多発性に両手指ＤＩＰ，ＰＩＰ関節の骨破壊を来した１例

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  • A case of generalized destructive arthritis of the distal and proximal interphalangeal joints in the bilateral hands.

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We experienced a case that showed generalized destructive arthritis of the distal and proximal interphalangeal joints which was difficult to diagnose and treatment.<br>A 48-year-old woman gradually developed the clinical features of polyarthritis of the hands, feet, with recurrent intraarticular effusions of the knees. Small skin nodules were observed. She had pain and swelling in the interphalangeal joints of effected fingers for the first 4-years. Her fingers, on physical examination revealed inflammatory synovitis with mild functional impairment. Hands of the patient showed soft tissue thickening due to the presence of cutaneous nodules. Radiographic appearance of finger interphlangeal joints showed articular erosions, expansion of joint space, and well preserved bone density. Laboratory test results including full blood count, ESR, were all within normal range and total cholesterol was slightly increased (253mg/dl↑). Other biochemistry values were within the normal range. Rheumatoid factor was negative but antinuclear antibody was positive. A nodule of skin was biopsied. Histologic examination showed fibrous tissue without histiocytes and multinucleated giant cells.<br>We had suspected multicentric reticulohistiocytosis but this was not supported by histologic examination. We can not yet make a definitive diagnosis, and we will observe the patient's course.

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