disease. The fact that inflammatory arthritis can occur in other conditions that are not rheumatologic is a primary reason we found this case worth sharing.
Letters To The Editor
In reply: Not all joint pain is arthritis
Cleveland Clinic Journal of Medicine. 2013 November;80(11):734
Gursimran Singh Kochhar, MD, CNSC, FACP
The Clinical Picture
- Gursimran S. Kochhar, MD
- Maged Rizk, MD
- Deepa T. Patil, MD
A 47-year-old man who was diagnosed with rheumatoid arthritis 5 years ago now has pleural effusions and abdominal pain.